The Role of Hybrid PET-MRI in the Diagnosis and Management of Cardiac Sarcoidosis—A Narrative Review

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Cardiac sarcoidosis. Intervention: Hybrid PET/MRI vs. Separate PET and MRI modalities. Primary outcome: Diagnostic accuracy and prognostic value.

Q: What does this research mean for the field?

Hybrid PET/MRI enhances diagnostic accuracy for cardiac sarcoidosis by identifying specific subgroups and detecting active disease compared to separate imaging modalities. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Salmane Nasri Elmi; Marina Sennaraj; Sharan Kapadia; Ali Hafeez Malik; Sukruth Kundur; Łukasz A. Małek; Sanjay Sivalokanathan

doi:10.3390/jcm15145563

July 15, 2026Journal of Clinical MedicineOpen Access

The Role of Hybrid PET-MRI in the Diagnosis and Management of Cardiac Sarcoidosis—A Narrative Review

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Key result

Hybrid PET/MRI improves diagnostic accuracy and tissue characterization over separate imaging in cardiac sarcoidosis.

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Why the study?

Cardiac sarcoidosis requires accurate and timely diagnosis, and hybrid PET/MRI is an emerging tool offering potential advantages over independent PET and MRI techniques for diagnosis and prognosis.

Does hybrid PET/MRI improve diagnostic accuracy and prognostic prediction in adults with suspected or confirmed cardiac sarcoidosis compared to separate imaging modalities?

Key Points

Evaluate the clinical utility, diagnostic performance, and prognostic value of hybrid PET/MRI compared to separate imaging modalities in cardiac sarcoidosis.
Conducted a systematic search following PRISMA guidelines using terms for hybrid PET/MRI and cardiac sarcoidosis, identifying 10 eligible studies with JBI risk of bias scores ranging from 8 to 9.
Evaluated cohorts of predominantly middle-aged males (mean age 48 to 63.8 years) undergoing 18F-FDG PET and CMR with late gadolinium enhancement, with follow-up durations from 1.7 to 5.5 years across prognostic studies.
Co-localization of focal 18F-FDG uptake with late gadolinium enhancement yielded superior diagnostic performance (AUC 0.73 to 0.84) and differentiated active inflammation from chronic scar.
Concomitant PET and CMR abnormalities significantly predicted major adverse cardiac outcomes across four studies, with the target-to-normal myocardium ratio demonstrating an AUC of 0.77 for primary cardiac endpoints.
Hybrid imaging protocols required 122 ± 15 min for a single scan, reducing cumulative scanning duration by 43% compared to undergoing separate imaging procedures.

Study Design

Type

Systematic Review

Structured PICO

Does hybrid PET/MRI improve diagnostic accuracy and prognostic prediction in adults with suspected or confirmed cardiac sarcoidosis compared to separate imaging modalities?

P

Population

Systematic review of 10 studies evaluating hybrid PET/MRI in adults with suspected or confirmed cardiac sarcoidosis.

E

Exposure

Hybrid cardiac 18F-FDG-PET/MRI

C

Comparator

Separate PET and MRI modalities, or PET/CT

O

Outcome

Diagnostic accuracy and prognostic value for cardiac sarcoidosissurrogate

Hybrid PET/MRI offers enhanced diagnostic accuracy and comprehensive tissue characterization for cardiac sarcoidosis compared to separate imaging modalities, though its clinical integration requires further standardized prospective studies.

Limitations

Literature search restricted to MEDLINE and SCOPUS
Small and heterogeneous study populations
Substantial variation in diagnostic criteria, imaging protocols, and definitions of scan positivity
Most included studies were single-centre prospective cohort or case-series studies with limited follow-up
Absence of randomized or comparative trials
Literature search restricted to MEDLINE and SCOPUS, potentially introducing indexing bias.
Small and heterogeneous study populations with substantial variation in diagnostic criteria, imaging protocols, and definitions of scan positivity.
Most included studies were single-centre prospective cohort or case-series studies with relatively limited follow-up.
Absence of randomized or comparative trials.
Possibility of publication bias.

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Implication

May support hybrid PET/MR for cardiac sarcoidosis evaluation; extends separate-modality data but leaves open prospective standardization before routine adoption.

Abstract

Background/Objectives: Cardiac involvement in sarcoidosis necessitates meticulous management, with accurate and timely diagnosis being crucial. The hybrid positron emission tomography/magnetic resonance imaging (PET/MRI) modality is an emerging diagnostic tool for cardiac sarcoidosis, offering potential advantages over the use of independent PET and MRI techniques for both diagnosis and prognosis. Methods: Following the PRISMA guidelines for study selection, a comprehensive search using the terms “hybrid PET/MRI” and/or “cardiac sarcoidosis” identified a total of 10 eligible studies. Results: Patients were primarily middle-aged males. Overall, hybrid PET/MR enhanced diagnostic accuracy by identifying specific subgroups, detecting active disease, enabling detailed quantitative analysis, and assessing regional involvement. Additionally, it offered valuable insights that could improve phenotyping and prognostic predictions. The primary limitation was the longer duration of a single scan; however, the total scanning time was reduced compared to conducting two separate procedures. Conclusions: Hybrid PET/MR imaging offers several significant advantages over separate imaging modalities when diagnosing cardiac sarcoidosis, including increased diagnostic accuracy and comprehensive tissue characterization. Further comparative studies are needed to fully understand its clinical impact and potential limitations.

Discussion

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Cite This Study

Elmi et al. (2026) conducted a systematic review in Cardiac sarcoidosis. Hybrid PET/MRI vs. Separate PET and MRI modalities was evaluated on Diagnostic accuracy and prognostic value. Hybrid PET/MR imaging enhanced diagnostic accuracy and comprehensive tissue characterization compared to separate imaging modalities in patients with cardiac sarcoidosis.

synapsesocial.com/papers/6a5b181c18557b26c203a142 https://doi.org/10.3390/jcm15145563

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The Role of Hybrid PET-MRI in the Diagnosis and Management of Cardiac Sarcoidosis—A Narrative Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Role of Hybrid PET-MRI in the Diagnosis and Management of Cardiac Sarcoidosis—A Narrative Review

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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