Fig. 3

Patient with CS in which the ¹⁸F-FDG PET/CT was inconclusive due to insufficiently suppressed physiological ¹⁸F-FDG uptake by the myocardium. Left panel: MIPs showing patient no. 5 with dilated cardiomyopathy and multiple ¹⁸F-FDG and ⁶⁸Ga-DOTANOC avid lymph nodes (red arrows) both above and below the diaphragm. In addition, there is massive and diffusely increased activity in the lung parenchyma (black arrows) representing active pulmonary sarcoidosis. Right panel: transaxial slices of the cardiac region reveal a focal on diffuse pattern of ¹⁸F-FDG uptake (top) raising suspicion of cardiac involvement (SUVmax 21 in the septum). However, the image was rated inconclusive by a majority of expert reviewers. By contrast, all reviewers rated the ⁶⁸Ga-DOTANOC uptake (SUVmax 2.8, target-to-background 3.04) in the septum pathological (bottom). The patient was treated with corticosteroids and recovered