Costabel Ulrich, Ohshimo Shinichiro, Guzman Josune
Department of Pneumology/Allergy, Ruhrlandklinik, Medical Faculty, University of Duisburg-Essen, Essen, Germany.
Curr Opin Pulm Med. 2008 Sep;14(5):455-61. doi: 10.1097/MCP.0b013e3283056a61.
To describe the recent advances in the diagnostic procedures for sarcoidosis and explore future directions.
Novel imaging techniques have been explored in sarcoidosis, such as positron emission tomography using L-[3-F]-alpha-methyltyrosine, which is more specific for malignancy than F-fluorodeoxyglucose positron emission tomography. The combined modality of L-[3-F]-alpha-methyltyrosine-positron emission tomography with fluorodeoxyglucose-positron emission tomography could successfully discriminate sarcoidosis from malignancy. The finding of delayed enhancement in cardiac magnetic resonance imaging could identify cardiac involvement of sarcoidosis with higher sensitivity than echocardiography, thallium scintigraphy, and gallium scintigraphy. Endobronchial ultrasonograpy-guided transbronchial needle aspiration is a safe and useful tool for diagnosing sarcoidosis with a diagnostic accuracy, sensitivity and specificity of 85-93, 78-89, and 92-96%, respectively. Developments in genetics have demonstrated that 99% of the human leukocyte antigen DRB10301/DQB10201-positive patients with Löfgren's syndrome show a spontaneous remission, in contrast to only 55% of the human leukocyte antigen DRB10301/DQB10201-negative patients. These alleles could be novel promising factors for discriminating a prognosis in Löfgren's syndrome.
Recent development including novel imaging techniques, novel biopsy procedures, and genetic analyses could be of value for the diagnosis of sarcoidosis.
描述结节病诊断程序的最新进展并探索未来方向。
已在结节病中探索了新型成像技术，例如使用L-[3-F]-α-甲基酪氨酸的正电子发射断层扫描，其对恶性肿瘤的特异性高于F-氟脱氧葡萄糖正电子发射断层扫描。L-[3-F]-α-甲基酪氨酸正电子发射断层扫描与氟脱氧葡萄糖正电子发射断层扫描的联合模式能够成功区分结节病与恶性肿瘤。心脏磁共振成像中延迟强化的发现能够比超声心动图、铊闪烁显像和镓闪烁显像更敏感地识别结节病的心脏受累情况。支气管内超声引导下经支气管针吸活检是诊断结节病的一种安全且有用的工具，其诊断准确性、敏感性和特异性分别为85-93%、78-89%和92-96%。遗传学进展表明，99%的人类白细胞抗原DRB10301/DQB10201阳性的 Löfgren 综合征患者会自发缓解，相比之下，人类白细胞抗原DRB10301/DQB10201阴性的患者只有55%会自发缓解。这些等位基因可能是区分Löfgren综合征预后的新的有前景的因素。
包括新型成像技术、新型活检程序和基因分析在内的最新进展可能对结节病的诊断有价值。
