Cardiac FDG-PET to assess sarcoidosis in a cardiac allograft

A 58-year-old man with end-stage heart failure caused by cardiac sarcoidosis underwent an orthotopic heart transplant. His immediate posttransplant course was uncomplicated, but several months later, an endomyocardial biopsy revealed likely recurrent sarcoidosis. A cardiac F-FDG PET study subsequently showed focal anteroseptal uptake that suggested the presence of inflammation. Despite steroid therapy, a study repeated 3 months later showed persistent anteroseptal FDG uptake and new hypokinesis in that region. After escalating his steroid therapy, a final FDG-PET study ultimately demonstrated resolution of the uptake and normalization of anteroseptal wall motion.