THE SIGNIFICANCE OF QUANTITATIVE DATA FROM PET/CT IN THE COURSE OF SARCOIDOSIS AND THEIR ASSOCIATION WITH CLINICAL PARAMETERS

Öz

Objectives: To examine the potential correlation between the presence of a disease outside the chest and the likelihood of recurrence or need for therapy, as well as to assess the relationship between quantitative measurements obtained from 18F-FDG PET/CT scans and clinical and laboratory markers associated with sarcoidosis. Material and Methods: 18F-FDG PET/CT images of 78 patients diagnosed with sarcoidosis were retrospectively examined. The SUV max value of the lesions with the highest uptake in the thoracic and extrathoracic regions of the disease was determined. Clinical and laboratory parameters, and SUV max values of the lesions were compared. The relationship between the detection of an extrathoracic disease and the need for treatment, and the development of recurrence was also investigated. Results: No significant correlation was found between patients with thoracic and extrathoracic disease regarding SUVmax and clinical and laboratory results (p>0.05). A significant correlation was detected between the SUVmax value of mediastinal lymph nodes and the presence of extrathoracic disease (p<0.05). The need for treatment was found to be higher in patients with high 18F-FDG uptakes of the thoracic lesions. No relationship was found between the presence of extrathoracic disease and disease stage (p=0.821) and treatment requirement (p=0.793). A correlation was found between any organ involvement and the presence of recurrent disease at follow-up (p=0.018). Conclusion: 18F-FDG uptake in lung lesions and mediastinal lymph nodes may be a guide to identify patients requiring treatment by confirming the association between disease activity and clinical stage. Additionally, detection of any organ involvement on 18F-FDG PET/CT may be a predictor of the recurrent disease at follow-up.

Anahtar Kelimeler

• 18F-FDG PET/CT
• sarcoidosis
• maximum standardized uptake value
• extrathoracic disease

Sarkoidoz Seyrinde PET/BT’den Elde Edilen Kantitatif Verilerin Önemi ve Bunun Klinik Parametrelerle İlişkisi

Öz

Amaç: Toraks dışında bir hastalık varlığı ile nüksetme olasılığı veya tedavi ihtiyacı arasındaki potansiyel korelasyonun yanı sıra 18F-FDG PET/BT taramalarından elde edilen kantitatif ölçümler ile sarkoidozla ilişkili klinik ve laboratuvar belirteçleri arasındaki ilişkiyi değerlendirmek. Gereç ve Yöntemler: Sarkoidoz tanısı alan 78 hastanın 18F- FDG PET/BT görüntüleri retrospektif olarak incelendi. Hastalığın torakal ve ekstratorasik bölgelerde tutulumu en yüksek olan lezyonların SUVmax değeri belirlendi. Lezyonların klinik ve laboratuvar parametreleri ile SUVmax değerleri karşılaştırıldı. Ayrıca toraks dışında bir hastalığın saptanması ile tedavi ihtiyacı ve nüks gelişimi arasındaki ilişki de araştırıldı. Bulgular: Torasik ve ekstratorasik hastalığı olan hastalar arasında SUVmax ile klinik ve laboratuvar sonuçları arasında anlamlı bir korelasyon bulunamadı (p>0,05). Mediastinal lenf nodlarının SUVmax değeri ile ekstratorasik hastalık varlığı arasında anlamlı korelasyon tespit edildi (p<0,05). Torasik lezyonlarda 18F-FDG tutulumu yüksek olan hastalarda tedavi ihtiyacının daha fazla olduğu görüldü. Toraks dışı hastalık varlığı ile hastalığın evresi (p=0,821) ve tedavi gereksinimi (p=0,793) arasında ilişki bulunamadı. Herhangi bir organ tutulumu ile takipte hastalığın tekrarlaması arasında korelasyon bulundu (p=0,018). Sonuç: Akciğer lezyonlarında ve mediastinal lenf düğümlerinde 18F-FDG tutulumu, hastalık aktivitesi ile klinik evre arasındaki ilişkiyi doğrulayarak tedavi gerektiren hastaların belirlenmesinde yol gösterici olabilir. Ayrıca 18F-FDG PET/BT’de herhangi bir organ tutulumunun saptanması, takipte tekrarlayan hastalığın habercisi olabilir.

Anahtar Kelimeler

• 18F-FDG PET/BT
• sarkoidoz
• maksimum standardize edilmiş alım değeri
• ekstratorasik hastalık

Kaynakça

1. Costabel U, Hunninghake GW. ATS/ERS/WASOG statement on sarcoidosis. Sarcoidosis Statement Committee. American Thoracic Society. European Respiratory Society. World Association for Sarcoidosis and Other Granulomatous Disorders. Eur Respir J. 1999;14(4):735-737.
2. Harsini S, Werner T, Revheim ME, Abass Alavi A, Saboury B. 18F-FDG PET/CT Imaging of Infection and Inflammation. J Nucl Med. 2022;63(2):2669
3. Kung BT, Seraj SM, Zadeh MZ et al. An update on the role of 18F-FDG-PET/CT in major infectious and inflammatory diseases. Am J Nucl Med Mol Imaging. 2019;9(6):255–273.
4. Jamar F, Buscombe J, Chiti A, et al. EANM/SNMMI guideline for 18F-FDG use in inflammation and infection. J Nucl Med. 2013;54:647-658.
5. Zhuang H, Alavi A. 18-fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation. Semin Nucl Med. 2002; 32:47-59
6. Akaike G, Itani M, Shah H et al. PET/CT in the Diagnosis and Workup of Sarcoidosis: Focus on Atypical Manifestations. Radiographics. 2018;38(5):1536-1549.
7. Keijers RG, Van den Heuvel DAF, Grutters JC. Imaging the inflammatory activity of sarcoidosis. Eur Respir J. 2013;41(3):743-751
8. Lewis PJ, Salama A. Uptake of fluorine 18 fluorodeoxyglucose in sarcoidosis; J Nuck Med 1994;35(10):1647-1649

9. Keijsers RG, Verzijlbergen FJ, Oyen WJ et al. 18F-FDG PET, genotype-corrected ACE and sIL-2R in newly diagnosed sarcoidosis. Eur J Nucl Med Mol Imaging. 2009;36(7):1131–1137.
10. Soussan M, arcoidosis: FDG-PET/CT and MR features Clin Nucl Med. 2014;39(2):e146-159
11. Braun JJ, Kessler R, Constantinesco A, Imperiale A. 18F FDG PET/CT in sarcoidosis management:review and report of 20 cases. Eur J Nucl Med Mol Imaging. 2008;35(8):537-543
12. Cremers JP, Van Kroonenburgh MJ, Mostard RL, et al. Extent of disease activity assessed by 18F-FDG PET/CT in a dutch sarcoidosis population. Sarcoidosis Vasc Diffuse Lung Dis. 2014;31(1):37-45
13. Ambrosini V, Fasano L, Zumpattori M et al. 18F FDG PET/CT detects systemic involvement in sarcoidosis. Eur J Nucl Med Mol Imaging. 2011;38(11):2102
14. Teirstein AS, Machac J, Almeida O, Lu P, Padilla ML, Lanuzzi MC. Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis. Chest. 2007;132(6):1949–1953.
15. Oksüz MO, Werner MK, Aschoff P, Pfannenberg C. 18F-FDG PET/CT for the diagnosis of sarcoidosis in a patient with bilateral inflammatory involvement of the parotid and lacrimal glands (panda sign) and bilateral hilar and mediastinal lymphadenopathy (lambda sign). Eur J Nucl Med Mol Imaging. 2011;38(3):603.
16. Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med. 2004;45(9):1431-1434
17. Sobic-Saranovic D, Grozdic I, Videnovic-Ivanov J et al. The utility of 18F-FDG PET/CT for diagnosis and adjustment of therapy in patients with active chronic sarcoidosis. J Nucl Med. 2012;53(10):1543-1549
18. Brudin LH, Valind SO, Khudes CGet al. Fluorine-18 deoxyglucose uptake in sarcoidosis measured with positron emission tomography. Eur J Nucl Med 1994;21(4):297-305
19. Keijsers RG, Verzijlbergen EJ, van den Bosch JM et al. 18F-FDG PET as a predictor of pulmonary function in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2011;28(2):123-129
20. Ambrosini V, Zompatori M, Fasano L et al. (18)F-FDG PET/CT for the assessment of disease extension and activity in patients with sarcoidosis: results of a preliminary prospective study Clin Nucl Med. 2013;38(4):e171-177.
21. Lieberman J. Elevation of serum angiotensin-converting-enzyme (ACE) level in sarcoidosis. Am. J. Med. 1975;59(3):365–372.
22. Mostard RL, Voo S, van Kroonenburgh MJ et al. Inflammatory activity assessment by F18 FDG-PET/CT in persistent symptomatic sarcoidosis. Respir Med. 2011;105(12):1917-1924.
23. Keijsers RG, Verzijlbergen JF, van Diepen DM, van den Bosch JM, Grutters JC. 18F-FDG PET in sarcoidosis: an observational study in 12 patients treated with infliximab. Sarcoidosis Vasc Diffuse Lung Dis. 2008;25(2):143-149.
24. Mostard RLM, Verschakelen JA, van Kroonenburgh MJPG et al. Severity of pulmonary involvement and (18)F-FDG PET activity in sarcoidosis Respir Med. 2013;107(3):439-447.
25. Mostard RLM, Van Kuijk S, Verschakelen JA, et al. A predictive tool for an effective use of (18)F-FDG PET in assessing activity of sarcoidosis BMC Pulm Med. 2012;14:12:57.
26. Vorselaars AD, Verwoerd A, van Moorsel CH, Keijsers RG, Rijkers GT, Grutters JC. Prediction of relapse after discontinuation of infliximab therapy in severe sarcoidosis. Eur Respir J. 2014;43(2):602-609.