F-18 DEOXYGLUCOSE UPTAKE IN SARCOIDOSIS MEASURED WITH POSITRON EMISSION TOMOGRAPHY

Regional pulmonary glucose metabolism (MR(glu); mu mol h(-1) g(-1)), extravascular lung density (D-EV; g cm(-3)) and vascular volume (V-B; ml cm(-3)) were measured in a single midthoracic transaxial slice (similar to 2 cm thick) using positron emission tomography (PET) in seven patients with histologically proven sarcoidosis. The measurements were repeated 1-7 months later after steroid therapy (in two cases, no treatment) in order to assess MR(glu) as an index of inflammation and relate it to routine pulmonary function tests, chest radiography and serum angiotensin converting enzyme (SACE) levels. MR(glu) was computed from serial lung scans and peripheral venous blood samples for 60 min following an i.v. injection of F-18-2-fluoro-2-deoxy-D-glucose ((18)FDG). Both MR(glu) (which was increased in six of seven patients) and elevated SACE levels returned to normal in those patients treated with high-dose steroids. Regional vascular volume was normal in six of seven cases and did not change significantly with therapy. The high tissue density measured in all patients decreased significantly in two of three patients treated with 40 mg prednisolone daily. The abnormal MR(glu) observed in active sarcoidosis becomes comes normal pari passu with SACE levels during high-dose steroid therapy. We conclude that MR(glu) measured with (18)FDG and PET may reflect ''disease activity'' in sarcoidosis in quantitative terms (per gram lung tissue) and in respect of disease distribution.