Failure of Follow-up Gallium Single-Photon Emission Computed Tomography and Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography to Predict the Deterioration of a Patient With Cardiac Sarcoidosis

Abstract

Although gallium-67-citrate (⁶⁷Ga) scanning and single-photon emission computed tomography (SPECT) are useful in the assessment of disease activity in cardiac sarcoidosis, a patient with cardiac sarcoidosis in whom SPECT imaging with ⁶⁷Ga failed to predict the deterioration in the clinical course is presented. A 53-year-old woman diagnosed with cardiac sarcidosis had ⁶⁷Ga scanning and ⁶⁷Ga SPECT, both of which showed abnormal high uptake. After treatment with corticosteroid, there was an apparent improvement in the ⁶⁷Ga SPECT findings, and the dose of the corticosteroid was reduced. Subsequently, the disease activity of the cardiac sarcoidosis was thought to be well controlled, because abnormal uptake was not found on repeat ⁶⁷Ga SPECT. However, 4 years after initial diagnosis, thinning at the basal ventricular septal wall and complete atrioventricular block were noted. Despite repeating the evaluation with ⁶⁷Ga SPECT and additional fluorine-18-fluorodeoxyglucose positron emission tomography (¹⁸FDG PET) after discovering this progression, neither of these examinations showed any abnormality. Unfortunately, in this patient, the disease activity of cardiac sarcoidosis was underestimated by the diagnostic imaging modalities. (Circ J 2004; 68: 802 - 805)