Abstract
Purpose
Bronchoalveolar lavage (BAL) and 18F-fluorodeoxyglucose (18F-FDG) PET can both demonstrate sarcoid activity. To assess whether metabolic activity imaged by 18F-FDG PET represents signs of disease activity as reflected by BAL, 18F-FDG PET patterns were compared with BAL cell profiles.
Methods
In this retrospective analysis, 77 newly diagnosed pulmonary sarcoidosis patients underwent BAL and 18F-FDG PET. Based on 18F-FDG PET, patients were diagnosed with exclusively mediastinal/hilar activity (group A) and activity in the lung parenchyma (group B). Per group, BAL lymphocytes (%), CD4/CD8 ratio, CD103+CD4+/CD4+ ratio and neutrophils (%) were compared with the extent of metabolic activity expressed as the maximum standardized uptake value (SUVmax). Additionally, SUVmax and BAL parameters per radiographic stage were analysed.
Results
Overall, the SUVmax in the lung parenchyma correlated with neutrophils and SUVmax of the mediastinum/hila correlated with the CD4/CD8 ratio. In both groups, a significant, negative correlation between the SUVmax of the mediastinum/hila and the CD103+CD4+/CD4+ ratio was found. In group B, the SUVmax of the mediastinum/hila correlated with the CD4/CD8 ratio, while the SUVmax in the lung parenchyma correlated with the CD103+CD4+/CD4+ ratio and neutrophils. Significant differences were found in the SUVmax, CD4/CD8 ratio, CD103+CD4+/CD4+ ratio and neutrophils between the radiographic stages. The SUVmax of the lung parenchyma was positively related to the radiographic stage, while the SUVmax of the mediastinum/hila and CD4/CD8 ratio were inversely related.
Conclusion
18F-FDG PET correlates with the CD4/CD8 ratio and neutrophils, suggesting that 18F-FDG PET represents this specific cell profile in BAL. High SUVmax values of the lung parenchyma may therefore correlate with more severe parenchymal involvement, particularly when accompanied by a low SUVmax of the mediastinum/hila.
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References
Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007;357:2153–65.
Scadding JG. Prognosis of intrathoracic sarcoidosis in England. A review of 136 cases after five years’ observation. Br Med J 1961;2:1165–72.
Braun JJ, Kessler R, Constantinesco A, Imperiale A. (18)F-FDG PET/CT in sarcoidosis management: review and report of 20 cases. Eur J Nucl Med Mol Imaging 2008;35:1537–43.
Nishiyama Y, Yamamoto Y, Fukunaga K, Takinami H, Iwado Y, Satoh K, et al. Comparative evaluation of 18F-FDG PET and 67Ga scintigraphy in patients with sarcoidosis. J Nucl Med 2006;47:1571–6.
Yamada Y, Uchida Y, Tatsumi K, Yamaguchi T, Kimura H, Kitahara H, et al. Fluorine-18-fluorodeoxyglucose and carbon-11-methionine evaluation of lymphadenopathy in sarcoidosis. J Nucl Med 1998;39:1160–6.
Costabel U. Sarcoidosis: clinical update. Eur Respir J Suppl 2001;32:56s–68.
Verstraeten A, Demedts M, Verwilghen J, van den Eeckhout A, Mariën G, Lacquet LM, et al. Predictive value of bronchoalveolar lavage in pulmonary sarcoidosis. Chest 1990;98:560–7.
Ziegenhagen MW, Rothe ME, Schlaak M, Müller-Quernheim J. Bronchoalveolar and serological parameters reflecting the severity of sarcoidosis. Eur Respir J 2003;21:407–13.
Drent M, Jacobs JA, de Vries J, Lamers RJ, Liem IH, Wouters EF. Does the cellular bronchoalveolar lavage fluid profile reflect the severity of sarcoidosis? Eur Respir J 1999;13:1338–44.
Heron M, Slieker WA, Zanen P, van Lochem EG, Hooijkaas H, van den Bosch JM, et al. Evaluation of CD103 as a cellular marker for the diagnosis of pulmonary sarcoidosis. Clin Immunol 2008;126:338–44.
Kolopp-Sarda MN, Kohler C, De March AK, Béné MC, Faure G. Discriminative immunophenotype of bronchoalveolar lavage CD4 lymphocytes in sarcoidosis. Lab Invest 2000;80:1065–9.
No authors listed. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999;160:736–55.
Kruit A, Grutters JC, Gerritsen WB, Kos S, Wodzig WK, van den Bosch JM, et al. ACE I/D-corrected Z-scores to identify normal and elevated ACE activity in sarcoidosis. Respir Med 2007;101:510–5.
Kauffmann H. Standaardisatie van het protocol voor bronchoalveolaire lavage in Nederland. Pulmoscript 1994;5:66–8.
Hunninghake GW, Crystal RG. Pulmonary sarcoidosis: a disorder mediated by excess helper T-lymphocyte activity at sites of disease activity. N Engl J Med 1981;305:429–34.
Winterbauer RH, Lammert J, Selland M, Wu R, Corley D, Springmeyer SC. Bronchoalveolar lavage cell populations in the diagnosis of sarcoidosis. Chest 1993;104:352–61.
Ward K, O’Connor C, Odlum C, Fitzgerald MX. Prognostic value of bronchoalveolar lavage in sarcoidosis: the critical influence of disease presentation. Thorax 1989;44:6–12.
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Keijsers, R.G., Grutters, J.C., van Velzen-Blad, H. et al. 18F-FDG PET patterns and BAL cell profiles in pulmonary sarcoidosis. Eur J Nucl Med Mol Imaging 37, 1181–1188 (2010). https://doi.org/10.1007/s00259-009-1376-6
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DOI: https://doi.org/10.1007/s00259-009-1376-6