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Extensive Biventricular Cardiac Sarcoidosis Detected on FDG PET/CT Using a 72-Hour Ketogenic Diet Preparation
1From the Division of Diagnostic Imaging, Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract:
A 49-year-old man had right bundle-branch block, with decreased left ventricle ejection fraction of 43%. Cardiac MRI demonstrated abnormal multifocal delayed gadolinium enhancement involving both ventricles. Cardiac sarcoidosis was further confirmed at cardiac biopsy. Dedicated FDG PET/CT with 72-hour ketogenic diet preparation to suppress physiological myocardial uptake of FDG was performed for disease evaluation. PET/CT revealed multifocal abnormal uptake in both ventricles concordant with cardiac MRI findings, in addition to hypermetabolic lymphadenopathy. Six months later, posttreatment PET/CT with the same 72-hour ketogenic diet preparation showed good response with resolution of active inflammation.
Insights
Cardiac sarcoidosis, a rare condition, was diagnosed in a patient with heart block. Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) effectively monitored treatment response, showing reduced inflammation.
Area of Science:
- Cardiology
- Nuclear Medicine
- Oncology
Background:
- Cardiac sarcoidosis presents diagnostic challenges.
- Right bundle-branch block and reduced ejection fraction can indicate cardiac dysfunction.
Observation:
- Cardiac MRI revealed multifocal delayed gadolinium enhancement in both ventricles.
- Cardiac biopsy confirmed sarcoidosis.
- FDG PET/CT with ketogenic diet preparation assessed disease activity.
Findings:
- PET/CT showed multifocal uptake in ventricles, consistent with MRI findings.
- Hypermetabolic lymphadenopathy was also detected.
- Follow-up PET/CT demonstrated resolution of active inflammation after treatment.
Implications:
- FDG PET/CT with ketogenic diet is valuable for evaluating cardiac sarcoidosis activity.
- This imaging technique aids in monitoring treatment efficacy.
- Early diagnosis and treatment monitoring are crucial for managing cardiac sarcoidosis.
