Table 1

Imaging modalities in the diagnosis of cardiac sarcoidosis; utility, advantages and disadvantages

Imaging methodFindingsAdvantagesDisadvantagesSensitivitySpecificity
Echocardiography
  • Abnormal LV or RV function; wall thickening, basal septum thinning; atypical hypertrophic cardiomyopathy or aneurysms

  • Diastolic dysfunction

  • Effective method to follow LV function

  • Evaluation of diastolic function

Low sensitivity and specificityLow to moderateLow
Thallium-201/Tc- 99m based MPIReverse redistribution (microvascular obstruction)—MPI defects at rest and stress due to granulomas or scarringEvaluation of ischaemic heart disease
  • Findings non-specific

  • Radiation

ModerateModerate
Gallium-67 scintigraphyAbnormal accumulation corresponds to areas of active inflammation
  • Identifies active inflammation

  • May be used to assess treatment response

  • Less sensitive than PET

  • Radiation

LowHigh
PET MPI + FDG
  • Normal rest MPI with focal increased fasting FDG uptake indicates active inflammation

  • Rest MPI defect with no increased FDG indicates scar

  • Rest MPI defect with increased FDG may indicate mixture of scar + inflammation or more severe inflammation

  • High sensitivity for detecting active CS and myocardial scar

  • May be used to follow treatment response

RadiationHighModerate to high
Cardiac MRI
  • Sarcoid infiltration may be visualised as areas of increased signal intensity on T2 weighted and gadolinium enhanced images

  • Delayed myocardial enhancement may be seen in scarred areas

  • Detects active disease and myocardial scarring

  • RV and LV function assessment

  • High accuracy for detecting active CS and scar

  • May guide EMB

  • Contraindicated in patients with pacemaker/ICD and severe renal failure

  • Sensitivity may vary depending on protocol used

Moderate to highHigh
  • CS, cardiac sarcoidosis; EMB, endomyocardial biopsy; FDG, fluorodeoxyglucose; ICD, implantable cardioverter-defibrillator; LV, left ventricle; MPI, myocardial perfusion imaging; PET, positron emission tomography; RV, right ventricle.

  • Adapted from Ayyala et al.13