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Fig. 3 | EJNMMI Research

Fig. 3

From: Semi-quantitative metabolic values on FDG PET/CT including extracardiac sites of disease as a predictor of treatment course in patients with cardiac sarcoidosis

Fig. 3

Representative case from the group with daily maintenance dose of prednisone of > 10 mg (patient no. 12). Pretreatment FDG PET/CT (a 3D maximum intensity projection; b, c fused PET/CT) demonstrate multiple organ disease involving lymph nodes (thoracic and abdominal), the lung (b arrows), and heart (c arrows). The max SUV, metabolic volume, and total lesion glycolysis of all involved organ system and the heart are 15.9 (heart), 580.3 ml, and 2782.5 g, and 15.9, 246 ml, and 1393.9 g, respectively. Follow-up PET/CT performed at 3 months since the initial study (d, f) show near complete metabolic resolution except for persistent metabolic activity in the heart (d, f arrows, max SUV 4.0). The patient was started with 30 mg of daily corticosteroid, but the dose was increased to 40 mg at 3 months visit, which was later reduced to 15 mg at 6 months. The patient continued on corticosteroid therapy for years and later methotrexate was added to the treatment regimen, though follow-up PET/CT at 4 years since the initial study still show persistent metabolic activity (e, g arrows, max SUV 4.1) in the heart. Reconstructed vertical long axis images of the left ventricle at 4 years since the initial study (h perfusion images on the top and FDG images on the bottom) show increased metabolic activity in the anterior and anterolateral wall with corresponding reduced perfusion (arrowheads), suggestive of active inflammation. Note that reduced perfusion in the apical 1/2 of the inferior wall without FDG activity is compatible with scar tissue

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