Department of Pulmonary Medicine, Istanbul Cerrahpasa University, Istanbul.
Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul Cerrahpasa University, Istanbul.
Monaldi Arch Chest Dis. 2020 Dec 23;90(4). doi: 10.4081/monaldi.2020.1509.
Sarcoidosis is a chronic granulomatous disease of unknown etiology. The disease most commonly involves the lungs and the mediastinal lymph nodes while extrapulmonary organs such as the skin, eye, liver or spleen may also be comprised. Many imaging modalities have been used for the clinical evaluation of sarcoidosis patients but all have been found to have certain drawbacks for a reliable identification assessment due to the equivocal diagnostic results. This case series was designed to determine the clinical trenchancy of simultaneous 68Ga citrate PET/CT [Positron emission tomography with 68Ga citrate (68Ga citrate PET/CT)] and 18F-FDG PET/CT [Positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT)] imaging in sarcoidosis patients. The main goal of the study was to evaluate sarcoidosis with respect to disease activity and organ involvement. A total of eight sarcoidosis patients with a comorbid disease suspicion were included in the study. Conventional clinical parameters used for the diagnosis and the activity of sarcoidosis including CT [Computed tomography (CT)] were compared with the 68Ga-citrate PET/CT findings. Concurrent 18F-FDG PET/CT was performed to verify the granulomatous inflammation of sarcoidosis and to determine coexisting malignant or other inflammatory diseases. Our study results revealed that 68Ga citrate PET/CT imaging appears to be highly useful for the diagnosis, activity assessment and extrapulmonary organ involvement in sarcoidosis. Another crucial finding was the detection of extrapulmonary organ disease that are exceptionally involved, almost inaccessible by biopsy and that could not be otherwise displayed by other conventional imaging modalities. The third hallmark was the identification of a clinically asymptomatic and occult malignancy accompanying sarcoidosis that would not be revealed in any way if synchronous 18FDG PET/CT had not been performed. Simultaneous application of 68Ga citrate and 18FDG PET/CT may provide extremely useful data for the clinical evaluation of sarcoidosis patients in terms of the primary disease diagnosis, activity state, extrapulmonary organ involvement unachievable for biopsy and the clinically occult malignant disorders.
结节病是一种病因不明的慢性肉芽肿性疾病。这种疾病最常累及肺部和纵隔淋巴结，而肺外器官如皮肤、眼睛、肝脏或脾脏也可能受累。许多影像学方法已被用于结节病患者的临床评估，但由于诊断结果不确定，所有这些方法都被发现对可靠的识别评估存在一定的缺陷。本病例系列旨在确定 68Ga 柠檬酸盐 PET/CT[68Ga 柠檬酸盐正电子发射断层扫描（68Ga 柠檬酸盐 PET/CT）]和 18F-FDG PET/CT[2-脱氧-2-[氟-18]氟-D-葡萄糖与计算机断层扫描（18F-FDG PET/CT）相结合的正电子发射断层扫描]联合成像在结节病患者中的临床准确性。该研究的主要目的是评估结节病的疾病活动度和器官受累情况。本研究共纳入 8 例怀疑合并疾病的结节病患者。比较了用于诊断和评估结节病活动度的常规临床参数、CT[计算机断层扫描（CT）]与 68Ga 柠檬酸盐 PET/CT 结果。同时进行 18F-FDG PET/CT 以验证结节病的肉芽肿性炎症，并确定是否存在共存的恶性肿瘤或其他炎症性疾病。我们的研究结果表明，68Ga 柠檬酸盐 PET/CT 成像对于结节病的诊断、活动评估和肺外器官受累具有高度的应用价值。另一个重要发现是检测到异常受累的肺外器官疾病，这些疾病几乎无法通过活检获得，也无法通过其他常规影像学方法显示。第三个特征是识别出与结节病同时存在的临床无症状和隐匿性恶性肿瘤，如果不进行同步 18FDG PET/CT，则无法以任何方式揭示这些肿瘤。68Ga 柠檬酸盐和 18FDG PET/CT 的同步应用可为结节病患者的临床评估提供极其有用的数据，包括疾病的初步诊断、活动状态、无法进行活检的肺外器官受累以及临床隐匿性恶性疾病。
