Hybrid Imaging in Evaluation of Abdominal Sarcoidosis

Author(s): Isidora Grozdic Milojevic*, Dragana Sobic-Saranovic, Nebojsa Petrovic, Slobodanka Beatovic, Marijana Tadic, Vera M. Artiko

Journal Name: Current Medical Imaging
Formerly: Current Medical Imaging Reviews

Volume 15 , Issue 1 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Objective: To determine the prevalence of abdominal involvement, distribution pattern and evaluate role of hybrid molecular imaging in patients with abdominal sarcoidosis.

Methods: Between January 2010 and December 2011, 98 patients with chronic sarcoidosis and presence of prolonged symptoms or other findings suggestive of active disease were referred to FDG PET/CT examination. Active disease was found in 82 patients, and they all were screened for the presence of abdominal sarcoidosis on FDG PET/CT. All patients also underwent MDCT and assessment of serum ACE level. Follow up FDG PET/CT examination was done 12.3±5.4 months after the baseline.

Results: Abdominal sarcoidosis was present in 31/82 patients with active sarcoidosis. FDG uptake was present in: retroperitoneal lymph nodes (77%), liver (26%), spleen (23%), adrenal gland (3%). Majority of patients had more than two locations of disease. Usually thoracic disease was spread into the extrathoracic localizations, while isolated abdominal sarcoidosis was present in 10% of patients. After first FDG PET/CT examination therapy was changed in all patients. Eleven patients came to the follow up examination where SUVmax significantly decreased in the majority of them. Three patients had total remission, three had absence of abdominal disease but discrete findings in thorax and others had less spread disease. ACE levels did not correlate with SUVmax level.

Conclusion: FDG PET/CT can be a useful tool for detection of abdominal sarcoidosis and in the evaluation of therapy response in these patients. Awareness of the presence of intra-abdominal sarcoidosis is important in order to prevent long-standing unrecognized disease.

Keywords: FDG PET/CT, chronic sarcoidosis, abdominal sarcoidosis, SUVmax, ACE, patients.

Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med 2007; 357: 2153-65.
Smith H, Ranschaert E, et al. Sarcoidosis (Abdominal manifestations). Available from: . https://radiopaedia.org/articles/sarcoidosis-abdominal-manifestations-1
Malaisamy S, Dalal B, Bimenyuy C, Soubani AO. The Clinical and radiologic features of nodular pulmonary sarcoidosis. Lung 2009; 187: 9-15.
Warshauer DM, Lee JK. Imaging manifestations of abdominal sarcoidosis. AJR Am J Roentgenol 2004; 182(1): 15-28.
Jung G, Brill N, Poll LW, Koch JA, Wettstein M. MRI of hepatic sarcoidosis: Large confluent lesions mimicking malignancy. AJR Am J Roentgenol 2004; 183(1): 171-3.
Lynch JP III, Sharma OP, Baughman RP. Extrapulmonary sarcoidosis. Semin Respir Infect 1998; 13(3): 229-54.
Gezer NS, Başara I, Altay C, et al. Abdominal sarcoidosis: Cross-sectional imaging findings. Diagn Interv Radiol 2015; 21(2): 111-7.
Prabhakar HB, Rabinowitz CB, Gibbons FK, O’Donnell WJ, Shepard JA, Aquino SL. Imaging features of sarcoidosis on MDCT, FDG PET, and PET/CT. AJR Am J Roentgenol 2008; 190(Suppl. 3): S1-6.
Cox CE, Davis-Allen A, Judson MA. Sarcoidosis. Med Clin North Am 2005; 89: 817-28.
McGrath DS, Foley PJ, Petrek M, et al. Ace gene I/D polymorphism and sarcoidosis pulmonary disease severity. Am J Respir Crit Care Med 2001; 164: 197-201.
Akira M, Kozuka T, Inoue Y, Sakatani M. Long-term follow-up CT scan evaluation in patients with pulmonary sarcoidosis. Chest 2005; 127: 185-91.
El-Haddad G, Zhuang H, Gupta N, Alavi A. Evolving role of positron emission tomography in the management of patients with inflammatory and other benign disorders. Semin Nucl Med 2004; 34(4): 313-29.
Gotthardt M, Bleeker-Rovers CP, Boerman OC, Oyen WJ. Imaging of inflammation by PET, conventional scintigraphy, and other imaging techniques. J Nucl Med 2010; 51(12): 1937-49.
Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. Radiographics 2005; 25: 1357-68.
Grozdic MIT, Milojevic B, Sobic-Saranovic DP, Artiko VM. Impact of hybrid molecular imaging in retroperitoneal fibrosis: A systematic review. Rheumatol Int 2018; 38(2): 179-87.
Yudistiro R, Arisaka Y, Tokue A, Nakajima T. Differentiation of sarcoidosis-lymphoma syndrome lesions: A case report on the use of two different positron emission tomography tracers. BMC Med Imaging 2016; 16: 1.
Mostard RLM, Voo S, van Kroonenburgh MJ, Verschakelen JA, Wijnen PA, Nelemans PJ, et al. Inflammatory activity assessment by F18 FDG-PET/CT in persistent symptomatic sarcoidosis. Respir Med 2011; 105: 1917-24.
Kapoor V, McCook BM, Torok FS. An introduction to PET-CT imaging. Radiographics 2004; 24: 523-43.
Sobic-Saranovic D, Grozdic I, Videnovic-Ivanovic J, et al. The utility of 18F- fluoro-deoxy-glucose PET/CT for diagnosis and adjustment of therapy in patients with active chronic sarcoidosis. J Nucl Med 2012; 53(10): 1543-9.
Sobic-Saranovic D, Grozdic I, Videnovic-Ivanov J, et al. Responsiveness of FDG PET/CT to treatment of patients with active chronic sarcoidosis. Clin Nucl Med 2013; 38(7): 516-21.
Grozdic MI, Sobic-Saranovic D, Videnovic-Ivanov J, Saranovic D, Odalovic S, Artiko V. FDG PET/CT in bone sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33(1): 66-74.
Paramothayan S, Lasserson T. Treatments for pulmonary sarcoidosis. Respir Med 2008; 102: 1-9.
Tonkopi E, Ross AA, MacDonald A. Journal club: CT dose optimization for whole-body PET/CT examinations. AJR Am J Roentgenol 2013; 201(2): 257-63.

Rights & PermissionsPrintExport Cite as

Article Details

Year: 2019
Page: [26 - 31]
Pages: 6
DOI: 10.2174/1573405614666180531111616
Price: $65

Article Metrics

PDF: 20