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01.09.2011 | Review Article | Ausgabe 9/2011

European Journal of Nuclear Medicine and Molecular Imaging 9/2011

18F-Fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis

Zeitschrift:
European Journal of Nuclear Medicine and Molecular Imaging > Ausgabe 9/2011
Autoren:
Hiroshi Ohira, Ichizo Tsujino, Keiichiro Yoshinaga

Abstract

Cardiac sarcoidosis (CS) is a rare and potentially life-threatening disease that causes conduction disturbance, systolic dysfunction, and most notably sudden cardiac death. Accurate diagnosis of CS is thus mandatory; however, a reliable approach that enables diagnosis of CS with high sensitivity and specificity has yet to be established. Recent studies have demonstrated the promising potential of 18F-fluoro-2-deoxyglucose positron emission tomography (18F-FDG PET) in the diagnosis and assessment of CS. Indeed, 18F-FDG PET provides a wide variety of advantages over previous imaging modalities; however, there are pitfalls and limitations that should be recognized. In this review article, (1) the rationale for 18F-FDG PET application in CS, (2) suitable pretest preparations, and (3) evaluation protocols for the 18F-FDG PET images obtained will be addressed. In particular, sufficient suppression of physiological 18F-FDG uptake in the heart is essential for accurate assessment of CS. Also, (4) recent studies addressing the diagnostic role of 18F-FDG PET and (5) the clinically important differences between 18F-FDG PET and other imaging technologies will be reviewed. For example, active sarcoid lesions and their response to steroid treatment will be better detected by 18F-FDG PET, whereas fibrotic lesions might be shown more clearly by magnetic resonance imaging or other nuclear myocardial perfusion imaging. In the last decade, 18F-FDG PET has substantially enhanced detection of CS; however, CS would be better evaluated by a combination of multiple modalities. In the future, advances in 18F-FDG PET and other emerging imaging modalities are expected to enable better management of patients with sarcoidosis.

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