The role of PET in the management of sarcoidosis

Abstract

Purpose of reviewPET has emerged as method to determine the location and extent of disease activity in sarcoidosis. As most clinicians do not routinely utilize PET in the management of sarcoidosis, an understanding of the imaging technique is needed to comprehend the impact that PET abnormalities have on diagnosis, prognosis, and treatment.Recent findingsAlthough PET can detect inflammation because of sarcoidosis throughout the body, it is most often utilized for the diagnosis of cardiac sarcoidosis for which it may provide information about prognosis and adverse events. Whenever PET is combined with cardiac magnetic resonance (CMR), clinicians may be able to increase the diagnostic yield of imaging. Furthermore, PET abnormalities have the potential to be utilized in the reduction or augmentation of therapy based on an individual's response to treatment. Although various biomarkers are used to monitor disease activity in sarcoidosis, an established and reproducible relationship between PET and biomarkers does not exist.SummaryPET has the potential to improve the diagnosis of sarcoidosis and alter treatment decisions but prospective trials are needed to define the role of PET while also standardizing the performance and interpretation of the imaging modality.

Personalized medicine in sarcoidosis: unravelling biomarkers for targeted care

“…FDG-PET/CT is an important diagnostic tool in both thoracic and extra-thoracic sarcoidosis because of its ability to identify active inflammation [26 ▪▪ ]; however, it is still not indicated in standard work-up. Currently, it is mainly used to evaluate cardiac sarcoidosis and detect hidden extra-thoracic involvement in persistently symptomatic patients.…”

The role of primary care in sarcoidosis

“…Apart from the accurate assessment of the cardiac structure and tissue characterization, cardiac MRI offers significant prognostic information for patients with suspected/known cardiac sarcoidosis [16 ▪▪ ,17,18]. Fluro-deoxy-glucose (FDG)-PET is an alternative advanced imaging modality used to identify myocardial (and body) inflammation and has a complementary role to cardiac MRI in the diagnostic pathway [19]. However, the selective use of these advanced imaging modalities at expert centres does not address the problem of screening, especially with regard to the presence of subclinical disease.…”

Clinical Manifestations and Management of Fibrotic Pulmonary Sarcoidosis

“…In pulmonary sarcoidosis, FDG-PET/CT has exhibited a high sensitivity rate ranging between 94% and 100% in identification of ongoing inflammatory processes ( Figure 3 ) [ 60 , 61 ]. Few studies have investigated its diagnostic use in pulmonary sarcoidosis [ 62 , 63 , 64 ]. One retrospective study involving 95 patients, with 85% demonstrating signs of fibrotic disease, found that the severity of pulmonary involvement as assessed by HRCT and lung function parameters was associated with increased FDG uptake at a threshold standardized uptake value (SUVmax) of greater than or equal to 2.5 [ 63 ].…”