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Although 18F-FDG-PET scanning is already recognized as a tool for diagnosing cardiac sarcoidosis, much remains to be learned about its most appropriate roles as well as its limitations, according to authors of a new guideline.
Issued jointly by the American Society of Nuclear Cardiology and the Society of Nuclear Medicine and Molecular Imaging, the "comprehensive consensus statement" acknowledges that randomized trials are probably impractical for this rare condition, and therefore clinicians will have to rely largely on their own experience, the limited studies currently available, and expert opinion.
That opinion, prepared by a multidisciplinary team assembled by the two groups, included the following:
- Exclude the presence of significant coronary artery disease, history of myocardial infarction, resting ischemia, or hibernating myocardium before performing cardiac PET
- Prolonged fasting, dietary alterations, and IV heparin may be advised to inhibit physiologic myocardial glucose uptake during imaging
- Scan results must be interpreted in the context of other evidence, including clinical symptoms
- Whole-body 18F-FDG-PET is often a good idea to monitor extra-cardiac uptake
- Diagnostic precision of PET scans in this condition has not been conclusively established
- Perhaps most important, more research is needed to clarify the role of 18F-FDG-PET in cardiac sarcoidosis diagnosis and management
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