Fluorodeoxyglucose PET Scan in Pulmonary Sarcoidosis during Treatment with Inhaled and Oral Corticosteroids

Abstract

The objective was to investigate longitudinal changes in fluorodeoxyglucose PET scan (FDG-PET) in a patient with pulmonary sarcoidosis prior to and during treatment with inhaled corticosteroids followed by systemic corticosteroids. The patient was a 41-year-old man presenting with stage I pulmonary sarcoidosis (hilar adenopathy), which had progressed to stage II (pulmonary infiltrates) 19 months later. FDG-PET was performed at 19, 29 and 33 months after presentation. No treatment was given prior to the 1st PET. Subsequently, before the 2nd PET, the patient was treated with inhaled beclomethasone (QVAR Autohaler^®) 0.8 mg/day for 8 months. Finally, prior to the 3rd PET, the patient was treated with oral prednisolone 30 mg/day for 3 months. The 1st PET showed a high FDG uptake in the hilar and mediastinal lymph nodes and a high focal uptake in the peripheral parts of the lungs. The 2nd PET showed a slight uptake in a few mediastinal lymph nodes and an unchanged high focal uptake in the peripheral parts of the lungs and the pleura. The 3rd PET showed no abnormal uptake at all. In conclusion, as assessed by FDG-PET, inhaled beclomethasone had no recognizable influence on sarcoid inflammatory activity. Treatment with oral prednisolone depressed the inflammatory activity to such a degree that it was undetectable by PET. The results are in accordance with clinical studies on pulmonary sarcoidosis, showing a marginal effect of inhaled corticosteroids and a marked effect of systemic corticosteroids.

Use of PET-CT for the assessment of treatment results in patients with sarcoidosis

“…The SUVmax values of the mediastinum in patients with currently diagnosed and relapsed stage 1 sarcoidosis were higher than those in patients with stage 2 sarcoidosis (p = 0.003). Also, Milman et al [20] showed a significant decrease in the FDG uptake in the hilum and mediastinum and an unchanged or slightly increased uptake in the lung parenchyma following treatment with inhaled corticosteroids, consistent with a shift from stage 1 to stage 2 disease, as in our study.…”

“…Moreover, when Braun et al [8] treated five patients with corticosteroids, complete regression occurred in two patients, improvement but incomplete regression occurred in another two, and disease progression occurred in the fifth patient. Some case reports have also demonstrated the efficacy of corticosteroid treatment as evidenced by FDG PET [20,21,23].…”

“…Although some studies have shown that corticosteroid treatment affects disease activity as shown by wholebody PET, no studies have investigated the effects of indomethacin on disease activity [20][21][22][23].…”

PET-CT in children: where is it appropriate?

“…These areas of increased metabolic activity resolved with appropriate therapy while corresponding CT abnormalities persisted [40]. Similar utility has been reported in cases of sarcoidosis [41]. …”

The Utility of 18F-FDG PET/CT for Diagnosis and Adjustment of Therapy in Patients with Active Chronic Sarcoidosis

“…Several published case reports and small case series indicate the usefulness of 18 F-FDG PET and 18 F-FDG PET/CT for monitoring the effect of therapy in patients with sarcoidosis (19,(32)(33)(34). To our best knowledge, however, this was the first prospective study to specifically address the association between 18 F-FDG PET/CT results and subsequent patient management.…”