PO31 - Sarcoidosis phenotypes identified by [18]FDG PET/CT. A proof of concept study.
Małgorzata Kobylecka PhD MD (Poland)1; Anna Goljan-Geremek, PhD MD (Poland)2; Agnieszka Kołodzińska,PhD MD dr hab. n. med., (Poland)3; Renata Główczyńska PhD MD (Poland)3; Elżbieta Puścińska PhD,MD (Poland)4; Konrad Giełdowski MD (Poland)5; Michał Kocemba MD (Poland)1; Krzysztof Bieńkowski MD (Poland)1; Joanna Żuchowska MD (Poland)6; Sonia Borodzicz-Jażdzyk PhD,MD (Poland)3; Katarzyna Romanowska-Próchnicka PhD,MD (Poland)7; Patrycja Nejman-Gryz,PhD,MD (Poland)8; Marta Maskey-Warzęchowska, PhD,MD (Poland)2; Lena Kalinowska (Poland)9; Rafał Krenke PhD,MD (Poland)2;
1 - Department of Nuclear Medicine The National Institute of Medicine of the Ministry of the Interior and Administration, Warsaw, Poland; 2 - Department of Internal Medicine, Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland,; 3 - 1 Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland,; 4 - 2nd Dept of Respiratory Medicine,National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland.; 5 - Nuclear Medicine Department Warsaw Medical University; 6 - Second Department of Clinical Radiology Medical University of Warsaw, Warsaw, Poland; 7 - Departament of Biophysics, Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland,; 8 - Department of Internal Medicine, Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland; 9 - Students’ Scientific Association “Alveolus”, Medical University of Warsaw, Warsaw, Poland;
Keywords: Carb-free [18F]FDG PET/CT; PET uptake pattern; cardiac sarcoidosis;
Select the theme: Challenges in Sarcoidosis Diagnosis and Staging
Type: Original Papers
Presentation: Poster Presentation

Introduction: Sarcoidosis is a systemic disease with distinct clinical phenotypes associated with varying degrees of organ involvement. [18F]FDG PET/CT allows for the assessment of the location and activity of inflammation.  

Objectives: Attempt to identify organ involvement and identify PET phenotypic patterns of sarcoidosis based on FDG PET imaging 

Materials and Methods: Carb-free [18F]FDG PET/CT whole-body scans were performed in 90 steroid naïve patients diagnosed with sarcoidosis.  PET/CT images were qualitatively analyzed to assess the presence of active organ lesions with particular attention to cardiac involvement. A dominant phenotype based on organ involvement revealed by metabolic activity was determined in each patient. It was assumed that phenotypes may overlap, therefore an individual  patient could be assigned to more than one phenotypic group. 

Results: In 15/90 patients, no active lesions were detected. In 20 cases, active lesions were limited to the lungs and mediastinum; in the remaining cases, multi-organ involvement was observed. Seven patterns of organ involvement (PET phenotypes) could be identified: rheumatological (11), laryngological (10), parenchymal (11), nodal (9), hematological(16), pulmonary (20), and isolated cardiac (5) In 10 cases, phenotypic overlap was detected. Cardiac activity was seen  in 30 patients - isolated in 5 and with multi-organ involvement in the remaining 25 patients, with a considerable variety in the level of metabolic activity.

Conclusions: We were able to identify distinct [18F]FDG PET/CT phenotypes of sarcoidosis. Cardiac uptake was variable, what may have implied either sarcoidosis infiltrates or other nonspecific lesions including both pathological conditions and inadequate patient preparation. We postulate that [18]FDG PET may identify distinct sarcoidosis phenotypes, however these finding needs to be translated to clinical practice to enhance therapeutic decisions. Detected cardiac abnormalities should be interpreted with caution. Further relation between distinct [18F]FDG PET/CT patterns and clinical phenotypes of sarcoidosis will be investigated. 

3256_0.jpg