Role of Multimodality Imaging in Cardiac Sarcoidosis: A Retrospective Single-Center Experience

Background/Objectives: Cardiac sarcoidosis (CS) is a rare entity characterized by granulomatous infiltration of the myocardium, which can lead to myocardial fibrosis, conduction abnormalities, and the development of heart failure, thereby elevating the risk of sudden cardiac death (SCD). While endomyocardial biopsy (EMBx) is regarded as the gold standard for diagnosis, its low sensitivity and inherent procedural risks may limit its practical application. Methods: This study retrospectively explored the role of advanced imaging modalities, specifically cardiovascular magnetic resonance imaging (CMR) and fluorodeoxyglucose positron emission tomography (FDG-PET), in the diagnosis and management of CS within a single center. In this retrospective study, we aimed to assess the utility of advanced imaging modalities in the clinical diagnosis of CS and the monitoring of treatment. Results: A total of 92 patients were identified as having cardiac sarcoidosis, with males constituting 66.3% of the sample and a mean age of 62 years (±11.9). Among these patients, 80 (87%) underwent FDG-PET. Here, the basal inferolateral segment was the most frequently observed segment of the heart with FDG uptake. A total of 77 patients (84%) underwent CMR, with 51 demonstrating late gadolinium enhancement (LGE). The basal inferolateral segment exhibited the highest frequency of LGE (26%). Logistic regression analysis indicated that patients presenting with a combination of LGE, FDG uptake on PET, and a "mismatch pattern" faced a two-fold increase in the risk of experiencing major adverse cardiac events (odds ratio = 2.311, p = 0.077). Conclusions: This study underscores the importance of multimodality imaging as a non-invasive alternative for CS diagnosis and management, reducing reliance on EMBx.