Active Cardiac Sarcoidosis

Abstract

The hybridization of positron emission tomography (PET) and magnetic resonance imaging (MRI) within a single imaging bore is a major advance in noninvasive imaging. Intrinsic coregistration of metabolic/molecular probe imaging with morphological, functional, and tissue imaging presents new opportunities for disease characterization. Sarcoidosis is a multisystem inflammatory disease hallmarked by inflammation, noncaseating granuloma formation, and organ dysfunction. Cardiac involvement accounts for up to 25% of disease-related mortality and is conventionally diagnosed with the Japanese Ministry criteria.1 However, studies using cardiac PET and MRI suggest a robust capacity to identify cardiac involvement2,3—PET through identification of active inflammation and MRI through identification of mature fibrosis or scar. In this report, we describe the first clinical use of simultaneous PET-MRI to assist in the diagnosis of cardiac disease: active cardiac sarcoidosis. A 72-year-old woman was referred with a 12-month history of increasing shortness of breath and intermittent chest pain. A coronary angiogram and echocardiogram showed normal coronary arteries but an ejection fraction of 35%. Her history was significant for inflammatory polyarthritis, treated with etanercept and hydroxycholoquine, and biopsy of an enlarged scalene lymph node showing noncaseating granulomas. …