The utility of the chest radiograph in diagnosing exacerbations of pulmonary sarcoidosis.
OBJECTIVE
To quantify the CXR using a profusion of small lung opacities score in patients with pulmonary exacerbation of sarcoidosis. In particular, the study sought to determine whether the CXR changes were a reliable indicator of disease exacerbation.


METHODS
The study recruited patients with an exacerbation of pulmonary sarcoidosis, who were attending a university medical centre sarcoidosis clinic. Pulmonary exacerbation was defined as worsening pulmonary symptoms, thought to be related to sarcoidosis, that responded to an increase in corticosteroid dose. A subset of patients were identified who met the criteria of spirometric decline of >or=10% in FVC or FEV(1) from the previous (baseline) visit. Patients required a baseline CXR and spirometry and had CXR and spirometry performed at the initial assessment. Two International Labour Organisation B readers interpreted the CXR in a blinded manner.


RESULTS
All study patients (n = 36) were African American; there were 24 patients in the 'spirometric decline' subgroup. Agreement between the B readers was moderate (kappa = 0.54, P < 0.01). The mean profusion score increased, or worsened by 1.38 points (SD = 3.60, P = 0.008) for the exacerbation group while the 'spirometric decline' group worsened by an average of 1.80 points (SD = 3.81, P = 0.031). There was too much variation for a cut-off to be identified that would reliably diagnose exacerbations. There was no significant correlation between FVC or FEV(1) and profusion score.


CONCLUSIONS
The CXR International Labour Organisation profusion score is not a reliable test to detect pulmonary exacerbations of sarcoidosis. However, a CXR may be useful to exclude other diagnostic possibilities.
Judson
Marc A
MA
Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, USA. judsonma@musc.edu
Gilbert
Gregory E
GE
Rodgers
J Keith
JK
Greer
Charles F
CF
Schabel
Stephen I
SI
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008400:Mass Chest X-Ray; D008875:Middle Aged; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D017565:Sarcoidosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D005938:Glucocorticoids