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FDG uptake in upper abdominal lymph node as a distinctive pattern in sarcoidosis.
Ryogo Minamimoto1,2, Yumi Abe3, Ryota Morimoto4
1Department of Integrated Image Information Analysis, Nagoya University Graduate School of Medicine, 65, Tsurumaicho, Shouwa-ku, Nagoya, Aichi, 466-8550, Japan. ryogominamimoto@yahoo.co.jp.
Japanese Journal of Radiology
|February 5, 2026
Summary
Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) reveals characteristic sarcoidosis lymphatic spread patterns. Frequent upper abdominal lymph node involvement, especially with thoracic disease, aids in diagnosing cardiac sarcoidosis (CS).
Area of Science:
- Nuclear medicine imaging
- Radiology
- Pulmonology
Background:
- Cardiac sarcoidosis (CS) diagnosis can be challenging.
- Understanding sarcoidosis dissemination patterns is crucial for accurate diagnosis.
Purpose of the Study:
- To evaluate FDG-PET/CT findings in patients with suspected or known CS.
- To specifically analyze upper abdominal lymph node (LN) involvement and its association with thoracic lesions and myocardial uptake.
Main Methods:
- Retrospective analysis of 178 FDG-PET/CT scans in patients with suspected or known CS.
- Classification of FDG-positive LNs based on treatment response, characteristic patterns, or histology.
- Assessment of LN uptake patterns in relation to myocardial FDG uptake.
Main Results:
- Hilar and mediastinal LNs showed the highest FDG uptake (79% and 76%).
- Upper abdominal LNs (periportal, anterior, and posterior pancreaticoduodenal) were involved in 49.4% of patients.
- Strong co-occurrence between thoracic and upper abdominal LNs suggests lymphatic spread; peripheral LNs showed minimal uptake.
Conclusions:
- FDG-PET/CT effectively visualizes the structured lymphatic dissemination of sarcoidosis.
- Frequent upper abdominal LN uptake, alongside thoracic involvement, is a characteristic finding in sarcoidosis.
- Recognizing these patterns improves diagnostic accuracy for CS and differentiation from other systemic diseases.
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