Accuracy of Serial PET-CT Imaging in Systemic Sarcoidosis

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Abstract

Positron emission tomography (PET) in combination with computed tomography (PET-CT) is commonly used to identify malignant lesion in the lung. Despite there being only a few reports in literature, PET-CT imaging may have many advantages in the study of sarcoidosis, being useful in the diagnosis as well as in monitoring the response to treatment. The object of this case report is to highlight the clinical utility of integrated PET-CT imaging for evaluation of patients with systemic sarcoidosis and for comparing baseline findings to follow-up readings.

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Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis.

Ho Kim, Hicham Skali, Pedram Kazemian … (2014)

This study sought to relate imaging findings on positron emission tomography (PET) to adverse cardiac events in patients referred for evaluation of known or suspected cardiac sarcoidosis. Although cardiac PET is commonly used to evaluate patients with suspected cardiac sarcoidosis, the relationship between PET findings and clinical outcomes has not been reported. We studied 118 consecutive patients with no history of coronary artery disease, who were referred for PET, using [(18)F]fluorodeoxyglucose (FDG) to assess for inflammation and rubidium-82 to evaluate for perfusion defects (PD), following a high-fat/low-carbohydrate diet to suppress normal myocardial glucose uptake. Blind readings of PET data categorized cardiac findings as normal, positive PD or FDG, positive PD and FDG. Images were also used to identify whether findings of extra-cardiac sarcoidosis were present. Adverse events (AE)-death or sustained ventricular tachycardia (VT)-were ascertained by electronic medical records, defibrillator interrogation, patient questionnaires, and telephone interviews. Among the 118 patients (age 52 ± 11 years; 57% males; mean ejection fraction: 47 ± 16%), 47 (40%) had normal and 71 (60%) had abnormal cardiac PET findings. Over a median follow-up of 1.5 years, there were 31 (26%) adverse events (27 VT and 8 deaths). Cardiac PET findings were predictive of AE, and the presence of both a PD and abnormal FDG (29% of patients) was associated with hazard ratio of 3.9 (p < 0.01) and remained significant after adjusting for left ventricular ejection fraction (LVEF) and clinical criteria. Extra-cardiac FDG uptake (26% of patients) was not associated with AE. The presence of focal PD and FDG uptake on cardiac PET identifies patients at higher risk of death or VT. These findings offer prognostic value beyond Japanese Ministry of Health and Welfare clinical criteria, the presence of extra-cardiac sarcoidosis and LVEF. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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A concise review of pulmonary sarcoidosis.

Robert Baughman, Daniel Culver, Marc Judson (2011)

This is an update on sarcoidosis, focusing on etiology, diagnosis, and treatment. In the area of etiopathogenesis, we now have a better understanding of the immune response that leads to the disease as well as genetic factors that modify both the risk for the disease and its clinical outcome. Several groups have also identified possible agents as a cause for sarcoidosis. Although none of these potential causes has been definitely confirmed, there is increasing evidence to support that one or more infectious agents may cause sarcoidosis, although this organism may no longer be viable in the patient. The diagnosis of sarcoidosis has been significantly aided by new technology. This includes the endobronchial ultrasound, which has been shown to increase the yield of needle aspiration of mediastinal and hilar lymph nodes. The positive emission tomography scan has proven useful for selecting possible biopsy sites by identifying organ involvement not appreciated by routine methodology. It has also helped in assessing cardiac involvement. The biologic agents, such as the anti-tumor necrosis factor antibodies, have changed the approach to refractory sarcoidosis. There is increasing evidence that the clinician can identify which patient is most likely to benefit from such therapy. As new and more potent antiinflammatory agents have been developed, it is clear that there are other factors that burden the patient with sarcoidosis, including fatigue and sarcoidosis-associated pulmonary hypertension. There have been several recent studies demonstrating treatment options for these problems.

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Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis.

Alvin Teirstein, Josef Machac, Orlandino Almeida … (2007)

To study the role of whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scans in the identification of occult biopsy sites and reversible granulomatous disease in patients with sarcoidosis. A retrospective review was undertaken of 188 FDG PET scans performed in 137 patients with proven sarcoidosis. All patients had given a complete medical history and undergone a physical examination, standard chest radiograph, spirometry, diffusing capacity determination, and measurement of serum angiotensin-converting enzymes levels. One hundred thirty-nine whole-body scans had positive findings. The most common positive sites were mediastinal lymph nodes (54 scans), extrathoracic lymph nodes (30 scans), and lung (24 scans). The standardized uptake value (SUV) ranged from 2.0 to 15.8. Twenty occult disease sites were identified. Eleven repeat scans exhibited decreased SUV with corticosteroid therapy. The positive pulmonary FDG PET scan findings occurred in two thirds of patients with radiographic stage II and III sarcoidosis. Negative pulmonary FDG PET scan findings were common in patients with radiographic stage 0, I, and IV sarcoidosis. Whole-body FDG PET scans are of value in identifying occult and reversible granulomas in patients with sarcoidosis. However, a positive FDG PET scan finding, by itself, is not an indication for treatment.

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Author and article information

Journal

Journal ID (nlm-ta): J Clin Imaging Sci

Journal ID (iso-abbrev): J Clin Imaging Sci

Journal ID (publisher-id): JCIS

Title: Journal of Clinical Imaging Science

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2156-7514

ISSN (Electronic): 2156-5597

Publication date Collection: 2014

Publication date (Electronic): 29 April 2014

Volume: 4

Electronic Location Identifier: 21

Affiliations

[1]Respiratory Unit, Department of Internal Medicine Regional Hospital Aosta, and University of Genoa, Genoa, Italy

[1 ]Nuclear Medicine IRMET Torino, Italy

[2 ]Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio, USA

Author notes

Address for correspondence: Dr. Roberto G Carbone, MD FCCP Respiratory Unit, Department of Internal Medicine, Regional Hospital Aosta - Italy. E-mail: magister1@ 123456mail.com

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Publisher ID: JCIS-4-21

DOI: 10.4103/2156-7514.131645

PMC ID: 4060399

PubMed ID: 24987568

SO-VID: d471618c-4885-4af3-a988-21b14ac432d7

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Accuracy of Serial PET-CT Imaging in Systemic Sarcoidosis

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Chinese Journal of Radiological Health

Most cited references 11

Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis.

A concise review of pulmonary sarcoidosis.

Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis.

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