Cardiac sarcoidosis is a cause of dilated cardiomyopathy and complete heart block. Which diagnostic investigation is now the gold standard for detecting active cardiac sarcoidosis with the highest sensitivity?
- A Endomyocardial biopsy as sole gold standard
- B Cardiac FDG-PET-CT combined with gadolinium-enhanced cardiac MRI (LGE-CMR) ✓
- C Holter monitoring for ventricular ectopy pattern
- D Serum ACE level + chest X-ray bilateral hilar adenopathy
Correct answer: B. Cardiac FDG-PET-CT combined with gadolinium-enhanced cardiac MRI (LGE-CMR)
Explanation
Per 2014 Heart Rhythm Society expert consensus statement, combined FDG-PET (identifies metabolically active inflammation) + late gadolinium enhancement CMR (identifies scar/granuloma) provides the highest sensitivity (~90%) for cardiac sarcoidosis diagnosis. FDG-PET alone has sensitivity ~89%, LGE-CMR ~76%. Endomyocardial biopsy has poor sensitivity (~20%) due to patchy disease. Serum ACE is elevated in only 50% of cases and chest X-ray hilar adenopathy alone is non-diagnostic. This combination is essential for treatment monitoring with steroids.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.