Chest
Volume 132, Issue 6, December 2007, Pages 1949-1953
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Original Research
Sarcoidosis
Results of 188 Whole-Body Fluorodeoxyglucose Positron Emission Tomography Scans in 137 Patients With Sarcoidosis

https://doi.org/10.1378/chest.07-1178Get rights and content

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Section snippets

Materials and Methods

All patients attended the sarcoidosis service at Mount Sinai Medical Center (New York, NY). A total of 88 patients underwent whole-body scans as part of a study of perfusion (82Rb) and metabolic FDG PET scan imaging for the diagnosis and treatment of cardiac sarcoidosis. In addition, 49 patients underwent only whole-body FDG PET scans for one of the following indications: (1) seeking a diagnostic biopsy site not identified by standard techniques; and (2) identifying reversible granulomatous

Results

There were 72 men and 65 women in the study; 68 were white, 63 were African American, and 6 were other. The mean age was 50.4 years (age range, 19 to 81 years).

A total of 139 of the 188 FDG PET scans revealed hypermetabolism in the 137 patients. Table 1shows the results of the 139 extracardiac positive FDG PET scan findings in 137 patients. Forty-nine scans exhibited no extracardiac uptake of FDG. Mediastinal and extrathoracic lymph nodes and lungs were the most common sites of extracardiac PET

Discussion

In the vast majority of patients with sarcoidosis, the diagnosis is available by biopsy of a wide variety of organs. Twenty-six diagnostic biopsy sites were reported in A Case Controlled Etiologic Study of Sarcoidosis.9 Rarely, the clinical presentation suggests the diagnosis of sarcoidosis, but no readily available biopsy site is identified or only a single organ system is involved (eg, the patient who presents with anterior uveitis, normal chest radiograph findings, and no other imaging or

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    Combining anatomic evaluation by CT and metabolic assessment by FDG, FDG-PET/CT identifies active inflammation in lymph nodes and parenchymal lesions with a high sensitivity, ranging between 94% and 100% and a very good inter-observer agreement.44,45 Studies comparing FDG-PET to chest X-rays showed that PET identifies more lesions, notably in extra-thoracic sites and that some anatomic lesions on chest x-rays are non FDG avid46-48 more frequently in stages I and IV. Moreover, FDG-PET/CT enables identification of sarcoid lesions not detected on chest CT,49 predominantly lymphadenopathy of normal shape on CT and extra-thoracic disease (Fig. 1).

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All authors listed have no actual or potential conflicts of interest.

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