Frequency of late gadolinium enhancement-negative cardiac magnetic resonance imaging at initial presentation with metabolically active treatment-naïve cardiac sarcoidosis.
- 1Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
- 2Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
- 3Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Abstract
Aims
The 2024 American Heart Association statement recommends fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for patients with high clinical suspicion of cardiac sarcoidosis even without late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR), but this recommendation has been challenged. We determined the frequency of LGE-negative CMR at first presentation of clinically manifest, metabolically active, treatment-naïve cardiac sarcoidosis.Methods and results
In this single-centre sub-study of the prospective Cardiac Sarcoidosis Multi-Center Prospective Cohort Study, we analysed 46 consecutive treatment-naïve patients with de novo clinically manifest cardiac sarcoidosis and core-laboratory-defined abnormal cardiac and extracardiac FDG uptake, imaged within a 6-month interval, before immunosuppression. Four of 46 patients had no LGE on CMR (8.7%; exact 95% CI, 2.4-20.8%). All four presented with advanced atrioventricular conduction disease and none had ventricular tachycardia; three of four started immunosuppressive therapy. Compared with LGE-positive patients, LGE-negative patients had preserved left ventricular ejection fraction and lower cardiac inflammatory burden (left ventricular maximum standardized uptake value 3.9 ± 0.9 vs. 9.6 ± 5.2; P = 0.037).Conclusion
An LGE-negative phenotype can occur in clinically relevant, treatment-naïve, FDG-avid cardiac sarcoidosis. These findings suggest considering FDG-PET in selected patients with high clinical suspicion of cardiac sarcoidosis, even when CMR shows no LGE.
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BibTeX
@article{kadoya2026frequency,
title = {{Frequency of late gadolinium enhancement-negative cardiac magnetic resonance imaging at initial presentation with metabolically active treatment-naïve cardiac sarcoidosis.}},
author = {Yoshito Kadoya and Mehmet Onur Omaygenc and Bethlehem Mengesha and D Ian Paterson and Pablo B Nery and Kevin E Boczar and Anahita Tavoosi and Rob S Beanlands and Christiane Wiefels and David Birnie},
journal = {European heart journal. Imaging methods and practice},
year = {2026},
month = oct,
doi = {10.1093/ehjimp/qyag179},
url = {https://europepmc.org/article/MED/42926973},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Frequency of late gadolinium enhancement-negative cardiac magnetic resonance imaging at initial presentation with metabolically active treatment-naïve cardiac sarcoidosis.
AU - Yoshito Kadoya
AU - Mehmet Onur Omaygenc
AU - Bethlehem Mengesha
AU - D Ian Paterson
AU - Pablo B Nery
AU - Kevin E Boczar
AU - Anahita Tavoosi
AU - Rob S Beanlands
AU - Christiane Wiefels
AU - David Birnie
PY - 2026
DA - 2026/10/13
JO - European heart journal. Imaging methods and practice
DO - 10.1093/ehjimp/qyag179
UR - https://europepmc.org/article/MED/42926973
AB - Aims The 2024 American Heart Association statement recommends fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for patients with high clinical suspicion of cardiac sarcoidosis even without late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR), but this recommendation has been challenged. We determined the frequency of LGE-negative CMR at first presentation of clinically manifest, metabolically active, treatment-naïve cardiac sarcoidosis.Methods and results In this single-centre sub-study of the prospective Cardiac Sarcoidosis Multi-Center Prospective Cohort Study, we analysed 46 consecutive treatment-naïve patients with de novo clinically manifest cardiac sarcoidosis and core-laboratory-defined abnormal cardiac and extracardiac FDG uptake, imaged within a 6-month interval, before immunosuppression. Four of 46 patients had no LGE on CMR (8.7%; exact 95% CI, 2.4-20.8%). All four presented with advanced atrioventricular conduction disease and none had ventricular tachycardia; three of four started immunosuppressive therapy. Compared with LGE-positive patients, LGE-negative patients had preserved left ventricular ejection fraction and lower cardiac inflammatory burden (left ventricular maximum standardized uptake value 3.9 ± 0.9 vs. 9.6 ± 5.2; P = 0.037).Conclusion An LGE-negative phenotype can occur in clinically relevant, treatment-naïve, FDG-avid cardiac sarcoidosis. These findings suggest considering FDG-PET in selected patients with high clinical suspicion of cardiac sarcoidosis, even when CMR shows no LGE.
SN - 2755-9637
ER -