Predictive value of gallium scan, angiotensin-converting enzyme level, and bronchoalveolar lavage in two-year follow-up of pulmonary sarcoidosis

Abstract

Evaluation of patients with pulmonary sarcoidosis with serum angiotensin-converting enzyme (ACE), gallium scan, and bronchoalveolar lavage (BAL) has proved useful in demonstrating active disease, especially in the lungs. Long-term prognosis based on the results of pretreatment ACE, gallium scan, and BAL has not been previously clarified. We studied 44 patients with initially symptomatic pulmonary sarcoidosis who were begun on steroid therapy after initial evaluation. At 2 years, 21 of 44 (48%) patients still had worsening disease. Of 31 patients who had positive gallium scan pretreatment, 21 (68%) still had worsening disease at 2 years. None of the 13 patients with a negative gallium scan had worsening disease at 2 years (Chi square = 14.2, P less than 0.01). Similar analysis of the pretreatment serum ACE level, percentage of lymphocytes in the BAL fluid, and ratio of T-helper/inducer to T-suppressor/cytotoxic (T4/T8) in the BAL fluid also had some predictive value for worsening disease at 2 years; however, these tests were less sensitive than the gallium scan. In patients with pulmonary sarcoidosis, the finding of a negative gallium scan suggests a small likelihood that disease activity will worsen after 2 years.

Absolute quantitation of gallium-67 citrate accumulation in the lungs and its importance for the evaluation of disease activity in pulmonary sarcoidosis

“…In agreement with other authors (Bourguet et al 1986;Alberts and Van der Schoot 1988;Baughman and Eisentrout 1986), our experience suggests that the absolute quantitation of 67Ga lung uptake appears to be a suitable marker of disease activity in sarcoidosis. It is useful for the delineation of residual X-ray changes and it indicates the degree of lung parenchyma involvement.…”

Established and experimental medical therapy of pulmonary sarcoidosis

“…However, it may prove a useful measure in future studies. It should be noted that increased gallium activity is quickly suppressed by glucocorticoid therapy, and therefore serial studies have not been useful to monitor response to therapy [59].…”

Lacrimal Gland Uptake of67Ga-gallium Citrate Correlates with Biopsy Results in Patients with Suspected Sarcoidosis

“…8 In patients with pulmonary sarcoidosis, gallium scintigraphy has been shown to be sensitive in detecting lymphadenopathy and parenchymal disease, and useful in assessing disease activity and response to treatment. [11][12][13][14][15][16] Lacrimal gland uptake has also been found to be increased both in patients with pulmonary sarcoidosis and in those with isolated extrathoracic disesase. 10,[17][18][19][20][21][22] Weinreb et al found increased gallium uptake in the lacrimal gland in 87% of sarcoidosis patients versus 31% of patients without sarcoidosis.…”