Maturu Venkata Nagarjuna, Rayamajhi Sampanna Jung, Agarwal Ritesh, Aggarwal Ashutosh Nath, Gupta Dheeraj, Mittal Bhagwant Rai
Senior Resident Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER).
Sarcoidosis Vasc Diffuse Lung Dis. 2016 Dec 23;33(4):372-380.
ackground: Monitoring disease activity in sarcoidosis remains a clinical challenge as there is no gold standard. Positron emission tomography (PET) imaging is a novel tool to assess the metabolic activity. There is limited data on the role of serial PET scans in monitoring the disease activity.
This is a prospective study of 27 sarcoidosis patients treated with systemic corticosteroids. Patients underwent two serial PET/CT scans: one before initiating therapy and the follow up scan at end of therapy. The metabolic response on PET scan was classified as: (a) complete metabolic response (CMR); (b) partial metabolic response (PMR); (c) stable metabolic disease (SMD); and, (d) progressive metabolic disease (PMD). Patients with either CMR or PMR were classified as PET responders while those with SMD or PMD were considered as PET non-responders. All patients were followed at 3, 6 and 12 months after completion of therapy. Relapse rates and relapse-free survival was compared between the various groups.
There was significant decline in the median SUVmax of the mediastinal lymph nodes, peripheral lymph nodes and the lung parenchyma in the follow up PET scan. Eight patients achieved CMR, 6 patients achieved PMR while 13 patients were PET non-responders. There was no difference in the clinical remission rates between the responders and non-responders. However, the relapse rate was significantly higher in non-responders vs. responders (61.5% vs. 14.2%, p=0.018). None of the patients who achieved a CMR relapsed during the study period.
Patients with metabolic response on PET scan have significantly fewer relapses as compared to those with no response on PET scan.
背景：由于没有金标准，监测结节病的疾病活动仍然是一项临床挑战。正电子发射断层扫描（PET）成像是评估代谢活性的一种新工具。关于连续PET扫描在监测疾病活动中的作用的数据有限。
这是一项对27例接受全身皮质类固醇治疗的结节病患者的前瞻性研究。患者接受了两次连续的PET/CT扫描：一次在开始治疗前，另一次在治疗结束时进行随访扫描。PET扫描的代谢反应分为：（a）完全代谢反应（CMR）；（b）部分代谢反应（PMR）；（c）稳定代谢疾病（SMD）；以及（d）进行性代谢疾病（PMD）。CMR或PMR的患者被分类为PET反应者，而SMD或PMD的患者被视为PET无反应者。所有患者在治疗完成后3、6和12个月进行随访。比较了不同组之间的复发率和无复发生存率。
在随访PET扫描中，纵隔淋巴结、外周淋巴结和肺实质的中位SUVmax显著下降。8例患者达到CMR，6例患者达到PMR，而13例患者为PET无反应者。反应者和无反应者的临床缓解率没有差异。然而，无反应者的复发率显著高于反应者（61.5%对14.2%，p=0.018）。在研究期间，达到CMR的患者均未复发。
与PET扫描无反应的患者相比，PET扫描有代谢反应的患者复发明显较少。
