Galli Filippo, Lanzolla Tiziana, Pietrangeli Vittorio, Malviya Gaurav, Ricci Alberto, Bruno Pierdonato, Ragni Paola, Scopinaro Francesco, Mariotta Salvatore, Signore Alberto
Nuclear Medicine Unit, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Ospedale S. Andrea, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Roma, Italy.
Pneumology Unit, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Ospedale S. Andrea, "Sapienza" University of Rome, Via di Grottarossa 1035, 00189 Roma, Italy.
Biomed Res Int. 2015;2015:401341. doi: 10.1155/2015/401341. Epub 2015 Mar 19.
Sarcoidosis is a multisystemic granulomatous disorder characterized by multiple noncaseating granulomas involving intrathoracic lymph nodes and lung parenchyma. Recently, the use of anti-tumor necrosis factor alpha (anti-TNFα) agents has been introduced for therapy of chronic and refractory sarcoidosis with controversial results. Infliximab (Remicade) is a chimeric monoclonal antibody (mAb) that recognizes and binds TNFα, neutralizing its biological effects. In the present study, (99m)Tc labelled infliximab was used to study the expression of TNFα in sarcoid lesions and to evaluate its role as a predictive marker in response to therapy with Remicade.
A total of 10 patients with newly diagnosed sarcoidosis were enrolled together with 10 control patients affected by rheumatoid arthritis. All patients were studied by planar imaging of the chest with (99m)Tc-infliximab at 6 h and 24 h and total body [(18)F]-FDG PET/CT. Regions of interest were drawn over the lungs and the right arm and target-to-background ratios were analysed for (99m)Tc-infliximab. SUV mean and SUV max were calculated over lungs for FDG.
Image analysis showed low correlation between T/B ratios and BAL results in patients despite positivity at [(18)F]-FDG PET.
In conclusion, patients with newly diagnosed pulmonary sarcoidosis, with FDG-PET and BAL positivity, showed a negative (99m)Tc-infliximab scintigraphy.
结节病是一种多系统肉芽肿性疾病，其特征为多个非干酪样肉芽肿累及胸内淋巴结和肺实质。近来，抗肿瘤坏死因子α（抗TNFα）药物已被用于治疗慢性难治性结节病，但结果存在争议。英夫利昔单抗（类克）是一种嵌合单克隆抗体（mAb），可识别并结合TNFα，中和其生物学效应。在本研究中，使用（99m）Tc标记的英夫利昔单抗来研究结节病病变中TNFα的表达，并评估其作为预测类克治疗反应标志物的作用。
共纳入10例新诊断的结节病患者以及10例类风湿关节炎对照患者。所有患者均在6小时和24小时通过（99m）Tc-英夫利昔单抗进行胸部平面显像，并进行全身[（18）F]-FDG PET/CT检查。在肺部和右臂绘制感兴趣区，并分析（99m）Tc-英夫利昔单抗的靶本底比值。计算肺部FDG的SUV均值和SUV最大值。
图像分析显示，尽管（18）F-FDG PET呈阳性，但患者的T/B比值与BAL结果之间相关性较低。
总之，新诊断的肺部结节病患者，FDG-PET和BAL呈阳性，但（99m）Tc-英夫利昔单抗闪烁显像呈阴性。
