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Berntsson SG, Elmgren A, Gudjonsson O, Grabowska A, Landtblom AM, Moraes-Fontes MF. A comprehensive diagnostic approach in suspected neurosarcoidosis. Sci Rep 2023; 13:6539. [PMID: 37085608 PMCID: PMC10121682 DOI: 10.1038/s41598-023-33631-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 04/16/2023] [Indexed: 04/23/2023] Open
Abstract
Neurosarcoidosis presents a diagnostic challenge in clinical settings, as it has no pathognomonic symptoms or signs and a wide range of differential diagnoses. The aim of this report is to present the pathological features of our group of patients, obtained through a systematic diagnostic approach. This retrospective cohort study enrolled all adult patients primarily diagnosed with neurosarcoidosis at the neurology department of a tertiary center in Sweden over a period of 30 years, from 1990 to 2021. We identified 90 patients, 54 with possible neurosarcoidosis and 36 with probable neurosarcoidosis. CNS biopsy revealed an alternative diagnosis for 24 patients, who were then excluded. The collected data from medical records included demographic and clinical characteristics, systemic and/or neurological isolated involvement, various laboratory tests, including cerebrospinal fluid (CSF), serum analysis, imaging studies (MRI, FDG-PET/CT, and HRCT), nerve conduction studies, electromyography, and pathology reports of central nervous system (CNS), and extra-neural tissue biopsies. Sixty-six patients were included in our cohort. The median age at onset of symptoms was 49 years, with a similar sex distribution. Cranial neuropathies (38%), motor deficit (32%), headache (16%), and pituitary dysfunction (12%) were the most common presenting features. CSF studies were abnormal in 77% of the patients, who showed lymphocytosis (57%), elevated protein (44%), oligoclonal bands (40%), elevated ACE (28%), and raised T lymphocyte CD4+/CD8+ ratios (13%). Strikingly, MRI showed that 17% of the patients presented with isolated pituitary gland lesions. FDG-PET/CT was performed in 22 patients (33%) and confirmed systemic sarcoidosis in 11. Despite our extensive workup, the final classification for our patients only allowed for a definite diagnosis in 14 patients; the remainder were classified as probable (32) or possible (20) neurosarcoidosis. Since 2007, the employment of a structured laboratory and imaging approach and the increasing number of CNS biopsies have facilitated and improved the process of correct attribution in patients with presumptive neurosarcoidosis, especially in patients with isolated neurological lesions. We highlight a higher frequency of pituitary lesions due to neurosarcoidosis than has been classically described. A detailed laboratory diagnostic workup is included.
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Affiliation(s)
| | - Andreas Elmgren
- Department of Medical Sciences, Neurology, Uppsala University, 751 85, Uppsala, Sweden
| | - Olafur Gudjonsson
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Anna Grabowska
- Department of Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Anne-Marie Landtblom
- Department of Medical Sciences, Neurology, Uppsala University, 751 85, Uppsala, Sweden
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Sahin Ozdemirel T, Akıncı Özyürek B, Tatci E, Ertan O, Akkurt ES, Senturk A, Ozmen O. Relationships Between Systemic Inflammatory Markers and 18F-FDG PET/CT Imaging and Clinical Findings in Pulmonary Sarcoidosis. Cureus 2023; 15:e36521. [PMID: 37090303 PMCID: PMC10120846 DOI: 10.7759/cureus.36521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/25/2023] Open
Abstract
Background and aim Sarcoidosis is a multisystem inflammatory disease of unknown aetiology. This study aimed to evaluate the relationship between systemic inflammatory parameters, the systemic immune-inflammation index (SII) and the lymphocyte-to-monocyte ratio (LMR), and disease stage, clinical findings, and 18F-fluoro-2-deoxy-D-glucose (18F-FDG) tomography/computed tomography (PET/CT) uptake. Materials and methods Our study included 73 patients. The general characteristics, radiological features, spirometric tests, PET/CT findings, and laboratory parameters of the patients were recorded. Results Relapse and parenchymal fibrosis were not associated with metabolic parameters, such as LMR and SII. Serum angiotensin-converting enzyme (ACE) levels were lower in the relapsed group than in the non-relapse group. However, the patients' PET/CT images indicated that 18F-FDG parenchym maximum standard uptake value (SUV max), lymph node SUV max, lymph node short axis dimension, SII, and LMR were similar between all patients, relapsed or not. Conclusion Although found to be significant in other inflammatory diseases, we found that SII and LMR alone did not indicate disease prognosis in sarcoidosis due to the small number of patients and the lack of homogeneity between the groups in our study. The usefulness of these markers for clinical use should be investigated by studies that include those with extrapulmonary sarcoidosis, and that calculate these markers at the time of disease diagnosis and during the post-treatment period.
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Affiliation(s)
- Tugce Sahin Ozdemirel
- Pulmonary Medicine, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, TUR
| | - Berna Akıncı Özyürek
- Pulmonary Medicine, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, TUR
| | - Ebru Tatci
- Nuclear Medicine, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, TUR
| | - Ozlem Ertan
- Pulmonology, Ankara Ataturk Sanatorium Training and Research Hospital, Ankara, TUR
| | - Esma Sevil Akkurt
- Pulmonology, Ataturk Sanatorium Training and Research Hospital, Ankara, TUR
| | - Aysegul Senturk
- Pulmonology, Ankara Abdurrahman Yurtaslan Oncology Hospital, Ankara, TUR
| | - Ozlem Ozmen
- Nuclear Medicine, Ankara Ataturk Sanatorium Traning and Research Hospital, Ankara, TUR
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3
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Uehara M, Morita H. FDG-PET. Int Heart J 2023; 64:125-127. [PMID: 37005309 DOI: 10.1536/ihj.23-053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Affiliation(s)
- Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Benign lung diseases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00028-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Bhalla AS, Das A, Naranje P, Goyal A, Guleria R, Khilnani GC. Dilemma of diagnosing thoracic sarcoidosis in tuberculosis-endemic regions: An imaging-based approach. Part 2. Indian J Radiol Imaging 2021; 27:380-388. [PMID: 29379231 PMCID: PMC5761163 DOI: 10.4103/ijri.ijri_201_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The second part of the review discusses the role of different existing imaging modalities in the evaluation of thoracic sarcoidosis, including chest radiograph, computed tomography, magnetic resonance imaging, endobronchial ultrasound, and positron emission tomography. While summarizing the advantages and pitfalls of each imaging modality, the authors propose imaging recommendations and an algorithm to be followed in the evaluation of clinically suspected case of sarcoidosis in tuberculosis-endemic regions.
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Affiliation(s)
- Ashu S Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - P Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Gopi C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Garrì F, Rinaldi F, Perini P, Miscioscia A, Simonato D, Pizzi M, Margoni M, Gallo P. Slowly Progressive Optic Perineuritis as the First Clinical Manifestation of Sarcoidosis. J Neuroophthalmol 2021; 41:e39-e41. [PMID: 32141980 DOI: 10.1097/wno.0000000000000924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Federica Garrì
- Neurology Unit (FG, FR, PP, AM, MM, PG), University Hospital of Padova, Padova, Italy ; Neuroradiology Unit (DS), University Hospital of Padova, Padova, Italy ; and General Pathology and Cytopathology Unit (MP), Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
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Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollini M, Versari A, Signore A. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9:299-339. [PMID: 34277510 PMCID: PMC8271312 DOI: 10.1007/s40336-021-00445-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. METHODS In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [18F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. RESULTS Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. CONCLUSIONS Currently, [18F]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00445-w.
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Affiliation(s)
- Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Chiara Lauri
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Corinna Altini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Francesco Bertagna
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Cassarino
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Anna Paola Erba
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Ciro Gabriele Mainolfi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Andrea Palucci
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Napoleone Prandini
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Sergio Baldari
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Bartoli
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mirco Bartolomei
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Adriana D’Antonio
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Francesco Dondi
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Gandolfo
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Alessia Giordano
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Riccardo Laudicella
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Alberto Nieri
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Laura Vendramin
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Domenico Albano
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Burroni
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Alberto Cuocolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Laura Evangelista
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elena Lazzeri
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Natale Quartuccio
- grid.419995.9Nuclear Medicine Unit, A.R.N.A.S. Civico di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Brunella Rossi
- Nuclear Medicine Unit, Department of Services, ASUR MARCHE-AV5, Ascoli Piceno, Italy
| | - Giuseppe Rubini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Martina Sollini
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Alberto Signore
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
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What role does 18F-fluorodeoxyglucose PET-computed tomography have in the current pandemic and beyond? Nucl Med Commun 2020; 42:113-116. [PMID: 33252514 DOI: 10.1097/mnm.0000000000001320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hu MK, Mathur A, Dempsey OJ. Pulmonary Sarcoidosis: A Clinical Update. J R Coll Physicians Edinb 2020; 50:322-329. [DOI: 10.4997/jrcpe.2020.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sarcoidosis remains difficult to diagnose, assess and treat. The last decade has brought significant diagnostic and therapeutic advances in the field of sarcoidosis including endobronchial ultrasound, 18F-fluorodeoxyglucose positron emission tomography and biologics. In this article we use clinical vignettes to discuss commonly encountered cases to illustrate and explain the application of these, and other advances.
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Affiliation(s)
- May Khei Hu
- Academic Foundation Doctor, Department of Respiratory Medicine, Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Abhinav Mathur
- Honorary Research Fellow, School of Medicine & Dentistry, University of Aberdeen, Aberdeen, UK
| | - Owen J Dempsey
- Consultant Respiratory Physician, Department of Respiratory Medicine, Clinic C, Aberdeen Royal Infirmary, Aberdeen, UK
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Vigneswaran S, Gonem R, Ma J, Singh A. Imaging tools in sarcoidosis. Rheumatology (Oxford) 2020; 59:1182-1183. [PMID: 31628480 DOI: 10.1093/rheumatology/kez491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Rania Gonem
- Department of Rheumatology, Royal Free London NHS Foundation Trust, London, UK
| | - Jianfei Ma
- Department of Rheumatology, Royal Free London NHS Foundation Trust, London, UK
| | - Animesh Singh
- Department of Rheumatology, Royal Free London NHS Foundation Trust, London, UK
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Kalshetty A, Basu S. PET/Computed Tomography in Pulmonary and Thoracic Inflammatory Diseases (Including Cardiac Sarcoidosis): The Current Role and Future Promises. PET Clin 2020; 15:163-173. [PMID: 32145887 DOI: 10.1016/j.cpet.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
18F-fluorodeoxyglucose PET/computed tomography (CT) can play a valuable adjunct role in initial and post-treatment assessment of thoracic and pulmonary inflammatory disorders and is particularly helpful when the conventional biomarkers and anatomical imaging are non-contributory or inconclusive. PET/CT can potentially help in chronic obstructive pulmonary disease (COPD). Quantitative regional parameters of inflammation, perfusion, and ventilation estimated by PET/CT have the potential to cause a paradigm shift in the management of COPD. This article highlights the role of PET/CT in thoracic inflammatory disorders, with an overview of newer aspects such as quantification, disease phenotyping, new tracers, and new techniques.
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Affiliation(s)
- Ashwini Kalshetty
- Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Parel, Mumbai 400012, India; Homi Bhabha National Institute, Mumbai 400094, India
| | - Sandip Basu
- Radiation Medicine Centre (BARC), Tata Memorial Hospital Annexe, Parel, Mumbai 400012, India; Homi Bhabha National Institute, Mumbai 400094, India.
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Abstract
Bilateral lung parenchymal involvement is seen in infective as well as noninfective conditions, appearing as focal or diffuse lung disease. PET/CT with FDG helps in characterization (increased glucose utilization is seen by both inflammatory and neoplastic cells). In this article, we describe the spectrum of patterns of FDG uptake and associated CT changes involving bilateral lung parenchyma. Benign conditions described are aspiration pneumonia; pulmonary toxicity by bleomycin; infections, namely, sarcoidosis, miliary pulmonary tuberculosis, and pulmonary nocardiosis; and inflammatory conditions such as pulmonary Langerhans cell histiocytosis and pulmonary alveolar proteinosis. Neoplastic conditions described are bilateral pulmonary metastases and lymphangitic carcinomatosis.
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Tana M, di Carlo S, Romano M, Alessandri M, Schiavone C, Montagnani A. FDG-PET/CT Assessment of Pulmonary Sarcoidosis: A Guide for Internists. Curr Med Imaging 2020; 15:21-25. [PMID: 31964323 DOI: 10.2174/1573405614666180528101755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 09/03/2017] [Accepted: 04/07/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND 18F-fluorodeoxyglucose positron emission tomography integrated with computed tomography (18-F-FDG-PET/CT) is getting wide consensus in the diagnosis and staging of neoplastic disorders and represents a useful tool in the assessment of various inflammatory conditions. DISCUSSION Sarcoidosis is an uncommon disease characterized by the systemic formation of noncaseating granulomas. Lungs are the sites most often affected, and investigation with high resolution computed tomography and biopsy is essential to achieve a correct diagnosis. 18-F-FDGPET/ CT is effective in the assessment of pulmonary sarcoidosis by demonstrating pulmonary and extrathoracic involvement and findings correlate well with pulmonary function in patients affected. CONCLUSION This review would illustrate the usefulness and limits of 18-F-FDG-PET/CT in the assessment of pulmonary sarcoidosis.
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Affiliation(s)
- Marco Tana
- Internal Medicine Unit, USL Sudest Toscana, Grosseto, Italy
| | | | | | | | - Cosima Schiavone
- Department of Internistic Ultrasound, G. D'Annunzio University, Chieti, Italy
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Douglas KAA, Douglas VP, Cestari DM. Relapsing Optic Neuropathy and Multiple Cranial Neuropathies in a Middle-aged Woman. JAMA Ophthalmol 2020; 138:95-96. [DOI: 10.1001/jamaophthalmol.2019.4410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Dean M. Cestari
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Boston
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Carrasquillo JA, Chen CC, Price S, Whatley M, Avila NA, Pittaluga S, Jaffe ES, Rao VK. 18F-FDG PET Imaging Features of Patients With Autoimmune Lymphoproliferative Syndrome. Clin Nucl Med 2019; 44:949-955. [PMID: 31689275 PMCID: PMC8189160 DOI: 10.1097/rlu.0000000000002816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Autoimmune lymphoproliferative syndrome (ALPS) is a rare immune dysregulatory condition, usually presenting in childhood with massive lymphadenopathy, splenomegaly, and an increased incidence of lymphoma. Methods to differentiate between benign ALPS adenopathy and lymphoma are needed. To this end, we evaluated the usefulness of FDG PET. METHODS We prospectively evaluated 76 ALPS/ALPS-like patients including FS-7-associated surface antigen (FAS) germline mutation with (n = 4) and without lymphoma (n = 50), FAS-somatic (n = 6), ALPS-unknown (n = 6), and others (n = 10) who underwent FDG PET. Uptakes in 14 nodal sites, liver, and spleen were determined. RESULTS In 76 ALPS patients, FDG PET showed uptake in multiple nodal sites in all but 1 patient. The highest SUVmax values in FAS mutation without lymphoma, FAS mutation with lymphoma, FAS somatic, ALPS-unknown, and other genetic mutations were a median (range) 9.2 (4.3-25), 16.2 (10.7-37.2), 7.6 (4.6-18.1), 11.5 (4.8-17.2), and 5.5 (0-15.3), respectively. Differences between uptake in the FAS group with and without lymphoma were statistically significant, but overlapped, making discrimination between individuals with/without lymphoma impossible. The spleen:liver uptake ratio was greater than 1 in 82% of patients. CONCLUSIONS While statistically significant differences were observed in FAS mutation ALPS with and without lymphoma, the significant overlap in FDG uptake and visual appearance in many patients prevents discrimination between patients with and without lymphoma. Similar patterns of FDG biodistribution were noted between the various ALPS subgroups.
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Affiliation(s)
- Jorge A. Carrasquillo
- Nuclear Medicine Division, Department of Radiology & Imaging Science, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
- Currently at Memorial Sloan Kettering Cancer Center and Weill Cornell Medical Center, New York, NY
| | - Clara C. Chen
- Nuclear Medicine Division, Department of Radiology & Imaging Science, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - Susan Price
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD
| | - Millie Whatley
- Nuclear Medicine Division, Department of Radiology & Imaging Science, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - Nilo A. Avila
- Department of Radiology &Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD
| | - Stefania Pittaluga
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - Elaine S. Jaffe
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD
| | - V. Koneti Rao
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, Bethesda, MD
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Ben Hassine I, Rein C, Comarmond C, Glanowski C, Saidenberg-Kermanac’h N, Meunier B, Schleinitz N, Chanson N, Sacré K, Scherlinger M, Richez C, Hirschi S, Groh M, Devilliers H, Bielefeld P, Saadoun D, Chapelon-Abric C, Arnaud L, Cacoub P. Osseous sarcoidosis: A multicenter retrospective case-control study of 48 patients. Joint Bone Spine 2019; 86:789-793. [DOI: 10.1016/j.jbspin.2019.07.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
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17
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Shariatmaghani S, Salari R, Sahebari M, Tabrizi PS, Salari M. Musculoskeletal Manifestations of Sarcoidosis: A Review Article. Curr Rheumatol Rev 2019; 15:83-89. [PMID: 29692254 DOI: 10.2174/1573397114666180425111901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/06/2018] [Accepted: 04/12/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sarcoidosis is a multisystem inflammatory disease with an etiology that is not clearly understood. Amongst the different organs that may be affected, the lungs are the most common. Musculoskeletal manifestations of the disease are uncommon. OBJECTIVES They include arthropathy, bone lesions, or myopathy, all of which may occur as initial symptoms or develop during the course of the disease. METHODS Articular involvement my present as arthralgia or arthritis. Skeletal complications usually develop in the chronic state of the disease. Muscular disease is rare and usually asymptomatic. Appropriate imaging modalities including X-ray, MRI, FDG-PET/CT assist in the diagnosis of rheumatic sarcoidosis. However, biopsy is necessary for definite diagnosis. RESULT AND CONCLUSION In most cases of musculoskeletal involvement, NSAIDs and corticosteroids are sufficient for symptomatic management. For more resistant cases immunosuppressive drugs (i.e., methotrexate) and TNF- inhibitors are used. Our aim is to review various types of musculoskeletal involvement in sarcoidosis and their existing treatment options.
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Affiliation(s)
- Somayeh Shariatmaghani
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roshanak Salari
- Department of Clinical Persian Pharmacy, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payman Shalchian Tabrizi
- Department of Internal Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Salari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Rahman WT, Wale DJ, Viglianti BL, Townsend DM, Manganaro MS, Gross MD, Wong KK, Rubello D. The impact of infection and inflammation in oncologic 18F-FDG PET/CT imaging. Biomed Pharmacother 2019; 117:109168. [PMID: 31334700 PMCID: PMC7104808 DOI: 10.1016/j.biopha.2019.109168] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/22/2019] [Accepted: 06/25/2019] [Indexed: 12/30/2022] Open
Abstract
Sites of infection and inflammation can be misleading in oncology PET/CT imaging because these areas commonly show 18F-FDG activity. Caution in the interpretation must be taken to avoid the misdiagnosis of malignancy. Utilization of both CT findings as well as patient history can help differentiate benign infectious and inflammatory processes from malignancy, although occasionally additional work-up may be required. This article discusses the mechanism of 18F-FDG uptake in infection and inflammation with illustrative examples.
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Affiliation(s)
- W Tania Rahman
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Daniel J Wale
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA.
| | - Benjamin L Viglianti
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Danyelle M Townsend
- Division of Drug Discovery and Pharmaceutical Sciences, Medical University of South Carolina, USA
| | - Matthew S Manganaro
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Milton D Gross
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA; Nuclear Medicine Service, Department of Veterans Affairs Health System, Ann Arbor, MI, USA
| | - Ka Kit Wong
- Nuclear Medicine Division, Department of Radiology, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, Neuroradiology, Interventional Radiology, Pathology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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19
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Tana C, Ticinesi A, Ricci F, Tana M, di Carlo S, Meschi T. Extrapulmonary Sarcoidosis: A Chameleon Disease at Imaging. Curr Med Imaging 2019. [DOI: 10.2174/157340561505190619094634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Claudio Tana
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
| | - Andrea Ticinesi
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Institute of Cardiology, Imaging and Clinical Sciences, , Italy
| | - Marco Tana
- Internal Medicine Unit, Urbino Hospital, Urbino, Italy
| | - Silvio di Carlo
- Geriatrics Unit, Hospital of Pescara, AUSL Pescara, Pescara, Italy
| | - Tiziana Meschi
- Medicine Geriatric-Rehabilitation Department, Internal Medicine and Critical Subacute Care Unit, University- Hospital of Parma, Parma, Italy
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20
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Gan Q, Stewart JM, Valik E, Eapen G, Caraway NP. Cytologic Evaluation of Positron Emission Tomography-Computed Tomography-Positive Lymph Nodes Sampled by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: Experience at a Large Cancer Center. Arch Pathol Lab Med 2019; 143:1265-1270. [PMID: 31063012 DOI: 10.5858/arpa.2018-0483-oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is routinely used to evaluate mediastinal lymph nodes (LNs), especially for cancer staging. There are limited large studies evaluating the cytologic, radiologic, and clinical features of 18F-fluorodeoxy glucose positron emission tomography-computed tomography-positive (PET-CT+) LNs. OBJECTIVE.— To compare cytologic, radiologic, and clinical features of PET-CT+, cytology-malignant (PET-CT+/Cyto+) and PET-CT+, cytology-benign (PET-CT+/Cyto-) LNs. DESIGN.— The pathology database was searched for cases of mediastinal LNs obtained by EBUS-TBNA from January 1, 2015 to December 31, 2015. The cytologic, radiologic, and clinical features were collected for all PET-CT+ LNs. RESULTS.— Of 2267 mediastinal LNs obtained by EBUS-TBNA during this period, 577 LNs met the criteria. Of the latter, 263 (46%) were PET-CT+/Cyto+ and 314 (54%) were PET-CT+/Cyto-. All of the patients with PET-CT+/Cyto+ results had a prior or concurrent diagnosis of malignancy as compared to 89% of patients with PET-CT+/Cyto- results. Of the 224 patients with PET-CT+/Cyto+ LNs, 177 (79%) had metastases from lung primary, 43 (19%) had metastases from nonlung primaries, and 7 (3%) had lymphoma. Average LN size was larger in the PET-CT+/Cyto+ group than in the PET-CT+/Cyto- group (14.6 mm versus 9.58 mm), and mean standardized uptake value in PET-CT+/Cyto+ LNs was higher than that of PET-CT+/Cyto- LNs (10.05 versus 5.99). Significant cytologic findings in PET-CT+/Cyto- cases were necrosis and granulomatous inflammation, including 3 cases with fungal organisms. CONCLUSIONS.— PET-CT positivity alone was nonspecific for malignancy and insufficient to guide management of patients with mediastinal adenopathy, but specificity could be improved when combined with LN size and standardized uptake value.
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Affiliation(s)
- Qiong Gan
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| | - John M Stewart
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| | - Erik Valik
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| | - George Eapen
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
| | - Nancy P Caraway
- From the Section of Cytopathology, Department of Pathology (Drs Gan, Stewart, and Caraway) and Department of Pulmonology (Drs Valik and Eapen), The University of Texas MD Anderson Cancer Center, Houston
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21
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Talreja J, Talwar H, Bauerfeld C, Grossman LI, Zhang K, Tranchida P, Samavati L. HIF-1α regulates IL-1β and IL-17 in sarcoidosis. eLife 2019; 8:44519. [PMID: 30946009 PMCID: PMC6506207 DOI: 10.7554/elife.44519] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/03/2019] [Indexed: 12/12/2022] Open
Abstract
Sarcoidosis is a complex systemic granulomatous disease of unknown etiology characterized by the presence of activated macrophages and Th1/Th17 effector cells. Data mining of our RNA-Seq analysis of CD14+monocytes showed enrichment for metabolic and hypoxia inducible factor (HIF) pathways in sarcoidosis. Further investigation revealed that sarcoidosis macrophages and monocytes exhibit higher protein levels for HIF-α isoforms, HIF-1β, and their transcriptional co-activator p300 as well as glucose transporter 1 (Glut1). In situ hybridization of sarcoidosis granulomatous lung tissues showed abundance of HIF-1α in the center of granulomas. The abundance of HIF isoforms was mechanistically linked to elevated IL-1β and IL-17 since targeted down regulation of HIF-1α via short interfering RNA or a HIF-1α inhibitor decreased their production. Pharmacological intervention using chloroquine, a lysosomal inhibitor, decreased lysosomal associated protein 2 (LAMP2) and HIF-1α levels and modified cytokine production. These data suggest that increased activity of HIF-α isoforms regulate Th1/Th17 mediated inflammation in sarcoidosis. Sarcoidosis is a rare disease that is characterized by the formation of small lumps known as granulomas inside the body. These lumps are made up of clusters of immune cells, and are commonly found in the skin, lung or eye. Other organs of the body can also be affected, and symptoms will vary depending on where in the body lumps form. There is currently no specific treatment for sarcoidosis, as the direct cause of the disease is unknown. The disease is often treated with drugs that suppress the immune system. However, this type of treatment can lead to significant side effects and patients will respond to these drugs in different ways. Patients with sarcoidosis have a heightened immune response to microbes that can cause infections, and rather than providing protection, this heightened response causes damage and inflammation to the body’s organs. Now, Talreja et al. have identified which genes and proteins control this inflammatory response in immune cells from the lungs and blood of sarcoidosis patients. Immune cells in the lungs of sarcoidosis patients were found to have higher levels of hypoxia inducible factor (HIF) – a gene-regulating protein that controls the uptake and metabolism of oxygen in mammals. In addition, lung tissue affected with granulomas also expressed increased levels of a specific version of HIF known as HIF-1. Talreja et al. showed that the increased expression of HIF in the immune cells of sarcoidosis patients was mechanistically linked to the production of several molecules that promote inflammation. Inhibiting HIF-1 led to a decrease in the production of these inflammatory molecules, indicating that increased activity of HIF-1 causes inflammation in sarcoidosis patients. It remains unclear what causes this abundance of HIF-1α. It is possible that specific modifications of this factor prevent it from degrading, resulting in higher levels. By identifying a link between HIF-1 and inflammation, these findings open up potential new avenues of the treatment for sarcoidosis patients.
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Affiliation(s)
- Jaya Talreja
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
| | - Harvinder Talwar
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
| | - Christian Bauerfeld
- Department of Pediatrics, Division of Critical Care, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
| | - Lawrence I Grossman
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, United States
| | - Kezhong Zhang
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, United States
| | - Paul Tranchida
- Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
| | - Lobelia Samavati
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
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22
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Talreja J, Talwar H, Bauerfeld C, Grossman LI, Zhang K, Tranchida P, Samavati L. HIF-1α regulates IL-1β and IL-17 in sarcoidosis. eLife 2019; 8. [PMID: 30946009 DOI: 10.7554/elife.44519.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/03/2019] [Indexed: 05/18/2023] Open
Abstract
Sarcoidosis is a complex systemic granulomatous disease of unknown etiology characterized by the presence of activated macrophages and Th1/Th17 effector cells. Data mining of our RNA-Seq analysis of CD14+monocytes showed enrichment for metabolic and hypoxia inducible factor (HIF) pathways in sarcoidosis. Further investigation revealed that sarcoidosis macrophages and monocytes exhibit higher protein levels for HIF-α isoforms, HIF-1β, and their transcriptional co-activator p300 as well as glucose transporter 1 (Glut1). In situ hybridization of sarcoidosis granulomatous lung tissues showed abundance of HIF-1α in the center of granulomas. The abundance of HIF isoforms was mechanistically linked to elevated IL-1β and IL-17 since targeted down regulation of HIF-1α via short interfering RNA or a HIF-1α inhibitor decreased their production. Pharmacological intervention using chloroquine, a lysosomal inhibitor, decreased lysosomal associated protein 2 (LAMP2) and HIF-1α levels and modified cytokine production. These data suggest that increased activity of HIF-α isoforms regulate Th1/Th17 mediated inflammation in sarcoidosis.
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Affiliation(s)
- Jaya Talreja
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
| | - Harvinder Talwar
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
| | - Christian Bauerfeld
- Department of Pediatrics, Division of Critical Care, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
| | - Lawrence I Grossman
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, United States
| | - Kezhong Zhang
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, United States
| | - Paul Tranchida
- Department of Pathology, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
| | - Lobelia Samavati
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine and Detroit Medical Center, Detroit, United States
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23
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Kobayashi M. Asymptomatic tiny subcutaneous eruptions in a patient with sarcoid neuropathy: the effectiveness of fluorine-18 fluorodeoxyglucose positron emission tomography for targeting safe biopsy sites. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:325-328. [PMID: 32476969 DOI: 10.36141/svdld.v36i4.8436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/19/2019] [Indexed: 11/02/2022]
Affiliation(s)
- Makoto Kobayashi
- Department of Neurology, Asahi General Hospital, Asahi, Chiba, Japan
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24
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Wang Y, Andrews J, Jenkins Colon P, Wundes A. FDG-PET abnormalities leading to the diagnosis of an unusual case of probable neurosarcoidosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e506. [PMID: 30345332 PMCID: PMC6192693 DOI: 10.1212/nxi.0000000000000506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/15/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Yujie Wang
- Department of Neurology (Y.W., A.W.), University of Washington; Division of Rheumatology (J.A.), Department of Internal Medicine, University of Washington; and Department of Pathology (P.J.C.), University of Washington, Seattle
| | - James Andrews
- Department of Neurology (Y.W., A.W.), University of Washington; Division of Rheumatology (J.A.), Department of Internal Medicine, University of Washington; and Department of Pathology (P.J.C.), University of Washington, Seattle
| | - Paula Jenkins Colon
- Department of Neurology (Y.W., A.W.), University of Washington; Division of Rheumatology (J.A.), Department of Internal Medicine, University of Washington; and Department of Pathology (P.J.C.), University of Washington, Seattle
| | - Annette Wundes
- Department of Neurology (Y.W., A.W.), University of Washington; Division of Rheumatology (J.A.), Department of Internal Medicine, University of Washington; and Department of Pathology (P.J.C.), University of Washington, Seattle
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25
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Makis W, Palayew M, Rush C, Probst S. Disseminated Multi-system Sarcoidosis Mimicking Metastases on 18F-FDG PET/CT. Mol Imaging Radionucl Ther 2018; 27:91-95. [PMID: 29889033 PMCID: PMC5996599 DOI: 10.4274/mirt.29200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/26/2017] [Indexed: 12/01/2022] Open
Abstract
A 60-year-old female with no significant medical history presented with hematuria. A computed tomography (CT) scan revealed extensive lymphadenopathy with hypodensities in the liver and spleen, and she was referred for an 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) study to assess for malignancy of unknown primary. PET/CT revealed extensive 18F-FDG avid lymphadenopathy as well as innumerable intensely 18F-FDG avid lung, liver and splenic nodules, highly concerning for malignancy. A PET-guided bone marrow biopsy of the posterior superior iliac spine revealed several non-necrotizing, well-formed granulomas, consistent with sarcoidosis. The patient was managed conservatively and remained clinically well over the subsequent 9 years of follow-up.
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Affiliation(s)
- William Makis
- Cross Cancer Institute, Department of Diagnostic Imaging, Edmonton, Canada
| | - Mark Palayew
- Jewish General Hospital, Department of Nuclear Medicine, Montreal, Canada
| | - Christopher Rush
- Jewish General Hospital, Department of Nuclear Medicine, Montreal, Canada
| | - Stephan Probst
- Jewish General Hospital, Department of Nuclear Medicine, Montreal, Canada
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26
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27
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Diagnostic value of quantitative assessment of cardiac 18F-fluoro-2-deoxyglucose uptake in suspected cardiac sarcoidosis. Ann Nucl Med 2018; 32:319-327. [DOI: 10.1007/s12149-018-1250-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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28
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Krumm P, Mangold S, Gatidis S, Nikolaou K, Nensa F, Bamberg F, la Fougère C. Clinical use of cardiac PET/MRI: current state-of-the-art and potential future applications. Jpn J Radiol 2018. [PMID: 29524169 DOI: 10.1007/s11604-018-0727-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Combined PET/MRI is a novel imaging method integrating the advances of functional and morphological MR imaging with PET applications that include assessment of myocardial viability, perfusion, metabolism of inflammatory tissue and tumors, as well as amyloid deposition imaging. As such, PET/MRI is a promising tool to detect and characterize ischemic and non-ischemic cardiomyopathies. To date, the greatest benefit may be expected for diagnostic evaluation of systemic diseases and cardiac masses that remain unclear in cardiac MRI, as well as for clinical and scientific studies in the setting of ischemic cardiomyopathies. Diagnosis and therapeutic monitoring of cardiac sarcoidosis has the potential of a possible 'killer-application' for combined cardiac PET/MRI. In this article, we review the current evidence and discuss current and potential future applications of cardiac PET/MRI.
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Affiliation(s)
- Patrick Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Stefanie Mangold
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Sergios Gatidis
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Felix Nensa
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Fabian Bamberg
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Christian la Fougère
- Department of Radiology, Nuclear Medicine and Clinical Molecular Imaging, University of Tübingen, Tübingen, Germany
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29
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Parisi MT, Otjen JP, Stanescu AL, Shulkin BL. Radionuclide Imaging of Infection and Inflammation in Children: a Review. Semin Nucl Med 2017; 48:148-165. [PMID: 29452618 DOI: 10.1053/j.semnuclmed.2017.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With the exception of radiolabeled monoclonal antibodies, antibody fragments and radiolabeled peptides which have seen little application in the pediatric population, the nuclear medicine imaging procedures used in the evaluation of infection and inflammation are the same for both adults and children. These procedures include (1) either a two- or a three-phase bone scan using technetium-99m methylene diphosphonate; (2) Gallium 67-citrate; (3) in vitro radiolabeled white blood cell imaging (using 111Indium-oxine or 99mTechnetium hexamethyl-propylene-amine-oxime-labeled white blood cells); and (4) hybrid imaging with 18F-FDG. But children are not just small adults. Not only are the disease processes encountered in children different from those in adults, but there are developmental variants that can mimic, but should not be confused with, pathology. This article discusses some of the differences between adults and children with osteomyelitis, illustrates several of the common developmental variants that can mimic disease, and, finally, focuses on the increasing use of 18F-FDG PET/CT in the diagnosis and response monitoring of children with infectious and inflammatory processes. The value of and need for pediatric specific imaging protocols are reviewed.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA.; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA..
| | - Jeffrey P Otjen
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - A Luana Stanescu
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
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Norikane T, Yamamoto Y, Maeda Y, Noma T, Dobashi H, Nishiyama Y. Comparative evaluation of 18F-FLT and 18F-FDG for detecting cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis. EJNMMI Res 2017; 7:69. [PMID: 28853043 PMCID: PMC5574834 DOI: 10.1186/s13550-017-0321-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/18/2017] [Indexed: 01/02/2023] Open
Abstract
Background 18F-FDG PET has been used in sarcoidosis for diagnosis and determination of the extent of the disease. However, assessing inflammatory lesions in cardiac sarcoidosis using 18F-FDG can be challenging because it accumulates physiologically in normal myocardium. Another radiotracer, 3′-deoxy-3′-18F-fluorothymidine (18F-FLT), has been investigated as a promising PET tracer for evaluating tumor proliferative activity. In contrast to 18F-FDG, 18F-FLT uptake in the normal myocardium is low. The purpose of this retrospective study was to compare the uptake of 18F-FLT and 18F-FDG in the evaluation of cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis. Data for 20 patients with newly diagnosed sarcoidosis were examined. 18F-FLT and 18F-FDG PET/CT studies had been performed at 1 h after each radiotracer injection. The patients had fasted for at least 18 h before 18F-FDG PET/CT but were given no special dietary instructions regarding the period before 18F-FLT PET/CT. Uptake of 18F-FLT and 18F-FDG was examined visually and semiquantitatively using maximal standardized uptake value (SUVmax). Results Two patients had cardiac sarcoidosis, 7 had extra-cardiac thoracic sarcoidosis, and 11 had both cardiac and extra-cardiac thoracic sarcoidosis. On visual analysis for diagnosis of cardiac sarcoidosis, 4/20 18F-FDG scans were rated as inconclusive because the 18F-FDG pattern was diffuse, whereas no FLT scans were rated as inconclusive. The sensitivity of 18F-FDG PET/CT for detection of cardiac sarcoidosis was 85%; specificity, 100%; and accuracy, 90%. The corresponding values for 18F-FLT PET/CT were 92, 100, and 95%, respectively. Using semiquantitative analysis of cardiac sarcoidosis, the mean 18F-FDG SUVmax was significantly higher than the mean 18F-FLT SUVmax (P < 0.005). Both 18F-FDG and 18F-FLT PET/CT studies detected all 24 extra-cardiac lesions. Using semiquantitative analysis of extra-cardiac sarcoidosis, the mean 18F-FDG SUVmax was significantly higher than the mean 18F-FLT SUVmax (P < 0.001). Conclusions The results of this preliminary study suggest that 18F-FLT PET/CT can detect cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis as well as 18F-FDG PET/CT, although uptake of 18F-FLT in lesions was significantly lower than that of 18F-FDG. However, 18F-FLT PET/CT may be easier to perform since it requires neither prolonged fasting nor a special diet prior to imaging.
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Affiliation(s)
- Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yukito Maeda
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takahisa Noma
- Division of Cardiorenal and Cerebrovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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The "cluster of black pearls" sign of sarcoid lymphadenopathy: a new sign on thin-section contrast-enhanced multidetector CT. Clin Radiol 2017; 72:729-736. [PMID: 28655404 DOI: 10.1016/j.crad.2017.03.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/24/2022]
Abstract
AIM To identify a specific diagnostic sign for sarcoid adenopathy on contrast-enhanced multidetector computed tomography (MDCT) based on nodal morphology. MATERIALS AND METHODS A prospective study was performed on 105 patients with 1654 nodes. Of this, 18 patients with sarcoidosis formed the study group. The control group consisted of the remaining 87 patients with other proven disease entities of metastatic adenocarcinoma, lymphoma, tuberculosis, and reactive adenopathy for comparison. CT examinations were undertaken using a 64-section helical mode in the arterial and venous phases with a 0.5-mm section thickness. The lymph nodes were evaluated for various morphological criteria and the presence of the "cluster of black pearls" (CBP) sign. The CBP sign was considered present when tiny round nodules each measuring 1-2 mm were seen distributed uniformly within the whole or part of the lymph node. RESULTS The CBP sign had a significance of p<0.001, 83% sensitivity, 98% specificity, 91% positive predictive value, and 96% negative predictive value on a per node basis and a sensitivity of 100% on a per patient basis. CONCLUSION The CBP sign is an accurate morphological sign differentiating sarcoid from other adenopathy.
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Bhattarai A, Nakajima T, Sapkota S, Arisaka Y, Tokue A, Yonemoto Y, Tsushima Y. Diagnostic value of 18F-fluorodeoxyglucose uptake parameters to differentiate rheumatoid arthritis from other types of arthritis. Medicine (Baltimore) 2017; 96:e7130. [PMID: 28640086 PMCID: PMC5484194 DOI: 10.1097/md.0000000000007130] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 12/23/2022] Open
Abstract
We aimed evaluate F-fluorodeoxyglucose uptake at major joints for differentiating patients with rheumatoid arthritis (RA) from those with non-RA arthritis using F-fluorodeoxyglucose (FDG)-positron emission tomography (PET).Eighteen patients with RA (13 women; age, 66.8 ± 13.2 years) and 17 patients with non-RA (6 women; age, 50.8 ± 12.5 years) were included. Twelve joints of each patient were examined: shoulder, elbow, wrist, hip, knee, and ankle on both sides. A visual scoring (VS) system was used; quantitative parameters such as maximum standardized uptake value (SUVmax), metabolic active volume (MAV), and total lesion glycolysis (TLG) were evaluated. Total score and value of each parameter were compared between the RA and non-RA groups.Total VS score (mean, 37.7 ± 9.0 vs 21.9 ± 7.2; P < .0001) and SUVmax (mean, 28.1 ± 8.5 vs 17.9 ± 5.8; P < .001) were significantly higher in the RA group than in the non-RA group. A significant between-group difference was also observed with respect to total MAV (608.3 ± 370.7 vs 176.5 ± 217.8; P < .001) and total TLG (1139.3 ± 759.1 vs 289.5 ± 395.4; P < .001). Receiver operating characteristic curve analysis revealed that total VS had the highest area under curve (.92), with sensitivity and specificity of 88.9% and 76.4%, respectively.Quantitative PET parameters could differentiate RA from non-RA. Total VS score, however, appears to be the best convenient qualitative tool for diagnosing RA.
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Affiliation(s)
- Anu Bhattarai
- Department of Diagnostic Radiology and Nuclear Medicine
| | | | | | | | - Azusa Tokue
- Department of Diagnostic Radiology and Nuclear Medicine
| | - Yukio Yonemoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine
- Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Gunma, Japan
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Manoushagian SJ, Lakhter V, Patil PV. Multimodality imaging in the diagnosis and management of cardiac sarcoidosis. J Nucl Cardiol 2017; 24:29-33. [PMID: 27837455 DOI: 10.1007/s12350-016-0721-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Shant J Manoushagian
- Department of Medicine, Section of Cardiology, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Vladimir Lakhter
- Department of Medicine, Section of Cardiology, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA
| | - Pravin V Patil
- Department of Medicine, Section of Cardiology, Lewis Katz School of Medicine at Temple University, 9th Floor Parkinson Pavilion, 3401 N. Broad Street, Philadelphia, PA, 19140, USA.
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USO DE FDG‐PET COMO INSTRUMENTO PARA IDENTIFICAÇÃO PRECOCE DE PROCESSO INFLAMATÓRIO EM LINFONODOS MEDIASTINAIS EM UM PACIENTE COM SARCOIDOSE: RELATO DE CASO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kemal CT, Aylin OA, Volkan K, Seda M, Recep B, Can S. The importance of PET/CT findings and hematological parameters in prediction of progression in sarcoidosis cases. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2017; 34:242-250. [PMID: 32476852 PMCID: PMC7170101 DOI: 10.36141/svdld.v34i3.5299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 01/23/2017] [Indexed: 12/02/2022]
Abstract
Aim: We aimed to reveal the correlation of NLR rate, RDW and MPV values and with the findings of PET/CT regarding the prediction of disease progression and the clinical characteristics. Materials and methods: The treatment naive sarcoidosis cases, of whose PET/CT have been taken due to mediastinal lymphadenopathy of whose diagnosis have been confirmed by biopsy, were included in the study. Hematological parameters, clinical, radiological and PET/CT findings are evaluated. Results: 40 sarcoidosis and 40 healthy control cases were included in the study. NLR, RDW, MPV and the sedimentation values in the sarcoidosis group were determined statistically significantly higher. In patients having parenchymal involvement in PET/CT, the values of FVC%, DLCO, DLCO%, DLCO/VA and DLCO/VA% were determined significantly lower. High NLR and PET/CT LAP SUVmax values and low DLCO% values are statistically significantly correlated with one-year disease progression. For predicting the progression, for the NLR cut-off value 3.20, the area under the curve was determined as 0.79 (CI 62.2-96.5), sensitivity as 80.0%, specificity as 76.7% and for the PET/CT SUVmax cut-off value 9.5, the area under the curve was determined as 0.71 (CI 46.6-95.9), sensitivity as 70.0%, specificity as 82.1%. Conclusion: We determined that the values observed in routine hematologic examinations such as NLR, RDW and MPV, were high in sarcoidosis cases. In addition, the values of NLR, DLCO% and PET/CT SUVmax might be used in predicting the progression. At the same, once again we showed that the lung parenchyma involvement in PET/CT correlates with many pulmonary function parameters. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 242-250)
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Affiliation(s)
- Can Tertemiz Kemal
- Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | | | - Karacam Volkan
- Thoracic Surgery, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Mersin Seda
- Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Bekis Recep
- Nuclear Medicine, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Sevinc Can
- Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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Sarcoidosis in the Head and Neck: An Illustrative Review of Clinical Presentations and Imaging Findings. AJR Am J Roentgenol 2017; 208:66-75. [DOI: 10.2214/ajr.16.16058] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Correlation of spleen metabolism assessed by 18F-FDG PET with serum interleukin-2 receptor levels and other biomarkers in patients with untreated sarcoidosis. Nucl Med Commun 2016; 37:273-7. [PMID: 26544095 DOI: 10.1097/mnm.0000000000000431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of our study was to assess the possible relationship between splenic F-18-fluorodeoxyglucose (18F-FDG) uptake and other established biochemical markers of sarcoidosis activity. PATIENTS AND METHODS Thirty treatment-naive sarcoidosis patients were prospectively enrolled in this study. They underwent biochemical laboratory tests, including serum interleukin-2 receptor (sIL-2R), serum C-reactive protein, serum angiotensin-I converting enzyme, and 24-h urine calcium levels, and a whole-body combined 18F-FDG PET/computed tomography (PET/CT) scan as a part of an ongoing study at our institute. These biomarkers were statistically compared in these patients. RESULTS A statistically significant linear dependence was detected between sIL-2R and log-transformed spleen-average standard uptake value (SUV avg) (R2=0.488, P<0.0001) and log-transformed spleen-maximum standard uptake value (SUV max) (R2=0.490, P<0.0001). sIL-2R levels and splenic size correlated linearly (Pearson's r=0.373, P=0.042). Multivariate linear regression analysis revealed that this correlation remained significant after age and sex adjustment (β=0.001, SE=0.001, P=0.024). No statistically significant associations were detected between (a) any two serum biomarkers or (b) between spleen-SUV measurements and any serum biomarker other than sIL-2R. CONCLUSION Our analysis revealed an association between sIL-2R levels and spleen 18F-FDG uptake and size, whereas all other serum biomarkers were not significantly associated with each other or with PET 18F-FDG uptake. Our results suggest that splenic inflammation may be related to the systemic inflammatory response in sarcoidosis that may be associated with elevated sIL-2R levels.
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Febrile syndrome of unknown origin: Indications for 18F-FDG PET/CT in inflammatory and infectious processes. RADIOLOGIA 2016; 59:253-263. [PMID: 27671947 DOI: 10.1016/j.rx.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/09/2016] [Accepted: 07/19/2016] [Indexed: 12/17/2022]
Abstract
Fever of unknown origin is defined as a body temperature greater than 38.3°C lasting more than three weeks for which the cause could not be found within one week of hospital admission. More than 200 causes have been reported, and these can be classified into four categories: infections, inflammatory diseases, oncologic processes, and miscellaneous conditions. Noninvasive diagnostic techniques are used in 69.2% of cases and invasive techniques in 30.8%. Structural imaging techniques show the morphological changes from infectious, inflammatory, and tumor-related processes, but they do not allow the detection of the early changes brought about by these processes. The metabolic information provided by 18F-FDG PET/CT has a promising role in these patients. 18F-FDG uptake is based on the cells' use of glucose as a source of energy, so it can be observed in infectious, inflammatory, and tumor-related processes. The established non-oncologic indications for 18F-FDG PET/CT are sarcoidosis, osteomyelitis, spondylodiscitis, fever of unknown origin, and vasculitis, which together account for more than 85% of studies.
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T wave amplitude in lead aVR as a novel diagnostic marker for cardiac sarcoidosis. Heart Vessels 2016; 32:352-358. [DOI: 10.1007/s00380-016-0881-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
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40
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Guidry C, Fricke RG, Ram R, Pandey T, Jambhekar K. Imaging of Sarcoidosis. Radiol Clin North Am 2016; 54:519-34. [DOI: 10.1016/j.rcl.2015.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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41
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Polte CL, Burck I, Gjertsson P, Lomsky M, Nekolla SG, Nagel E. Cardiac Positron Emission Tomography: a Clinical Perspective. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016. [DOI: 10.1007/s12410-016-9371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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42
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Bengel FM. Radionuclide imaging. IMAGING 2016. [DOI: 10.1183/2312508x.10002215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Sarcoidosis is a systemic, inflammatory, granulomatous disease of unknown origin that can involve any organ. More than 90% of patients have thoracic sarcoidosis, which most frequently presents with bilateral hilar lymphadenopathy. In approximately 20% of patients with thoracic sarcoidosis there is involvement of the lung parenchyma as well as mostly asymptomatic cardiac sarcoidosis in up to 55% of patients. Most patients are asymptomatic and the diagnosis is an incidental finding on chest X-ray or during clarification of unspecific symptoms, such as fatigue or cough. In approximately two thirds of patients the disease undergoes spontaneous remission and in one third the disease follows a chronic or even progressive course. Furthermore, sarcoidosis can also be manifested in the abdominal organs, the central nervous system (CNS) and the musculoskeletal system. These manifestations are frequently subclinical and require targeted diagnostics when sarcoidosis is clinically suspected.
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Affiliation(s)
- H Prosch
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Allgemeines Krankenhaus Wien, Währingergürtel 18-22, 1090, Wien, Österreich.
| | | | - C Loewe
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Allgemeines Krankenhaus Wien, Währingergürtel 18-22, 1090, Wien, Österreich
| | - D Beitzke
- Univ. Klinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Allgemeines Krankenhaus Wien, Währingergürtel 18-22, 1090, Wien, Österreich
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Aptel S, Lecocq-Teixeira S, Olivier P, Regent D, Gondim Teixeira P, Blum A. Multimodality evaluation of musculoskeletal sarcoidosis: Imaging findings and literature review. Diagn Interv Imaging 2016; 97:5-18. [DOI: 10.1016/j.diii.2014.11.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 10/23/2014] [Accepted: 11/06/2014] [Indexed: 10/23/2022]
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Abstract
We herein describe a second Japanese case of sarcoidosis presenting Addison's disease. A 52-year-old man was diagnosed with sarcoidosis based on clinical and laboratory findings, including bilateral hilar lymphadenopathy and elevated levels of serum angiotensin-converting enzyme and lysozyme, as well as the presence of noncaseating epithelioid granulomas. The patient also exhibited general fatigue, pigmentation, weight loss, hypotension and hyponatremia, suggestive of chronic adrenocortical insufficiency. An endocrine examination confirmed primary adrenocortical insufficiency. This case suggests the direct involvement of sarcoid granuloma in the adrenal glands.
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Affiliation(s)
- Kentaro Takahashi
- Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Japan
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46
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Malignant disease as an incidental finding at ¹⁸F-FDG-PET/CT scanning in patients with granulomatous lung disease. Nucl Med Commun 2015; 36:430-7. [PMID: 25646704 DOI: 10.1097/mnm.0000000000000274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Fluorine-18 fluorodeoxyglucose (¹⁸F-FDG)-PET/computed tomography (CT) is used for assessment of the extent and activity of disease in patients with inflammatory granulomatous lung disease, in particular sarcoidosis and tuberculosis. The aim of this retrospective analysis was to assess the value of ¹⁸F-FDG-PET/CT in the identification of previously unknown malignant disease during routine investigation of granulomatous lung disease. MATERIALS AND METHODS From July 2008 to December 2013, a total of 122 patients with tuberculosis (76 male and 46 female patients; age range 19.6-88.6 years, mean 52.8±16.6 years) and 85 patients with sarcoidosis (46 male and 39 female patients; age range 17.8-76.5 years, mean 48.6±13.8 years) underwent ¹⁸F-FDG-PET/CT. Reports were generated in consensus by both a nuclear medicine physician and a radiologist. Possibly malignant findings underwent biopsies and/or follow-up. Quantitative parameters (maximum standardized uptake value) were pooled and compared from reference lesions in each group. RESULTS Malignant disease was suspected in 18 of 122 tuberculosis patients and in eight of 85 sarcoidosis patients. Malignancy was finally confirmed in six patients with tuberculosis and in two patients with sarcoidosis. In one single case a malignant lung tumour had been overlooked on PET/CT. Patients were also analysed according to their age. In the patient group older than 60 years, four malignancies were confirmed in 44 tuberculosis patients and in one in 20 sarcoidosis patients, whereas in patients aged between 30 and 60 years only three of 63 tuberculosis and one of 58 sarcoidosis cases showed malignancy compared with the 18 false-positive findings on a total patient basis. The most common site of malignant disease was the chest. Besides the intrathoracic findings, two cases of malignancy were detected outside the thorax. Quantitative evaluation did not reveal any statistically significant difference between the tuberculosis and sarcoidosis groups. CONCLUSION Differentiation between granulomatous inflammation and malignancy is challenging with ¹⁸F-FDG-PET/CT because of a large number of false-positive findings. The highest probability of detecting coexistent malignant disease was seen in patients older than 60 years who were suffering from tuberculosis. An important feature for identification of malignant disease, especially in the assessment of intrathoracic findings, has turned out to be the CT pattern; quantitative evaluation, in contrast, seems to have little clinical value.
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Simonen P, Lehtonen J, Kandolin R, Schildt J, Marjasuo S, Miettinen H, Airaksinen J, Vihinen T, Tuohinen S, Haataja P, Kupari M. F-18-fluorodeoxyglucose positron emission tomography-guided sampling of mediastinal lymph nodes in the diagnosis of cardiac sarcoidosis. Am J Cardiol 2015; 116:1581-5. [PMID: 26411357 DOI: 10.1016/j.amjcard.2015.08.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/29/2022]
Abstract
Histologic proof of granulomatous inflammation is prerequisite for the diagnosis of cardiac sarcoidosis (CS). Because of the limited sensitivity of endomyocardial biopsy (EMB), confirmation of sarcoidosis often has to be acquired from extracardiac biopsies. We set out to review our experience of F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG PET) in guiding extracardiac tissue biopsies in suspected CS. We included in this work 68 consecutive patients with proved CS who had undergone cardiac F-18-FDG PET with (n = 57) or without whole-body imaging as part of initial diagnostic evaluation. Their hospital charts, imaging studies, and diagnostic biopsies were reviewed in retrospect. Whole-body PET images showed extracardiac foci of abnormally high F-18-FDG uptake in 39 of 57 patients, of whom 38 had involvement of mediastinal lymph nodes (MLN). Parallel F-18-FDG uptake was found in other lymph nodes (n = 10), lungs (n = 9), liver (n = 3), spleen (n = 2), and thyroid gland (n = 1). Adding the mediastinal findings at cardiac PET without whole-body imaging, abnormal F-18-FDG uptake in MLN was found in totally 43 of the 68 patients with CS (63%). Histology of systemic sarcoidosis was known at presentation of cardiac symptoms in 8 patients. Of the 60 patients with missing histology, 24 patients underwent mediastinoscopy for sampling of PET-positive MLN, most often (n = 20) after nondiagnostic EMB; microscopy revealed diagnostic noncaseating granulomatous inflammation in 24 of the 24 cases (sensitivity 100%). In the remaining 36 patients, sarcoidosis histology was confirmed by EMB (n = 30), by biopsy of lungs (n = 2) or peripheral lymph nodes (n = 2), or at autopsy (n = 1) or post-transplantation (n = 1). In conclusion, MLN accumulate F-18-FDG at PET in most patients with CS and provide a highly productive source for diagnostic biopsies either primarily or subsequent to nondiagnostic EMB.
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Affiliation(s)
- Piia Simonen
- Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
| | - Jukka Lehtonen
- Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Riina Kandolin
- Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Jukka Schildt
- Department of Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Suvi Marjasuo
- Department of Nuclear Medicine, HUS Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | - Suvi Tuohinen
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Petri Haataja
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Markku Kupari
- Division of Cardiology, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
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Kosaka N, Tsuchida T, Tsuji K, Shimizu K, Kimura H. Standardized uptake value differences between primary and metastatic lesions in ¹⁸F-FDG PET/CT of patients with lung cancer. Acta Radiol 2015; 56:1329-35. [PMID: 25398775 DOI: 10.1177/0284185114556705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/25/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND FDG-PET/CT is a robust tool for staging of lung cancer, but the differences in FDG uptake between primary and metastatic lesions have not yet been well described. PURPOSE To define the potential range of standardized uptake value (SUV) differences between primary and metastatic lesions in lung cancer patients and to identify the factors responsible for these differences. MATERIAL AND METHODS FDG-PET/CT images of 75 lung cancers with 296 metastases were analyzed retrospectively. Histological types, primary locations, and metastatic sites were recorded. The average and maximum SUV (SUVavg, SUVmax) of each primary tumor and metastasis were measured, and the ratio of metastatic SUVs to primary SUVs (M/Pavg, M/Pmax), its difference from 100% (diff-M/Pavg, diff-M/Pmax), the ratio of ROI area of metastatic to primary lesions (ROI-M/P), and its difference from 100% (diff-ROI-M/P) were calculated. RESULTS M/Pavg was in the range of 35.9-224.6% (mean ± SD: 97.9% ± 35.9%), while M/Pmax was in the range of 24.8-286.7% (98.1% ± 45.3%). Furthermore, values were in the range of 50-200% for M/Pavg in 280/296 lesions (94.6%) and for M/Pmax in 255/296 lesions (86.1%). M/Pavg and M/Pmax showed significant linear correlations with ROI-M/P (r = 0.62, 0.64, respectively). Multivariate analysis showed that diff-ROI-M/P had the greatest effect on diff-M/Pavg and diff-M/Pmax. CONCLUSION The SUVs of most metastatic lesions ranged from half to double those of primaries in lung cancer patients. When the SUV of a suspected metastasis is beyond the range of half to double that of the primary lung cancer, other non-metastatic lesions should be considered, while taking ROI size into account.
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Affiliation(s)
- Nobuyuki Kosaka
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tatsuro Tsuchida
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazunobu Tsuji
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kazuhiro Shimizu
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Erhamamci S, Reyhan M, Yapar AF, Canpolat T. Venous thrombosis of sarcoidosis as an unusual incidental finding on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med 2015; 30:352-4. [PMID: 26430325 PMCID: PMC4579626 DOI: 10.4103/0972-3919.164027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Sarcoidosis is defined as a multisystem granulomatous disorder of unknown cause. Venous thrombosis (VT) in the sarcoidosis is rare. The routine use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has resulted in clinicians detecting many incidental findings, which have proven to be clinically significant such as thrombosis. Here, we present a case with VT of sarcoidosis in the inferior vena cava and portal vein as an unusual incidental finding on 18F-FDG PET/CT.
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Affiliation(s)
- Seval Erhamamci
- Department of Nuclear Medicine, Faculty of Medicine, Baskent University, Turkey
| | - Mehmet Reyhan
- Department of Nuclear Medicine, Faculty of Medicine, Baskent University, Turkey
| | - Ali Fuat Yapar
- Department of Nuclear Medicine, Faculty of Medicine, Baskent University, Turkey
| | - Tuba Canpolat
- Department of Pathology, Faculty of Medicine, Baskent University, Turkey
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50
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Yonenaga Y, Kushihata F, Inoue H, Watanabe J, Tohyama T, Sugita A, Takada Y. Sarcoidosis manifesting as hepatic and splenic nodules mimicking ovarian cancer metastases: A case report. Oncol Lett 2015; 10:2166-2170. [PMID: 26622813 PMCID: PMC4579816 DOI: 10.3892/ol.2015.3566] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 06/05/2015] [Indexed: 12/15/2022] Open
Abstract
The current study presents a case of sarcoidosis manifesting as hepatic and splenic nodules, which was difficult to differentiate from ovarian cancer metastases. A 24-year-old female, who was previously diagnosed with right ovarian cancer and underwent surgery at the age of 21, was found to have two nodules in the spleen revealed by contrast-enhanced computed tomography (CT). 18F-fluorodeoxyglucose positron emission tomography/CT revealed two abnormal high uptake lesions in the spleen and one abnormal high uptake lesion in the liver. Under a diagnosis of hepatic and splenic metastases from right ovarian cancer, a laparoscopic splenectomy and partial hepatectomy were performed. Histopathological examination showed that a large number of non-caseating epithelioid cell granulomas formed these nodules, which was compatible with sarcoidosis. This case indicates that it is difficult to distinguish sarcoidosis from metastatic disease even using the latest modalities, and that laparoscopic surgery is a minimally invasive and useful tool for forming a differential diagnosis.
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Affiliation(s)
- Yoshikuni Yonenaga
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan ; Department of Surgery, Nagahama City Hospital, Nagahama, Shiga 526-8580, Japan
| | - Fumiki Kushihata
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Hitoshi Inoue
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Jota Watanabe
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Taiji Tohyama
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
| | - Atsuro Sugita
- Pathology Division, Ehime University Hospital, Toon, Ehime 791-0295, Japan
| | - Yasutsugu Takada
- Department of Hepatobiliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime 791-0295, Japan
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