open access

Vol 88, No 1 (2020)
Review paper
Published online: 2020-02-28
Submitted: 2019-10-02
Accepted: 2020-02-05
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Imaging methods for pulmonary sarcoidosis

Małgorzata Węcławek, Dariusz Ziora, Dariusz Jastrzębski
DOI: 10.5603/ARM.2020.0074
·
Pubmed: 32153004
·
Adv Respir Med 2020;88(1):18-27.

open access

Vol 88, No 1 (2020)
REVIEWS
Published online: 2020-02-28
Submitted: 2019-10-02
Accepted: 2020-02-05

Abstract

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. In more than 90% of patients with diagnosed sarcoidosis, mediastinal and hilar lymph nodes are affected. The objective of this paper is to discuss the most important chest imaging methods in pulmonary sarcoidosis. A chest X-ray remains the method of choice at both the diagnostic stage and during follow-up of the disease progress. High-resolution computed tomography allows for a more thorough description of lesions in terms of their location. Research demonstrates the superiority of FDG PET over both aforementioned techniques in the assessment of active inflammatory lesions. Magnetic resonance imaging is currently being used in diagnosing cardiac sarcoidosis. Although EBUS constitutes the basic diagnostic tool, the invasiveness of the method results in it not being used when monitoring the activity of the disease.

Abstract

Sarcoidosis is a chronic systemic granulomatous disease of unknown etiology. In more than 90% of patients with diagnosed sarcoidosis, mediastinal and hilar lymph nodes are affected. The objective of this paper is to discuss the most important chest imaging methods in pulmonary sarcoidosis. A chest X-ray remains the method of choice at both the diagnostic stage and during follow-up of the disease progress. High-resolution computed tomography allows for a more thorough description of lesions in terms of their location. Research demonstrates the superiority of FDG PET over both aforementioned techniques in the assessment of active inflammatory lesions. Magnetic resonance imaging is currently being used in diagnosing cardiac sarcoidosis. Although EBUS constitutes the basic diagnostic tool, the invasiveness of the method results in it not being used when monitoring the activity of the disease.

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Keywords

sarcoidosis; imaging; x- ray; HRCT

About this article
Title

Imaging methods for pulmonary sarcoidosis

Journal

Advances in Respiratory Medicine

Issue

Vol 88, No 1 (2020)

Article type

Review paper

Pages

18-27

Published online

2020-02-28

DOI

10.5603/ARM.2020.0074

Pubmed

32153004

Bibliographic record

Adv Respir Med 2020;88(1):18-27.

Keywords

sarcoidosis
imaging
x- ray
HRCT

Authors

Małgorzata Węcławek
Dariusz Ziora
Dariusz Jastrzębski

References (72)
  1. 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(2): 736–755.
  2. Bonifazi M, Gasparini S, Alfieri V, et al. Pulmonary sarcoidosis. Semin Respir Crit Care Med. 2017; 38(4): 437–449.
  3. Kouranos V, Hansell DM, Sharma R, et al. Advances in imaging of cardiopulmonary involvement in sarcoidosis. Curr Opin Pulm Med. 2015; 21(5): 538–545.
  4. Dziedzic DA, Peryt A, Orlowski T. The role of EBUS-TBNA and standard bronchoscopic modalities in the diagnosis of sarcoidosis. Clin Respir J. 2017; 11(1): 58–63.
  5. Bugalho A, Szlubowski A. Endobronchial ultrasound in sarcoidosis: time to rethink the diagnostic strategy? Rev Port Pneumol. 2014; 20(5): 235–236.
  6. Pedro C, Melo N, Novais E Bastos H, et al. Role of bronchoscopic techniques in the diagnosis of thoracic sarcoidosis. J Clin Med. 2019; 8(9).
  7. Culver DA. Diagnosing sarcoidosis. Curr Opin Pulm Med. 2015; 21(5): 499–509.
  8. Costabel U, Wessendorf TE, Bonella F, et al. Diagnosis of sarcoidosis. Clin Rev Allergy Immunol. 2015; 49(1): 54–62.
  9. Scadding JG. Prognosis of intrathoracic sarcoidosis in england. BMJ. 1961; 2(5261): 1165–1172.
  10. Muers MF, Middleton WG, Gibson GJ, et al. A simple radiographic scoring method for monitoring pulmonary sarcoidosis: relations between radiographic scores, dyspnoea grade and respiratory function in the British Thoracic Society Study of Long-Term Corticosteroid Treatment. Sarcoidosis Vasc Diffuse Lung Dis. 1997; 14(1): 46–56.
  11. Baughman RP, Shipley R, Desai S, et al. Changes in chest roentgenogram of sarcoidosis patients during a clinical trial of infliximab therapy: comparison of different methods of evaluation. Chest. 2009; 136(2): 526–535.
  12. Boros PW, Enright PL, Quanjer PH, et al. Impaired lung compliance and DLCO but no restrictive ventilatory defect in sarcoidosis. Eur Respir J. 2010; 36(6): 1315–1322.
  13. Pietinalho A, Tukiainen P, Haahtela T, et al. Early treatment of stage II sarcoidosis improves 5-year pulmonary function. Chest. 2002; 121(1): 24–31.
  14. Elicker BM, Kallianos KG, Henry TS. The role of high-resolution computed tomography in the follow-up of diffuse lung disease: Number 2 in the Series "Radiology" Edited by Nicola Sverzellati and Sujal Desai. Eur Respir Rev. 2017; 26(144).
  15. Ley-Zaporozhan J, Ley S. HRCT-Technik mit Low-dose-Protokollen bei interstitiellen Lungenerkrankungen. Der Radiologe. 2014; 54(12): 1153–1158.
  16. Hansell DM. High-resolution CT of diffuse lung disease: value and limitations. Radiol Clin North Am. 2001; 39(6): 1091–1113.
  17. Nunes H, Brillet PY, Valeyre D, et al. Imaging in sarcoidosis. Semin Respir Crit Care Med. 2007; 28(1): 102–120.
  18. Criado E, Sánchez M, Ramírez J, et al. Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics. 2010; 30(6): 1567–1586.
  19. Lee GM, Pope K, Meek L, et al. Sarcoidosis: a diagnosis of exclusion. AJR Am J Roentgenol. 2020; 214(1): 50–58.
  20. Hawtin KE, Roddie ME, Mauri FA, et al. Pulmonary sarcoidosis: the 'Great Pretender'. Clin Radiol. 2010; 65(8): 642–650.
  21. Nakatsu M, Hatabu H, Morikawa K, et al. Large coalescent parenchymal nodules in pulmonary sarcoidosis: "sarcoid galaxy" sign. AJR Am J Roentgenol. 2002; 178(6): 1389–1393.
  22. Herráez Ortega I, Alonso Orcajo N, López González L. The "sarcoid cluster sign". A new sign in high resolution chest CT. Radiologia. 2009; 51(5): 495–499.
  23. Oda M, Saraya T, Shirai T, et al. Multiple huge "cluster" and "galaxy" signs on chest radiography in a patient with pulmonary tuberculosis. Respirol Case Rep. 2019; 7(3): e00398.
  24. Koide T, Saraya T, Tsukahara Y, et al. Clinical significance of the "galaxy sign" in patients with pulmonary sarcoidosis in a Japanese single-center cohort. Sarcoidosis Vasc Diffuse Lung Dis. 2016; 33(3): 247–252.
  25. Heo JN, Choi YoW, Jeon SC, et al. Pulmonary tuberculosis: another disease showing clusters of small nodules. AJR Am J Roentgenol. 2005; 184(2): 639–642.
  26. Godoy MCB, Viswanathan C, Marchiori E, et al. The reversed halo sign: update and differential diagnosis. Br J Radiol. 2012; 85(1017): 1226–1235.
  27. Marchiori E, Zanetti G, Escuissato DL, et al. Reversed halo sign: high-resolution CT scan findings in 79 patients. Chest. 2012; 141(5): 1260–1266.
  28. Zhan Xi, Zhang L, Wang Z, et al. Reversed halo sign: presents in different pulmonary diseases. PLoS One. 2015; 10(6): e0128153.
  29. Kumazoe H, Matsunaga K, Nagata N, et al. "Reversed halo sign" of high-resolution computed tomography in pulmonary sarcoidosis. J Thorac Imaging. 2009; 24(1): 66–68.
  30. Kouranos V, Wells A, Walsh S. Why do people die from pulmonary sarcoidosis? Curr Opin Pulm Med. 2018; 24(5): 527–535.
  31. Ziora D, Jastrzębski D, Labus Ł. Advances in diagnosis of pulmonary sarcoidosis. Pneumonol Alergol Pol. 2012; 80(4): 355–364.
  32. Ziora D, Kornelia K, Jastrzebski D, et al. High resolution computed tomography in 2-year follow-up of Stage I sarcoidosis. Adv Exp Med Biol. 2013; 788: 369–374.
  33. Murdoch J, Müller NL. Pulmonary sarcoidosis: changes on follow-up CT examination. AJR Am J Roentgenol. 1992; 159(3): 473–477.
  34. Remy-Jardin M, Giraud F, Remy J, et al. Pulmonary sarcoidosis: role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology. 1994; 191(3): 675–680.
  35. Valeyre D, Nunes H, Bernaudin JF. Advanced pulmonary sarcoidosis. Curr Opin Pulm Med. 2014; 20(5): 488–495.
  36. Levy A, Hamzeh N, Maier LA. Is it time to scrap Scadding and adopt computed tomography for initial evaluation of sarcoidosis? F1000Res. 2018; 7.
  37. Zappala CJ, Desai SR, Copley SJ, et al. Accuracy of individual variables in the monitoring of long-term change in pulmonary sarcoidosis as judged by serial high-resolution CT scan data. Chest. 2014; 145(1): 101–107.
  38. Drent M, Vries J, Lenters M, et al. Sarcoidosis: assessment of disease severity using HRCT. European Radiology. 2003; 13(11): 2462–2471.
  39. Ors F, Gumus S, Aydogan M, et al. HRCT findings of pulmonary sarcoidosis; relation to pulmonary function tests. Multidiscip Respir Med. 2013; 8(1): 8.
  40. Aleksonienė R, Zeleckienė I, Matačiūnas M, et al. Relationship between radiologic patterns, pulmonary function values and bronchoalveolar lavage fluid cells in newly diagnosed sarcoidosis. J Thorac Dis. 2017; 9(1): 88–95.
  41. Sulavik SB, Spencer RP, Palestro CJ, et al. Recognition of distinctive patterns of gallium-67 distribution in sarcoidosis. J Nucl Med. 1990; 31(12): 1909–1914.
  42. Leung AN, Brauner MW, Caillat-Vigneron N, et al. Sarcoidosis activity: correlation of HRCT findings with those of 67Ga scanning, bronchoalveolar lavage, and serum angiotensin-converting enzyme assay. J Comput Assist Tomogr. 1998; 22(2): 229–234.
  43. Malinowska E, Doboszyńska A, Śliwińska A, et al. The use of 67Ga scintigraphy in patients with sarcoidosis. Nucl Med Rev Cent East Eur. 2018; 21(1): 59–65.
  44. Tannen BL, Kolomeyer AM, Turbin RE, et al. Lacrimal gland uptake of (67)Ga-gallium citrate correlates with biopsy results in patients with suspected sarcoidosis. Ocul Immunol Inflamm. 2014; 22(1): 15–22.
  45. Piotrowski WJ, Bieńkiewicz M, Frieske I, et al. Somatostatin receptor scintigraphy in sarcoidosis: relation to selected clinical and laboratory markers. Pol Arch Med Wewn. 2012; 122(3): 98–106.
  46. Lebtahi R, Crestani B, Belmatoug N, et al. Somatostatin receptor scintigraphy and gallium scintigraphy in patients with sarcoidosis. J Nucl Med. 2001; 42(1): 21–26.
  47. Vis R, Malviya G, Signore A, et al. ⁹⁹mTc-anti-TNF-α antibody for the imaging of disease activity in pulmonary sarcoidosis. Eur Respir J. 2016; 47(4): 1198–1207.
  48. Galli F, Lanzolla T, Pietrangeli V, et al. In vivo evaluation of TNF-alpha in the lungs of patients affected by sarcoidosis. Biomed Res Int. 2015; 2015: 401341.
  49. Braun JJ, Kessler R, Constantinesco A, et al. 18F-FDG PET/CT in sarcoidosis management: review and report of 20 cases. Eur J Nucl Med Mol Imaging. 2008; 35(8): 1537–1543.
  50. Treglia G, Annunziata S, Sobic-Saranovic D, et al. The role of 18F-FDG-PET and PET/CT in patients with sarcoidosis: an updated evidence-based review. Acad Radiol. 2014; 21(5): 675–684.
  51. Sobic-Saranovic D, Artiko V, Obradovic V. FDG PET imaging in sarcoidosis. Semin Nucl Med. 2013; 43(6): 404–411.
  52. Mostard RLM, Verschakelen JA, van Kroonenburgh MJ, et al. A predictive tool for an effective use of (18)F-FDG PET in assessing activity of sarcoidosis. BMC Pulm Med. 2012; 12(3): 57–447.
  53. Akaike G, Itani M, Shah H, et al. PET/CT in the diagnosis and workup of sarcoidosis: focus on atypical manifestations. Radiographics. 2018; 38(5): 1536–1549.
  54. Adams H, Keijsers RG, Korenromp IHE, et al. FDG PET for gauging of sarcoid disease activity. Semin Respir Crit Care Med. 2014; 35(3): 352–361.
  55. Sobic-Saranovic D, Grozdic I, Videnovic-Ivanov J, et al. The utility of 18F-FDG PET/CT for diagnosis and adjustment of therapy in patients with active chronic sarcoidosis. J Nucl Med. 2012; 53(10): 1543–1549.
  56. Vorselaars ADM, Crommelin HA, Deneer VHM, et al. Effectiveness of infliximab in refractory FDG PET-positive sarcoidosis. Eur Respir J. 2015; 46(1): 175–185.
  57. Keijsers RG, Verzijlbergen FJ, Oyen WJ, et al. 18F-FDG PET, genotype-corrected ACE and sIL-2R in newly diagnosed sarcoidosis. Eur J Nucl Med Mol Imaging. 2009; 36(7): 1131–1137.
  58. Kaira K, Oriuchi N, Otani Y, et al. Diagnostic usefulness of fluorine-18-alpha-methyltyrosine positron emission tomography in combination with 18F-fluorodeoxyglucose in sarcoidosis patients. Chest. 2007; 131(4): 1019–1027.
  59. Dubrey SW, Sharma R, Underwood R, et al. Cardiac sarcoidosis: diagnosis and management. Postgrad Med J. 2015; 91(1077): 384–394.
  60. Moore SL, Teirstein A, Golimbu C. MRI of sarcoidosis patients with musculoskeletal symptoms. AJR Am J Roentgenol. 2005; 185(1): 154–159.
  61. Sherman JL, Stern BJ, Sherman JL, et al. Sarcoidosis of the CNS: comparison of unenhanced and enhanced MR images. AJNR Am J Neuroradiol. 1990; 11(5): 915–923.
  62. Brady D, Lavelle LP, McEvoy SH, et al. Assessing fibrosis in pulmonary sarcoidosis: late-enhanced MRI compared to anatomic HRCT imaging. QJM. 2016; 109(4): 257–264.
  63. Chung JH, Little BP, Forssen AV, et al. Proton MRI in the evaluation of pulmonary sarcoidosis: comparison to chest CT. Eur J Radiol. 2013; 82(12): 2378–2385.
  64. Craig DA, Colletti PM, Ratto D, et al. MRI findings in pulmonary sarcoidosis. Magn Reson Imaging. 1988; 6(5): 567–573.
  65. Chung JH, Cox CW, Forssen AV, et al. The dark lymph node sign on magnetic resonance imaging: a novel finding in patients with sarcoidosis. J Thorac Imaging. 2014; 29(2): 125–129.
  66. Jenssen C, Annema JT, Clementsen P, et al. Ultrasound techniques in the evaluation of the mediastinum, part 2: mediastinal lymph node anatomy and diagnostic reach of ultrasound techniques, clinical work up of neoplastic and inflammatory mediastinal lymphadenopathy using ultrasound techniques and how to learn mediastinal endosonography. J Thorac Dis. 2015; 7(10): E439–E458.
  67. Erol S, Anar C, Erer OF, et al. The contribution of ultrasonographic characteristics of mediastinal lymph nodes on differential diagnosis of tuberculous lymphadenitis from sarcoidosis. Tanaffos. 2018; 17(4): 250–256.
  68. Agrawal SP, Ish P, Goel AD, et al. Diagnostic utility of endobronchial ultrasound features in differentiating malignant and benign lymph nodes. Monaldi Arch Chest Dis. 2018; 88(2): 928.
  69. Cancellieri A, Leslie KO, Tinelli C, et al. Sarcoidal granulomas in cytological specimens from intrathoracic adenopathy: morphologic characteristics and radiographic correlations. Respiration. 2013; 85(3): 244–251.
  70. Hirche TO, Hirche H, Cui XW, et al. Ultrasound evaluation of mediastinal lymphadenopathy in patients with sarcoidosis. Med Ultrason. 2014; 16(3): 194–200.
  71. Ohana M, Ludes C, Schaal M, et al. What future for chest X-ray against ultra-low-dose computed tomography? Rev Pneumol Clin. 2017; 73(1): 3–12.
  72. Martusewicz-Boros MM, Boros PW, Wiatr E, et al. Systemic treatment for sarcoidosis was needed for 16% of 1810 Caucasian patients. Clin Respir J. 2018; 12(4): 1367–1371.

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