Article No : ujrnm-v1-1001
Todd A. Faasse

Abstract

Cardiovascular disease continues to lead as one of the greatest contributors to mortality [1]. Cardiac sarcoidosis is a lesser known but highly lethal clinical condition that has been increasing in incidence and prevalence globally [1]. Within the radiologic modalities, both cardiac magnetic resonance imaging (MR) and positron emission tomography-computed tomography (PET-CT) have emerged as ideal imaging modalities used in evaluating and assisting with treatment considerations for cardiac sarcoidosis. MR and PET-CT are complementary in regards to imaging capabilities but certain patient population considerations lend themselves to favoring PET-CT over MR, In particular, although an increasing number of implanted cardiac defibrillators (ICDs) are MR-compatible, many patients do not have MR-compliant devices and are unable to have MR for sarcoidosis evaluation due to the dangers inherent to the MR’s magnetic field and the ferromagnetic properties of ICDs. Cardiac MRI is unable to differentiate between active or inactive cardiac sarcoid. However, PET-CT allows the identification of active cardiac sarcoid; information necessary to guide the clinical management of patients. Furthermore, for patient safety, cardiac PET-CT may be the only effective imaging option available. To date, PET has not been widely used for cardiac sarcoidosis [2]. This has largely been due to the limited availability of PET-CT imaging devices, the primacy of oncology for existing PET-CT scanner use and for many imaging departments, lack of knowledge base for optimized cardiac PET-CT and patient protocols. This review of PET-CT cardiac sarcoidosis will provide an overview of key considerations and provisions necessary for high-quality PET-CT cardiac sarcoidosis imaging. Chief considerations reviewed will include physiologic mechanism of radiopharmaceutical localization, imaging protocol, patient throughput, patient dietary preparation, medication adjuncts for optimization, optimal uptake times, and considerations for departmental collaboration and staffing.

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