Detection of denervated but viable myocardium in cardiac sarcoidosis with I-123 MIBG and Tl-201SPECT imaging

A 58-year-old man, who had biopsy-proven cardiac sarcoidosis, underwent Tl-201 and I-123 MIBG cardiac scintigraphy. Although no perfusion defect was identified by Tl-201, mild heterogeneity of I-123 MIBG uptake was present in the myocardium. The denervated but viable myocardium was demonstrated in the heart with sarcoidosis. Cardiac sympathetic nerve function was impaired in cardiac sarcoidosis, slightly improved with steroid therapy. I-123 MIBG scintigraphy may be useful to assess extent of myocardial involvement and response to therapy.