Hybrid-PET/MRT bei inflammatorischer Kardiomyopathie

BACKGROUND: Diagnostic work-up for myocarditis and inflammatory cardiomyopathy is challenging for its different aetiologies, phenotypes and stages. METHODICAL INNOVATIONS AND CHALLENGES: Cardiac PET/MRI is an excellent tool for myocardial tissue characterization with MRI as well as for diagnosis of active myocardial inflammation with PET. The combination of MRI and PET is rather synergistic than only summative: myocardial changes detected by MRI can be differentiated with PET to (potentially still reversible) active inflammation vs. chronic and inactive (irreversible) scars. The strengths of a hybrid PET/MRI can show to advantage in cardiac sarcoidosis with potentially coexistent active and chronic involvement. Good dietary preparation with a low-carb diet is essential to warrant sufficient suppression of myocardial glucose uptake for robust cardiac PET in context of inflammatory cardiomyopathy. RECOMMENDATIONS: Hybrid cardiac PET/MRI to diagnose inflammatory cardiomyopathy and further differentiation in acute vs. chronic processes is feasible. This could be demonstrated in cardiac involvement of sarcoidosis.