Key result
Stepwise multimodality imaging with 18F-FDG PET/CT successfully diagnoses active isolated cardiac sarcoidosis.
Why the study?
Cardiac sarcoidosis is diagnostically challenging when myocardial inflammation occurs without clinically active extracardiac disease, requiring multimodality imaging for diagnosis and management.
Case Report (n=1)
This case highlights that stepwise multimodality imaging with echocardiography, CMR, and 18F-FDG PET/CT provides decisive incremental value in diagnosing and guiding therapy for clinically isolated active cardiac sarcoidosis.
Answers are grounded in this paper and cite their sources.
Stepwise multimodality imaging may aid isolated cardiac sarcoidosis diagnosis; extends case evidence but leaves generalizability open.
Background Cardiac sarcoidosis remains a major diagnostic challenge when myocardial inflammation occurs in the absence of clinically active extracardiac disease. In this setting, non-invasive tissue characterization and metabolic imaging may provide critical incremental value over conventional structural assessment. Case summary A 62-year-old woman with progressive exertional dyspnoea and long-standing ventricular ectopy underwent multimodality evaluation. Echocardiography showed mild biventricular systolic dysfunction, reduced global longitudinal strain, and focal basal-to-mid septal abnormalities. Coronary computed tomography (CT) angiography excluded obstructive coronary artery disease and showed inactive pulmonary granulomatous sequelae. Cardiac magnetic resonance demonstrated mild-to-moderate biventricular dysfunction and patchy non-ischaemic late gadolinium enhancement in the basal-to-mid septum with elevated native T1 values but no T2 evidence of oedema. 18F-fluorodeoxyglucose positron emission tomography/CT subsequently revealed focal and multifocal myocardial uptake on a suppressed background, confirming active myocardial inflammation without extracardiac hypermetabolic disease. Immunosuppressive therapy was initiated, and guideline-directed heart failure therapy was optimized. Discussion This case illustrates how stepwise multimodality imaging can establish the diagnosis of active cardiac sarcoidosis, provide precise non-invasive tissue characterization, distinguish active inflammation from fibrosis, and directly guide immunosuppressive treatment when extracardiac disease is clinically silent.
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Briceño et al. (2026) conducted a case report in Clinically isolated cardiac sarcoidosis (n=1). Multimodality imaging (Echocardiography, CMR, 18F-FDG PET/CT) was evaluated on Diagnosis of active myocardial inflammation. Stepwise multimodality imaging, specifically 18F-FDG PET/CT following echocardiography and CMR, successfully established the diagnosis of active clinically isolated cardiac sarcoidosis.
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