"Cardiac Sarcoidosis" - Case-Based Webinar (CME)-Cardiac Sarcoidosis

Video Transcription

Video Summary

This webinar focused on <strong>cardiac sarcoidosis</strong>, emphasizing how <strong>multimodality imaging—especially cardiac MRI (CMR) and FDG PET—helps diagnose, risk-stratify, and guide treatment</strong>.

Dr. Patel opened with a case of a young man with exertional symptoms, conduction disease, and MRI findings strongly suggestive of cardiac sarcoidosis, including <strong>patchy late gadolinium enhancement (LGE)</strong> and extracardiac lymphadenopathy. Biopsy confirmed non-necrotizing granulomas. He contrasted this with a more typical but slower workup that might begin with stress testing, angiography, and echo before reaching CMR. He reviewed how cardiac sarcoid is often missed because it can be clinically silent, biopsy has low sensitivity, and standard tests are not very sensitive. He highlighted prognostic value of LGE, RV involvement, and the relationship between imaging findings and ventricular arrhythmia risk.

Dr. Almallah then expanded on <strong>FDG PET technique and preparation</strong>, stressing that strict <strong>low-carbohydrate diet and fasting</strong> are essential to suppress normal myocardial glucose uptake. PET helps distinguish <strong>active inflammation</strong> from <strong>scar/fibrosis</strong>, especially when paired with perfusion imaging. He presented several cases showing how PET and CMR complement each other: PET tracks inflammatory activity and treatment response, while CMR shows scar burden. He also discussed how persistent LGE may remain after inflammation resolves, and how PET can help decide when to taper immunosuppression.

The discussion ended with practical questions on <strong>ICD decisions, biopsy strategy, differentiating sarcoid from myocarditis or ARVC, isolated cardiac sarcoidosis, and what to do when imaging is inconclusive</strong>. The key takeaway: <strong>early recognition and combined imaging are critical because cardiac sarcoidosis carries significant arrhythmic and mortality risk.</strong>

Keywords

cardiac sarcoidosis

multimodality imaging

cardiac MRI

CMR

FDG PET

late gadolinium enhancement

granulomas

myocardial inflammation

ventricular arrhythmia risk

immunosuppression

ICD decisions