Pinar Deniz Pelin, Duru Çetinkaya Pelin, Hanta İsmail, Arslan Merisa Sinem, Güney İsa Burak
Department of Respiratory Disease, Cukurova University Faculty of Medicine, Adana, Turkey.
Department of Nuclear Medicine, Faculty of Medicine, Cukurova University, Adana, Turkey.
Medicine (Baltimore). 2025 Jan 3;104(1):e41119. doi: 10.1097/MD.0000000000041119.
Positron emission tomography/computed tomography (PET/CT) is widely used to differentiate benign and malignant lesions. However, increased fluorodeoxyglucose (FDG) uptake may occur under certain benign conditions, leading to potential false positives in malignancy assessments. Tuberculosis and sarcoidosis are 2 conditions that can exhibit FDG uptake, presenting with both lymph node and extrathoracic involvement, alongside pulmonary manifestations. This study aimed to explore the utility of PET/CT in distinguishing between thoracic and extrathoracic involvement in patients with sarcoidosis and tuberculosis. A retrospective analysis was conducted on patients diagnosed with sarcoidosis or tuberculosis, either pathologically or microbiologically, who underwent 18F-FDG-PET/CT as part of their diagnostic process. This study evaluated demographic data, PET/CT findings, involvement sites, and maximum standardized uptake values (SUVmax) in patients with tuberculosis and sarcoidosis. PET/CT images of 62 patients (44 with tuberculosis and 18 with sarcoidosis) were analyzed. The median patient age was 55 years. Lymph node involvement in the cervical, abdominal, retro-pancreatic, inguinal, and extrathoracic regions was significantly more prevalent in patients with sarcoidosis than in those with tuberculosis (50% vs 20.5%, P = .0031; 27.8% vs 4.5%, P = .018; 22.2% vs 0%, P = .005; 27.8% vs 6.8%, P = .039; and 66.7% vs 27.3%, P = .009, respectively). No statistically significant difference was found in SUV values between patients with tuberculosis and those with sarcoidosis with regard to mediastinal lymph node, extrathoracic lymph node, lung, and bone PET/CT involvement. In conclusion, 18F-FDG-PET/CT imaging does not appear to be a reliable method for differentiating sarcoidosis and tuberculosis from malignant lesions, as it is not feasible to distinguish between sarcoidosis and tuberculosis solely based on 18F-FDG-PET/CT SUVmax values. Nevertheless, the increased prevalence of extrathoracic lymph node involvement in sarcoidosis compared to tuberculosis may offer valuable insights for clinicians in differential diagnosis.
正电子发射断层扫描/计算机断层扫描（PET/CT）被广泛用于鉴别良性和恶性病变。然而，在某些良性情况下可能会出现氟脱氧葡萄糖（FDG）摄取增加，从而导致恶性肿瘤评估中出现潜在的假阳性结果。结核病和结节病是两种可表现出FDG摄取的疾病，除肺部表现外，还伴有淋巴结和胸外受累。本研究旨在探讨PET/CT在区分结节病和结核病患者胸内和胸外受累情况方面的效用。对经病理或微生物学诊断为结节病或结核病且在诊断过程中接受了18F-FDG-PET/CT检查的患者进行了回顾性分析。本研究评估了结核病和结节病患者的人口统计学数据、PET/CT检查结果、受累部位以及最大标准化摄取值（SUVmax）。分析了62例患者（44例结核病患者和18例结节病患者）的PET/CT图像。患者的中位年龄为55岁。结节病患者颈部、腹部、胰后、腹股沟和胸外区域的淋巴结受累情况明显比结核病患者更常见（分别为50%对20.5%，P = 0.0031；27.8%对4.5%，P = 0.018；22.2%对0%，P = 0.005；27.8%对6.8%，P = 0.039；以及66.7%对27.3%，P = 0.009）。在纵隔淋巴结、胸外淋巴结、肺部和骨骼PET/CT受累方面，结核病患者和结节病患者的SUV值未发现有统计学显著差异。总之，18F-FDG-PET/CT成像似乎不是将结节病和结核病与恶性病变区分开来的可靠方法，因为仅根据18F-FDG-PET/CT的SUVmax值来区分结节病和结核病是不可行的。然而，与结核病相比，结节病患者胸外淋巴结受累的发生率增加可能为临床医生的鉴别诊断提供有价值的见解。
