Procedure Guideline for Detection of Inflammation With F-18 FDG PET/CT in Cardiac Sarcoidosis

Abstract

Histologic confirmation of cardiac sarcoidosis (CS) is challenging. When taken into account of either the invasive nature or potential false negativity of the endomyocardial biopsy, imaging methods represent as a major alternative to establish a clinical diagnosis. Among the imaging methods, the use of fluorine-18-fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) which detects active inflammation in CS is becoming widespread. Recently, F-18 FDG PET has been identified as one of the new diagnostic criteria in CS, by the Heart Rhythm Society. For diagnosis, a combination of both myocardial perfusion and inflammation findings should be interpreted visually and/or semiquantitatively. Yet, the precision of diagnostic accuracy has been limited by lack of an adequate reference standard. This procedure guideline presents current literature defining the role of F-18 FDG PET in the diagnosis and management of CS along with technical details and recommendations about imaging protocol and interpretation. © 2020 Nuclear Medicine Seminars. All Rights Reserved.