Depreotide scanning in sarcoidosis: a pilot study.
OBJECTIVE
To determine whether sarcoidosis results in uptake on (99m)Tc-labeled depreotide (DP) scintigraphy and to generate preliminary data to guide the development of future trials exploring this imaging modality in sarcoidosis patients.


METHODS
Prospective cohort trial among a convenience sample of patients with sarcoidosis.


METHODS
Tertiary care medical center pulmonary clinic.


METHODS
Subjects in whom sarcoidosis has been diagnosed based on a biopsy revealing nonnecrotizing granulomas.


METHODS
Two hours after IV administration of (99m)Tc-DP, all patients underwent whole-body anterior and posterior planar imaging, followed by thoracic single-photon emission CT scanning. Images were interpreted by two nuclear medicine physicians who were blinded to the patient's clinical status.


RESULTS
The study cohort included 22 subjects (mean [+/- SD] age, 41.3 +/- 9.3 years; 40% female). Approximately half of the cohort had stage I disease determined by chest radiographs (CXRs). The results of (99m)Tc-DP scintigraphy were positive for sarcoidosis in 18 individuals (81.8%; 95% confidence interval, 59.7 to 94.8%). Of the four persons lacking (99m)Tc-DP uptake, all had normalized their CXRs since the time of presentation. In the entire sample, the intraclass correlation between radiographic stage determined by CXR vs that determined by (99m)Tc-DP scintigraphy was robust (kappa = 0.79; p = 0.0005). Among patients with positive (99m)Tc-DP scan findings, the correlation was stronger (kappa = 0.94; p < 0.0001). Flow rates and lung volumes were lower in patients with parenchymal activity on (99m)Tc-DP scintigraphy (mean FEV(1), 68.6 +/- 13.9% predicted vs 84.5 +/- 10.7% predicted, respectively [p = 0.012]; mean FVC, 74.0 +/- 16.0% predicted vs 88.4 +/- 12.7% predicted [p = 0.041]). (99m)Tc-DP scintigraphy correctly identified all sites of known nonpulmonary visceral involvement with sarcoidosis.


CONCLUSIONS
The results of (99m)Tc-DP imaging are often positive in sarcoidosis patients, and correlate with disease stage determined by CXR and pulmonary function. (99m)Tc-DP scintigraphy does not preclude the need for biopsy if this is indicated to confirm the diagnosis of sarcoidosis or to exclude the possibility of malignancy. (99m)Tc-DP scintigraphy merits further study in the evaluation and management of sarcoidosis.
Shorr
Andrew F
AF
Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, 6900 Georgia Avenue NW, Washington, DC 20307, USA. afshorr@dnamail.com
Helman
Donald L
DL
Lettieri
Christopher J
CJ
Montilla
Jamie L
JL
Bridwell
Robert S
RS
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010865:Pilot Projects; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012507:Sarcoidosis / Q000000981:diagnostic imaging*; D013004:Somatostatin / Q000031:analogs & derivatives*; D015899:Tomography, Emission-Computed, Single-Photon
D015609:Organotechnetium Compounds; D013004:Somatostatin; C444119:technetium Tc 99m depreotide