FDG-PET in Cardiac Sarcoidosis — EECC MCQ

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ModerateCardiac ImagingFDG-PET in Cardiac SarcoidosisEECC

A 55-year-old man with suspected cardiac sarcoidosis has biopsy-proven pulmonary sarcoidosis but a non-diagnostic endomyocardial biopsy. CMR shows patchy LGE in the basal septum and lateral wall. What additional imaging modality is most helpful to confirm active cardiac inflammation?

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Correct answer: D — FDG-PET/CT with prolonged fasting preparation to suppress normal myocardial glucose uptake

FDG-PET/CT is the imaging modality of choice for detecting active myocardial inflammation in cardiac sarcoidosis. It is complementary to CMR (which detects fibrosis/scar via LGE). Prolonged fasting (≥12-18 hours, with a high-fat/low-carbohydrate diet the day before) is essential to suppress physiological myocardial FDG uptake, allowing focal inflammatory uptake to be distinguished. The combination of CMR (for scar assessment) and FDG-PET (for active inflammation) provides comprehensive evaluation. The 2023 ESC Cardiomyopathy Guidelines recommend this dual-imaging approach. FDG-PET is also valuable for monitoring treatment response and guiding immunosuppression duration. Technetium pyrophosphate scans are specific to ATTR amyloidosis, not sarcoidosis.

Reference: ESC (2023): Guidelines on Cardiomyopathies; HRS Expert Consensus on Cardiac Sarcoidosis