Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
J Nucl Med. 2012 Oct;53(10):1543-9. doi: 10.2967/jnumed.112.104380. Epub 2012 Aug 9.
The purpose of this study was to assess the utility of (18)F-FDG PET/CT for detection of inflammation in granulomatous sites and management of patients with chronic sarcoidosis. The 3 specific aims were to assess differences between (18)F-FDG PET/CT and multidetector CT (MDCT) findings, to compare (18)F-FDG PET/CT results with serum levels of angiotensin-converting enzyme (ACE), and to determine whether (18)F-FDG PET/CT findings are associated with the decision to change therapy.
We studied 90 sarcoidosis patients (mean age ± SD, 47 ± 12 y; 32 men and 58 women) with persistent symptoms who were referred for (18)F-FDG PET/CT evaluation to assess the extent of inflammation. They also underwent MDCT and measurement of serum ACE level. After the follow-up (12 ± 5 mo after (18)F-FDG PET/CT), the clinical status and changes in therapy were analyzed.
(18)F-FDG PET/CT detected inflammation in 74 patients (82%) (maximum standardized uptake value, 8.1 ± 3.9). MDCT was positive for sarcoidosis in 6 additional patients (80, 89%). The difference between the 2 methods was not significant (P = 0.238, McNemar test), and their agreement was fair (κ = 0.198). Although ACE levels were significantly higher in patients with positive than negative (18)F-FDG PET/CT results (P = 0.002, Mann-Whitney test), 38 patients (51%) with positive (18)F-FDG PET/CT results had normal ACE levels. The therapy was initiated or changed in 73 out of 90 patients (81%). Both univariate and multivariate logistic regression analyses indicated that positive (18)F-FDG PET/CT results were significantly (P < 0.001) associated with changes in therapy, with no contribution from age, sex, ACE level, CT results, or previous therapy.
Our results indicate that (18)F-FDG PET/CT is a useful adjunct to other diagnostic methods for detecting active inflammatory sites in chronic sarcoidosis patients with persistent symptoms, especially those with normal ACE levels. (18)F-FDG PET/CT proved advantageous for determining the spread of active disease throughout the body and influenced the decision to adjust the therapy.
本研究旨在评估 (18)F-FDG PET/CT 检测肉芽肿部位炎症和管理慢性结节病患者的效用。具体目的有三个，分别是评估 (18)F-FDG PET/CT 与多排 CT（MDCT）结果之间的差异，比较 (18)F-FDG PET/CT 结果与血清血管紧张素转换酶（ACE）水平，并确定 (18)F-FDG PET/CT 发现是否与改变治疗的决策相关。
我们研究了 90 名持续有症状的结节病患者（平均年龄 ± 标准差，47 ± 12 岁；男性 32 名，女性 58 名），他们因评估炎症范围而接受 (18)F-FDG PET/CT 评估。他们还进行了 MDCT 和血清 ACE 水平测量。在随访（(18)F-FDG PET/CT 后 12 ± 5 个月）后，分析了临床状况和治疗变化。
(18)F-FDG PET/CT 检测到 74 名患者（82%）（最大标准化摄取值，8.1 ± 3.9）有炎症。MDCT 还在另外 6 名患者（80%，89%）中发现了结节病。这两种方法之间的差异不显著（P = 0.238，McNemar 检验），并且它们的一致性为中等（κ = 0.198）。尽管 ACE 水平在阳性与阴性 (18)F-FDG PET/CT 结果的患者之间显著更高（P = 0.002，Mann-Whitney 检验），但 38 名（51%）阳性 (18)F-FDG PET/CT 结果的患者 ACE 水平正常。90 名患者中的 73 名（81%）开始或改变了治疗。单变量和多变量逻辑回归分析均表明，阳性 (18)F-FDG PET/CT 结果与治疗改变显著相关（P < 0.001），而年龄、性别、ACE 水平、CT 结果或以前的治疗均无贡献。
我们的结果表明，(18)F-FDG PET/CT 是一种有用的辅助手段，可与其他诊断方法结合，用于检测持续有症状的慢性结节病患者中活跃的炎症部位，尤其是那些 ACE 水平正常的患者。(18)F-FDG PET/CT 有助于确定全身活跃疾病的传播，并影响调整治疗的决策。
