SAT0551 Sensitivity of Chest Radiography in the Early Diagnosis of Sarcoidosis: is it Really Should be Done?

Treat to target and tight control: Could be a new approach in the treatment of sarcoidosis?

Sarcoidosis is a chronic granulomatous disease with multisystemic involvement. Although it is accepted as a benign disease, it can sometimes cause life-threatening organ (heart, brain) involvement that determines the prognosis of the disease. There are conflicting opinions about the treatment of the disease. In the generally accepted treatment approach the "step-by-step" model has gained weight. According to this approach, corticosteroids (CS) drugs alone are preferred in the first step in patients who require treatment. In the second step, immunosuppressive drugs (IS) are used in patients who do not respond to CS and/or have contraindications to CS use, and biologics (TNF-alpha inhibitors) are used in the third step. This treatment approach may be valid in cases with mild sarcoidosis. However, although sarcoidosis is considered a benign and self-limiting disease in some major organ involvement, the "step-by-step" approach may be a treatment option that puts the patient's life in danger. In such selected patients, much more rigorous, early and combined treatment approaches that definitely include CS, IS or biologic drugs may be required. In selected sarcoidosis patients with high risk, early diagnosis, "treat-to-target" (T2T) and "tight control" follow-up of patients seems to be a rational approach. This article reviews the "step-down" treatment regimens in light of recent literature data and hypothesizes that the T2T model may be a probable new treatment approach in patients with sarcoidosis.

Application of Multislice Spiral CT Imaging Technology in the Diagnosis of Patients with Chest Sarcoidosis

Objective

To study the qualitative value of multislice spiral CT (MSCT) dynamic enhancement scanning for solitary nodules (SPN) of the chest.

Methods

In this paper, 40 cases of chest nodules (including 25 cases of malignant nodules, 8 cases of inflammatory nodules, and 7 cases of benign nodules) were first scanned to determine the scope of nodules. At the two rates of 5 ml/s and 3 ml/s, CT dynamic enhancement scans were performed at the center of the nodule, and the CT values, peak enhancement (PH) and peak time (PT) before and after SPN enhancement, were recorded. It is mainly strengthened, with 80% (20/25) of net added value between 20 and 60 Hu, and 20% (5/25) >60 Hu or <20 Hu. The enhancement peak and peak time are (31.31 ± 10.62) Hu and 45 s, respectively. The time-density curve (T-DC) showed a slowly rising type; the inflammatory nodules were mainly severely strengthened, with a net increase of >40 Hu. The enhancement peak value is (49.25 ± 12.44) Hu, and the peak time is 80 s and 140 s. There is a characteristic of rising and falling and then rising in the curve.

Conclusion

Multislice spiral CT dynamic enhancement scan reflects the dynamic characteristics of chest nodular blood flow, which can be used to noninvasively evaluate and diagnose SPN.

Screening Sarcoidosis Patients for Occult Disease

As sarcoidosis may involve any organ, sarcoidosis patients should be evaluated for occult disease. Screening for some organ involvement may not be warranted if it is unlikely to cause symptoms, organ dysfunction, or affect clinical outcome. Even organ involvement that affects clinical outcome does not necessarily require screening if early detection fails to change the patient's quality of life or prognosis. On the other hand, early detection of some forms of sarcoidosis may improve outcomes and survival. This manuscript describes the approach to screening sarcoidosis patients for previously undetected disease. Screening for sarcoidosis should commence with a meticulous medical history and physical examination. Many sarcoidosis patients present with physical signs or symptoms of sarcoidosis that have not been recognized as manifestations of the disease. Detection of sarcoidosis in these instances depends on the clinician's familiarity with the varied clinical presentations of sarcoidosis. In addition, sarcoidosis patients may present with symptoms or signs that are not related to specific organ involvement that have been described as parasarcoidosis syndromes. It is conjectured that parasarcoidosis syndromes result from systemic release of inflammatory mediators from the sarcoidosis granuloma. Certain forms of sarcoidosis may cause permanent and serious problems that can be prevented if they are detected early in the course of their disease. These include (1) ocular involvement that may lead to permanent vision impairment; (2) vitamin D dysregulation that may lead to hypercalcemia, nephrolithiasis, and permanent kidney injury; and (3) cardiac sarcoidosis that may lead to a cardiomyopathy, ventricular arrhythmias, heart block, and sudden death. Screening for these forms of organ involvement requires detailed screening approaches.