title: The utility of 18F-FDG PET/CT for diagnosis and adjustment of therapy in patients with active chronic sarcoidosis.
abstract: The purpose of this study was to assess the utility of (18)F-FDG PET/CT for detection of inflammation in granulomatous sites and management of patients with chronic sarcoidosis. The 3 specific aims were to assess differences between (18)F-FDG PET/CT and multidetector CT (MDCT) findings, to compare (18)F-FDG PET/CT results with serum levels of angiotensin-converting enzyme (ACE), and to determine whether (18)F-FDG PET/CT findings are associated with the decision to change therapy.
  
  
  METHODS
  We studied 90 sarcoidosis patients (mean age ± SD, 47 ± 12 y; 32 men and 58 women) with persistent symptoms who were referred for (18)F-FDG PET/CT evaluation to assess the extent of inflammation. They also underwent MDCT and measurement of serum ACE level. After the follow-up (12 ± 5 mo after (18)F-FDG PET/CT), the clinical status and changes in therapy were analyzed.
  
  
  RESULTS
  (18)F-FDG PET/CT detected inflammation in 74 patients (82%) (maximum standardized uptake value, 8.1 ± 3.9). MDCT was positive for sarcoidosis in 6 additional patients (80, 89%). The difference between the 2 methods was not significant (P = 0.238, McNemar test), and their agreement was fair (κ = 0.198). Although ACE levels were significantly higher in patients with positive than negative (18)F-FDG PET/CT results (P = 0.002, Mann-Whitney test), 38 patients (51%) with positive (18)F-FDG PET/CT results had normal ACE levels. The therapy was initiated or changed in 73 out of 90 patients (81%). Both univariate and multivariate logistic regression analyses indicated that positive (18)F-FDG PET/CT results were significantly (P < 0.001) associated with changes in therapy, with no contribution from age, sex, ACE level, CT results, or previous therapy.
  
  
  CONCLUSIONS
  Our results indicate that (18)F-FDG PET/CT is a useful adjunct to other diagnostic methods for detecting active inflammatory sites in chronic sarcoidosis patients with persistent symptoms, especially those with normal ACE levels. (18)F-FDG PET/CT proved advantageous for determining the spread of active disease throughout the body and influenced the decision to adjust the therapy.
authors.affiliation: Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Dragana
authors.initials: D
authors.lastname: Sobic-Saranovic
authors.forename: Isidora
authors.initials: I
authors.lastname: Grozdic
authors.forename: Jelica
authors.initials: J
authors.lastname: Videnovic-Ivanov
authors.forename: Violeta
authors.initials: V
authors.lastname: Vucinic-Mihailovic
authors.forename: Vera
authors.initials: V
authors.lastname: Artiko
authors.forename: Djordjije
authors.initials: D
authors.lastname: Saranovic
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Djuric-Stefanovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Masulovic
authors.forename: Strahinja
authors.initials: S
authors.lastname: Odalovic
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Ilic-Dudvarski
authors.forename: Spasoje
authors.initials: S
authors.lastname: Popevic
authors.forename: Smiljana
authors.initials: S
authors.lastname: Pavlovic
authors.forename: Vladimir
authors.initials: V
authors.lastname: Obradovic
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D049268:Positron-Emission Tomography; D012507:Sarcoidosis / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy*; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18; D007703:Peptidyl-Dipeptidase A