Sarcoidosis with bone involvement mimicking metastatic disease at 18F-FDG PET/CT: problem solving by diffusion whole-body MRI

Abstract

Bone involvement has been reported in 1–13% of patients with sarcoidosis. Both 18F-fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) and conventional magnetic resonance imaging (MRI) are sensitive in detecting sarcoidosis bone lesions, but are not always reliable in differentiating sarcoidosis bone lesions from metastatic disease, thus often requiring bone biopsy. We describe the use of diffusion whole-body MRI for bone assessment in a patient with breast cancer and sarcoidosis, presenting with bone marrow lesions mimicking metastatic disease at 18F-FDG PET/CT. In our case, diffusion whole-body MRI represented a useful tool for bone assessment and overcame the limitation of 18F-FDG PET/CT in discriminating inflammatory bone marrow involvement from metastatic disease.

Osseous sarcoidosis: A multicenter retrospective case-control study of 48 patients

“…Osseous lesions of sarcoidosis can be incidentally detected with imaging modalities, especially MRI and PET/CT (1,5). However, histological proof remains necessary since imaging modalities have limited specificity in differentiating between sarcoidosis and malignancy (16)(17)(18). All patients in our study had histological confirmation of sarcoidosis with evidence of non-caseating epithelioid cell granulomas in the bones or in other sites (5).…”

Coexistence of sarcoidosis and metastatic lesions: A diagnostic and therapeutic dilemma (Review)

“…Chest X-ray and 18 FDG-PET-CT were performed for staging of the tumor and showed a bilateral mediastinal lymphadenopathy and an increased FDG-uptake in supra-diaphragmatic and pelvic lymph nodes. Biopsy of an example lesion obtained sarcoidosis ( 12 ). Secondly, an 80-year-old female's CT scan revealed a tumor suspicious mass in the upper lobe of the right lung, multiple smaller nodules and hilar lymphadenopathy.…”

Bone marrow involvement in sarcoidosis: an elusive extrapulmonary manifestation

“…As a result of limited health care access and health literacy, the evolution from cutaneous to systemic sarcoidosis is unclear. In terms of imaging, positron emission tomography/computed tomography is highly sensitive in detecting granulomatous BM lesions [55]. It may help select appropriate candidates for a BM biopsy, but was not obtained for this patient.…”