Sarcoidosis: Follow-up With 18f-FDG PET/CT After Different Therapy

Abstract

SESSION TITLE: Imaging SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The purpose of this study was to assess the utility of 18F-FDG PET/CT (PET/CT scan) for detection of inflammation in granulomatous sites and management of sarcoidosis patients with different therapy. The specific aims were to compare PET/CT scan findings with x-ray score, serum levels of chitotriosidase (CTO), serum angiotensin converting enzyme (sACE) at the time of diagnosis and at different SUV-Max activity in different organs in body and to evaluate therapies with glucocorticoid and antimicotic. METHODS: The study comprises 86 sarcoidosis patients who underwent PET/CT scan between March 2010 and April 2015, at the time of diagnosis and at the end of therapy and follow-up without therapy. The presence of inflammatory activity was assessed using PET/CT scan. Correlations between PET/CT scan findings (MaxSUV, MaxSUV in lung parenchyma, MaxSUV in lymph nodes), CTO, sACE, radiological evaluation (X-ray score) and pulmonary function at the time of diagnosis and at follow-up were calculated for all patients and separately for patients without therapy and patients receiving antifungal and/or corticosteroid therapy. RESULTS: PET/CT scan findings at the time of diagnosis MaxSUV1 10.8±1.1; MaxParenhim1 2.2±0.4; MaxLymphN1 8.3±1.1. MaxSUV1 were correlated with X-ray score-1 (r=0.369, p=0.001; with sACE (r=0.266, p=0.017) with CTO (r=0.483, p=0.000). MaxSUV2 was 6.2±1.1 in whole group without correlations with markers except X-ray score-2 (p=0.055). Correlations with MaxSUV2 were only present in the group with antifungal therapy (CTO2, r=0.509, p=0.003) and X-ray score-2 (r=0.533, p=0.001). In the group without therapy and follow-up without therapy, MaxSUV2 correlated with X-ray score-2 (r=0.567, p=0.014). No correlations were found between first and second PET/CT scan and pulmonary function tests. CONCLUSIONS: The results show that PET/CT scan is useful as a diagnostic method for detecting active inflammatory granulomatous sites at the time of diagnosis sarcoidosis, especially those with normal level of sACE and normal DLco. It is also useful to determine the spread of active disease through the body and to assist in the decision to adjust the therapy. For the follow-up the effectiveness of therapy or for evaluate the activities of the disease, only after antifungal treatment the PET/CT scan correlated with other biomarkers of the activity of sarcoidosis. PET/CT scan had different information about the activity of disease comparing the other markers of sarcoidosis. The results suggest that follow up PET/CT is not needed after antifungal therapy, as the biomarker CTO and X-ray score correlate well with SUVMAX. PET/CT scan should be considered in case of treatment with corticosteroids, if there is clinical suspicion of recurrence or progress of the disease. CLINICAL IMPLICATIONS: The utility of PET/CT scan is useful for detection of granuloma inflammation. For the follow-up is better than serum markers of inflammation. DISCLOSURE: The following authors have nothing to disclose: Marjeta Tercelj-Zorman, Nadja Koren, Kaja Šifer, Maša Bizjak, Marina Hodolić, Barbara Salobir No Product/Research Disclosure Information