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

Einsatz von PET-CT bei der Erfassung von Behandlungsergebnissen bei Patienten mit Sarkoidose

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Summary

Background and aim

Sarcoidosis is a multisystem disease of unknown origin. Determining the involvement and the response to the treatment is important. The aim of this study was to identify the effects of methylprednisolone and indomethacine on metabolic activity and pulmonary function test parameters in patients with sarcoidosis.

Material and methods

A total of 24 pulmonary sarcoidosis patients were enrolled in the study. All the patients underwent spirometry and [18F]fluorodeoxyglucose positron emission tomography–computed tomography (FDG PET-CT) scan before treatment and were divided into two groups according to the necessity of corticosteroid treatment or not. Patients who did not have corticosteroid indication were treated with indomethacine. Symptomatic patients and patients who did not respond to indomethacine treatment received methylprednisolone. Patients were followed up on a monthly basis to determine the response. FDG uptakes as the disease activity were re-evaluated before ending the treatment at the sixth month.

Results

Mean age of patients (16 male, 8 female) was 39.79 (9.3) years. Besides mediastinum and pulmonary parenchyma, extrapulmonary sites were also involved in patients with pulmonary sarcoidosis (distant lymph nodes (upper abdominal, supraclavicular, inguinal, and axillary), liver, and spleen). Although maximum standard uptake values of methylprednisolone group regressed significantly (p < 0.001) after treatment, indomethacine group did not have significant regression (p = 0.345). Despite metabolic regressions, spirometry values of patients did not significantly increase (p > 0.005).

Conclusion

FDG PET-CT may be useful for determining activity and the efficacy of treatments. Methylprednisolone is effective in reducing metabolic activity but does not lead to improvement in functional parameters.

Zusammenfassung

Hintergrund und Ziel

Die Sarkoidose ist eine Multisystemerkrankung unbekannten Ursprungs. Die Bestimmung des Ausmaßes der Erkrankung und des Ansprechen auf Therapie ist wichtig. Das Ziel dieser Studie war es, die Wirkung von Methylprednisolon und Indomethacin auf die Stoffwechselaktivität und auf Lungenfunktionsparameter bei Patienten mit Sarkoidose zu erfassen.

Material und Methoden

Es wurden 24 Patienten mit Sarkoidose in die Studie aufgenommen. Bei allen Patienten wurde eine Spirometrie und ein FDG PET-CT vor der Therapie durchgeführt. Die Patienten wurden in zwei Gruppen je nach der Notwendigkeit einer Cortisontherapie geteilt. Die Patienten, bei denen keine Indikation für eine Cortisontherapie bestand, wurden mit Indomethacin behandelt. Patienten mit Symptomen und Patienten, die nicht auf die Indomethacin-Therapie ansprachen, erhielten Cortison. Die Patienten wurden zur Erfassung des Ansprechens auf die Therapie monatlich kontrolliert. Als Parameter der Aktivität der Erkrankung wurden FDG-Uptakes vor Ende der 6-monatigen Therapie neuerlich erhoben.

Ergebnisse

Das mittlere Alter der Patienten (16 Männer, 8 Frauen) lag bei 39,79 (9,3) Jahren. Neben dem Mediastinum und Lungenparenchym waren auch extrapulmonale Organe befallen (Lymphknoten im Bereich des oberen Abdomens, der Supraclaviculargruben, der Leisten und der Axillae; Leber und Milz). Obwohl die SUV max Werte in der Gruppe mit Methylprednisolon signifikant (p < 0,001) nach der Behandlung abfielen, blieben die Werte der Gruppe mit Indomethacin unverändert (p = 0,345). Trotz des Abfalls in der Stoffwechselaktivität kam es zu keiner Besserung der Spirometriewerte.

Schlussfolgerung

FDG PET-CT kann zur Erfassung der Aktivität der Sarkoidose und der Wirksamkeit einer Behandlung nützlich sein. Methylprednisolon ist wirksam im Bezug auf eine Reduktion der Stoffwechselaktivität, führt aber nicht zu einer Besserung der Lungenfunktionsparameter.

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Acknowledgments

The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/DxY8pE.

Conflict of interest

None of the authors declares any conflicts of interest.

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Authors and Affiliations

  1. Forensic Science Institution, Ministry of Justice, Istanbul, Turkey

    Aysun Yakar MD

  2. Department of Pulmonary Medicine, Bezmialem Vakıf University, Fatih, Istanbul, Turkey

    Fatih Yakar MD, Murat Sezer MD, Mehmet Bayram MD, Didem Özkan MD & Hatice K. Özçelik MD

  3. Department of Nuclear Medicine, Bezmialem Vakıf University, Istanbul, Turkey

    Ezgi Başak Erdoğan MD

  4. Department of Pulmonary Medicine, American Hospital, Istanbul, Turkey

    Levent Tabak MD

Authors
  1. Aysun Yakar MD
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  2. Fatih Yakar MD
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Correspondence to Fatih Yakar MD.

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Yakar, A., Yakar, F., Sezer, M. et al. Use of PET-CT for the assessment of treatment results in patients with sarcoidosis. Wien Klin Wochenschr 127, 274–282 (2015). https://doi.org/10.1007/s00508-014-0647-9

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  • DOI: https://doi.org/10.1007/s00508-014-0647-9

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