F-18-Fluorodeoxyglucose Positron Emission Tomography-Guided Sampling of Mediastinal Lymph Nodes in the Diagnosis of Cardiac Sarcoidosis Piia Simonen,

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F-18-Fluorodeoxyglucose Positron Emission Tomography-Guided Sampling of Mediastinal Lymph Nodes in the Diagnosis of Cardiac Sarcoidosis Piia Simonen, MD, Jukka Lehtonen, MD, Riina Kandolin, MD, Jukka Schildt, MD, Suvi Marjasuo, MD, Heikki Miettinen, MD, Juhani Airaksinen, MD, Tapani Vihinen, MD, Suvi Tuohinen, MD, Petri Haataja, MD, Markku Kupari, MD American Journal of Cardiology Volume 116, Issue 10, Pages 1581-1585 (November 2015) DOI: 10.1016/j.amjcard.2015.08.025 Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 1 Summary of the diagnostic strategy in suspicion of CS during the study period. EcFDG = abnormal extracardiac F-18-FDG uptake; LGE = late gadolinium enhancement; MyocFDG = abnormal myocardial F-18-FDG uptake. American Journal of Cardiology 2015 116, 1581-1585DOI: (10.1016/j.amjcard.2015.08.025) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 2 Examples of cardiac (A) and whole-body (B) F-18-FDG PET studies showing “hot” MLN together with foci of activity in the heart and outside the thoracic cavity. American Journal of Cardiology 2015 116, 1581-1585DOI: (10.1016/j.amjcard.2015.08.025) Copyright © 2015 Elsevier Inc. Terms and Conditions

Figure 3 The path to the histologic proof of sarcoidosis. In 60 patients with unknown histology at presentation, 101 tissue samples were taken and studied histologically in 3 successive biopsy rounds. Totally 24 MLNB and 71 EMBs were done. Granulomatous inflammation was ultimately confirmed in 24 of 24 MLNBs and in 30 of 71 EMBs. “*” Indicates “other” biopsy sites that included 2 transbronchial lung biopsies, 2 inguinal lymph node biopsies, and 1 post-transplantation study of the native heart; +/n = number of patients with positive biopsies per number of patients biopsied. MLNB = mediastinal lymph node biopsies. American Journal of Cardiology 2015 116, 1581-1585DOI: (10.1016/j.amjcard.2015.08.025) Copyright © 2015 Elsevier Inc. Terms and Conditions