Review of Multimodal Imaging in Cardiac Sarcoidosis

Sarcoidosis is a multisystemic disease that causes organ dysfunction through the formation of non-caseating granulomas. Cardiac sarcoidosis (CS) is a phenotype associated with a poor prognosis and benefits from timely diagnosis and management. A nonspecific clinical presentation and the lack of a reliable diagnostic gold standard make obtaining a definitive diagnosis challenging. Advanced cardiac imaging techniques, such as cardiac magnetic resonance imaging (CMR) and 18F-labeled fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET), play an essential role in CS assessment and have been incorporated into several diagnostic guidelines. These modalities have significantly improved our knowledge and understanding of CS by contributing to risk stratification and the assessment of inflammatory and therapeutic response monitoring. The integration of hybrid imaging techniques, such as PET/CMR and PET/computed tomography (PET/CT), has also demonstrated potential in enhancing diagnostic accuracy and disease staging. Each modality offers complementary insights, and their integration through multimodal and hybrid imaging improves diagnostic confidence, disease staging, and therapy monitoring. This review synthesizes current evidence and illustrative cases to highlight the clinical utility of multimodal imaging in CS and discusses limitations and emerging tools guiding future directions. J. Med. Invest. 72 : 225-234, August, 2025.