Cardiac MRI Findings of Early Sub-Acute Cardiac Sarcoidosis

Biana Roit ¹ Itzhak Vitkon, MD ² Mehrzad Cohenpour, MD ³ Mark Kats, MD ² Inna Yofik, MD ² Laurian Copel, MD ¹

¹Department of Radiology, Shamir Medical Center (Assaf Harofeh), Israel
²Department of Cardiology, Shamir Medical Center (Assaf Harofeh), Israel
³Department of Nuclear Medicine, Shamir Medical Center (Assaf Harofeh), Israel

Sarcoidosis is a systemic granulomatous disorder of unknown etiology; Cardiac sarcoidosis (CS) is a life-threatening condition with important therapeutic implications.

Cardiac MRI (CMR) and FDG-PET-CT are noninvasive advanced imaging techniques used for the detection of CS.

A 49 years-old woman with known pulmonary sarcoidosis was evaluated for syncope, newly diagnosed CLBBB and 2nd degree-AV-block on ECG.

Cardiac biomarkers and echocardiography were unremarkable.

CMR showed left ventricular subepicardial late gadolinium enhancement (LGE) in the inferior, inferolateral, and lateral walls, without myocardial edema, findings that may be consistent with a diagnosis of remote myocarditis or CS.

PET-CT showed focal high uptake of FDG with a good spatial agreement with LGE distribution on CMR and with normal uptake of MIBI on the perfusion-scan. Those findings were consistent with Early CS.

While the findings on CMR were non-conclusive for CS, the complementary PET-CT led us to the diagnosis of early sub-acute CS.