Abstract
Background:Sarcoidosis has a variable natural course from an asymptomatic state to a progressive disease. Management of sarcoidosis is complex due to the disease's variable natural history and response to treatment. There are also no clear objective indicators for predicting prognosis especially relapsing or progressive disease and standard practice (SP) uses a combination of clinical, functional and imaging criteria leading to significant differences in initiation and duration of treatment. 18F-FDG PEThas proved to be a sensitive technique in the assessment of disease activity. However the routine use of PET in the management of sarcoidosis is not validated.
Objective: to determine whether 18F-FDGPET may be useful in the management of sarcoidosis.
Methods: We have retrospectively analysed 30 patients (14 female; age 55 SD 13 years) with active pulmonary sarcoidosis requiring treatment with prednisone and/or immunosuppressives. 18-FDG PET was performed before the start and following 6-12 months of treatment (mean 9 SD 3 months). Treatment was discontinued if 18-FDG PET showed negative parenchymal activity . Follow-up was continued for at least 3 years.
Results:In 13 patients disease responded to treatment whereas 17 showed either incomplete response or relapse. There was a discrepancy between SP and 18-FDG PET at the end of treatment with the latter showing an 85% positive predictive value (95% CI 55-98%) and a 65% negative predictive value (95% CI 37-75%) for persistence or relapse of the disease.
Conclusions:While these data will have to be confirmed prospectively, they indicate 18-FDG PET may be superior to SP in predicting response to treatment in sacoidosis.
- © 2014 ERS