The Utility of 18F-FDG PET/CT for Diagnosis and Adjustment of Therapy in Patients with Active Chronic Sarcoidosis
The Utility of 18F-FDG PET/CT for Diagnosis and Adjustment of Therapy in Patients with Active Chronic Sarcoidosis
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DOI：
10.2967/jnumed.112.104380
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发表时间：
2012-10-01
影响因子：
9.3
通讯作者：
Obradovic, Vladimir
中科院分区：
文献类型：
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作者：
Sobic-Saranovic, Dragana;Grozdic, Isidora;Obradovic, Vladimir
本研究的目的是评估F-18-FDG PET/CT在肉芽肿部位炎症检测和慢性结节病患者治疗中的应用。3个具体目标是评估F-18-FDG PET/CT和多排CT（MDCT）结果之间的差异，比较F-18-FDG PET/CT结果与血清血管紧张素转换酶（ACE）水平，并确定F-18-FDG PET/CT结果是否与改变治疗的决定相关。研究方法：我们研究了90例有持续症状的结节病患者（平均年龄± SD，47 ± 12岁; 32例男性和58例女性），这些患者被转诊进行F-18-FDG PET/CT评估，以评估炎症程度。同时行MDCT及血清ACE水平测定。随访后（F-18-FDG PET/CT后12 +/- 5个月），分析临床状态和治疗变化。结果：F-18-FDG PET/CT在74例患者（82%）中检测到炎症（最大标准化摄取值，8.1 ± 3.9）。另外6例患者（80，89%）的MDCT为结节病阳性。两种方法之间的差异不显著（P = 0.238，McNemar检验），其一致性一般（kappa = 0.198）。尽管F-18-FDG PET/CT结果阳性患者的ACE水平显著高于阴性患者（P = 0.002，Mann-Whitney检验），但38例F-18-FDG PET/CT结果阳性患者（51%）的ACE水平正常。90例患者中有73例（81%）开始或改变了治疗。单变量和多变量logistic回归分析均表明，阳性F-18-FDG PET/CT结果与治疗变化显著相关（P < 0.001），而年龄、性别、ACE水平、CT结果或既往治疗无影响。结论：我们的研究结果表明，F-18-FDG PET/CT是一个有用的辅助其他诊断方法检测活动性炎症部位的慢性结节病患者的持续症状，特别是那些正常的ACE水平。F-18-FDG PET/CT被证明有利于确定活动性疾病在全身的扩散，并影响调整治疗的决定。
The purpose of this study was to assess the utility of F-18-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 F-18-FDG PET/CT and multidetector CT (MDCT) findings, to compare F-18-FDG PET/CT results with serum levels of angiotensin-converting enzyme (ACE), and to determine whether F-18-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 F-18-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 F-18-FDG PET/CT), the clinical status and changes in therapy were analyzed. Results: F-18-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 (kappa = 0.198). Although ACE levels were significantly higher in patients with positive than negative F-18-FDG PET/CT results (P = 0.002, Mann-Whitney test), 38 patients (51%) with positive F-18-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 F-18-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. Conclusion: Our results indicate that F-18-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. F-18-FDG PET/CT proved advantageous for determining the spread of active disease throughout the body and influenced the decision to adjust the therapy.