The role of the PET scan in the management of sarcoidosis

Mostard, Rémy L M; Kroonenburgh, M.J.P.G. van; Drent, Marjolein

doi:10.1097/mcp.0b013e328363ed0d

Cited by 56 publications

(31 citation statements)

References 36 publications

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“…[4] Recently, 18F-FDG-PET/CT scan has been demonstrated to be a sensitive and reliable tool to assess inflammatory activity and disease extent. [5] …”

Section: Introductionmentioning

confidence: 99%

Sarcoidosis mimicking metastatic progression of pancreatic neuroendocrine tumor

et al. 2017

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Rationale:Pancreatic neuroendocrine tumors (PNETs) account for less than 5% of all pancreatic tumors. PNETs develop from pancreatic endocrine islet cells and have a variable range of malignant potential. These neoplasms tend to have a slower growth rate than exocrine tumors and may remain undetectable for years. Achieving a correct diagnosis and staging is of key importance for the optimal management of the disease and requires experience with the disease, an accurate clinical status evaluation and a critical interpretation of the radiological findings derived from morphological and functional imaging techniques as well as an integrated multidisciplinary approach. The possibility that some clinical data and radiological findings encountered during the diagnostic and staging procedures may not be related to PNETs but to concomitant clinical conditions should always be taken into consideration. This is mandatory as an incorrect stadiation may lead to patients’ mis-management.Patient concerns:We report the case of a 34-year-old female, with a past medical history of idiopathic acute pancreatitis, presenting with a severe upper abdominal pain, steady and radiating to the back.Diagnoses:Initial investigations incidentally detected a nonfunctioning pancreatic neuroendocrine tumor (NF-PNET) of intermediate grade G2. Subsequent investigations aimed at determining a correct tumor staging showed a negative indium-111- OctreoScan but an increased 18F-labeled fluorodesossiglucose (18F-FDG) uptake in multiple bilateral nodules in the lungs and in 1 nodular lesion located in the right gluteal subcutaneous tissue. An early tumor progression of a G2 NF-PNET that had to be treated with chemotherapy was suspected.Interventions:The histological examination of the gluteal subcutaneous nodule showed noncaseating granulomas, disproving the initial clinical suspect and allowing the diagnosis of active sarcoidosis in the G2 NF-PNET patient.Lessons:A misdiagnosis and a consequent therapeutic mismanagement were avoided with the support of an integrated multidisciplinary team.

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“…[4] Recently, 18F-FDG-PET/CT scan has been demonstrated to be a sensitive and reliable tool to assess inflammatory activity and disease extent. [5] …”

Section: Introductionmentioning

confidence: 99%

Sarcoidosis mimicking metastatic progression of pancreatic neuroendocrine tumor

et al. 2017

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“…No es el estudio inicial de elección ni tampoco un método apropiado de tamizaje, principalmente por su alto costo y mayor dosis de radiación 6 . El estudio por imágenes inicial continúa siendo la radiografía de tórax y complementariamente, debido a su mayor capacidad de detección de las alteraciones parenquimatosas pulmonares y detección de adenopatías, la tomografía computada de tórax.…”

Section: Sospecha De Sarcoidosisunclassified

¿Cuándo solicitar PET/CT en la evaluación de sarcoidosis?

2019

Rev. méd. Chile

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When should a PET/CT be requested in sarcoidosis? Sarcoidosis is a multisystemic disease of variable course that mainly affects thoracic lymph nodes and lung parenchyma. However, any organ can be involved. There is no single test for the definitive diagnosis or a precise method to evaluate the course of the disease. PET/CT is not included in the standard workup for sarcoidosis, but it may assess the inflammatory activity, detect extrapulmonary disease such as cardiac involvement and evaluate the response to treatment. It is important to be aware of the optimal timing to request a PET/CT in sarcoidosis and which patients would benefit with this procedure.

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“…Sarcoidosis classically appears on gallium‐67 scanning as panda and lambda signs, where salivary glands, conjunctivae and nasal passages create the impression of the facial characteristics of a panda, and mediastinal and hilar lymph nodes represent the Greek letter lambda. Fluorine‐18 fluorodeoxyglucose ( 18 F‐FDG) positron emission tomography (PET) scanning has largely replaced gallium‐67 scanning and has been shown to be effective 26 in identifying disease activity in sarcoidosis. However, both procedures rely on pattern recognition.…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

Sarcoidosis: a state of the art review from the Thoracic Society of Australia and New Zealand

Ahmadzai

Huang

Steinfort

et al. 2018

Medical Journal of Australia

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Sarcoidosis is a systemic disease of unknown aetiology, characterised by non-caseating granulomatous inflammation. It most commonly manifests in the lungs and intrathoracic lymph nodes but can affect any organ. This summary of an educational resource provided by the Thoracic Society of Australia and New Zealand outlines the current understanding of sarcoidosis and highlights the need for further research. Our knowledge of the aetiology and immunopathogenesis of sarcoidosis remains incomplete. The enigma of sarcoidosis lies in its immunological paradox of type 1 T helper cell-dominated local inflammation co-existing with T regulatory-induced peripheral anergy. Although specific aetiological agents have not been identified, mounting evidence suggests that environmental and microbial antigens may trigger sarcoidosis. Genome-wide association studies have identified candidate genes conferring susceptibility and gene expression analyses have provided insights into cytokine dysregulation leading to inflammation. Sarcoidosis remains a diagnosis of exclusion based on histological evidence of non-caseating granulomas with compatible clinical and radiological findings. In recent years, endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes has facilitated the diagnosis, and whole body positron emission tomography scanning has improved localisation of disease. No single biomarker is adequately sensitive and specific for detecting and monitoring disease activity. Most patients do not require treatment; when indicated, corticosteroids remain the initial standard of care, despite their adverse side effect profile. Other drugs with fewer side effects may be a better long term choice (eg, methotrexate, hydroxychloroquine, azathioprine, mycophenolate), while tumour necrosis factor-α inhibitors are a treatment option for patients with refractory disease.

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The role of the PET scan in the management of sarcoidosis

Cited by 56 publications

References 36 publications

Sarcoidosis mimicking metastatic progression of pancreatic neuroendocrine tumor

Sarcoidosis mimicking metastatic progression of pancreatic neuroendocrine tumor

¿Cuándo solicitar PET/CT en la evaluación de sarcoidosis?

Sarcoidosis: a state of the art review from the Thoracic Society of Australia and New Zealand

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