Elevated (18)F-fluorodeoxyglucose uptake in the interventricular septum is associated with atrioventricular block in patients with suspected cardiac involvement sarcoidosis

Eur J Nucl Med Mol Imaging. 2013 Oct;40(10):1558-66. doi: 10.1007/s00259-013-2460-5. Epub 2013 May 29.


Purpose: Cardiac involvement in sarcoidosis is one of the leading causes of death associated with abnormalities of the conduction system. (18)F-FDG PET is useful for detecting inflammatory lesions in cardiac sarcoidosis. However, the relationship between ECG abnormalities and focal (18)F-FDG uptake has not been studied. The aim of this study was to evaluate the relationship between electrocardiogram (ECG) abnormalities and the location of elevated myocardial (18)F-FDG uptake in patients with sarcoidosis.

Methods: Included in the study were 50 patients (56.3 ± 14.9 years old) with histologically proven sarcoidosis with suspected cardiac involvement based on ECG or echocardiography. All patients had fasted for at least 6 h and were given unfractionated heparin (50 IU/kg) intravenously to reduce the physiological (18)F-FDG uptake in the myocardium. The left ventricle (LV) wall was divided into 17 segments by visual analysis. Obvious accumulation in each segment was defined as positive.

Results: Of the 50 patients, 33 showed some ECG abnormalities, including atrioventricular (AV) block in 13. Patients with abnormal ECG findings had a higher number of regions with (18)F-FDG uptake than patients without ECG abnormality (3.48 ± 2.73 vs. 1.41 ± 2.09 regions, p = 0.0051). Among ECG abnormalities, the predictor for interventricular septum wall (18)F-FDG involvement was AV block (p = 0.0025).

Conclusion: Patients with ECG abnormalities showed a higher number of abnormal (18)F-FDG myocardial uptake regions than patients without ECG abnormalities. In particular, focal (18)F-FDG uptake in the interventricular septum in cardiac sarcoidosis was associated with AV block. Therefore, determination of regional (18)F-FDG distribution might contribute to patient management in cardiac sarcoidosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Atrioventricular Block / diagnosis
  • Atrioventricular Block / diagnostic imaging*
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / diagnostic imaging*
  • Echocardiography
  • Electrocardiography
  • Female
  • Fluorodeoxyglucose F18* / pharmacokinetics
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Myocardial Perfusion Imaging
  • Positron-Emission Tomography*
  • Radiopharmaceuticals* / pharmacokinetics
  • Sarcoidosis / diagnosis
  • Sarcoidosis / diagnostic imaging*
  • Tomography, Emission-Computed, Single-Photon
  • Tomography, X-Ray Computed
  • Ventricular Septum / metabolism


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18