Imaging Features of Sarcoidosis on MDCT, FDG PET, and PET/CT
Hima B. Prabhakar1,
Chad B. Rabinowitz1,
Fiona K. Gibbons2,
Walter J. O'Donnell2,
Jo-Anne O. Shepard3 and
Suzanne L. Aquino3
1 Abdominal Imaging and Interventional Radiology, Department of Radiology,
Massachusetts General Hospital, 55 Fruit St., FND 270, Boston, MA 02114.
2 Department of Pulmonary/Critical Care Medicine, Massachusetts General
Hospital, Boston, MA.
3 Thoracic Radiology, Department of Radiology, Massachusetts General Hospital,
Boston, MA.
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Fig. 2 —Pulmonary nodules in peribronchovascular distribution in
44-year-old woman with sarcoidosis. High-resolution chest CT image shows
multiple tiny pulmonary nodules centered in peribronchovascular distribution
(upper arrow). Small pulmonary nodules can also be seen lining right
major fissure (lower arrow).
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Fig. 4 —Lambda ( ) sign on 67Ga scan in 26-year-old
man with biopsy-proven sarcoidosis. Anterior image of chest shows increased
tracer uptake in right paratracheal and bilateral hilar lymph nodes, in
configuration known as "lambda sign."
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Fig. 5 —Palpable submental lymph node with FDG uptake in 56-year-old
woman with palpable submental lymph node. Axial fused contrast-enhanced PET/CT
image shows enlarged left submental lymph node (arrow) with increased
FDG uptake. Lesion was biopsied and was consistent with sarcoidosis.
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Fig. 6A —Confluent parenchymal lung nodules and mediastinal and
bilateral hilar lymphadenopathy with increased FDG uptake in 56-year-old woman
with biopsy-proven sarcoidosis. Axial CT image (A) shows confluent
parenchymal lung nodules (yellow arrows) and mediastinal and
bilateral hilar lymphadenopathy (blue arrows). These abnormalities
show increased FDG uptake on fused PET/CT (B) and unfused PET
(C) images.
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Fig. 6B —Confluent parenchymal lung nodules and mediastinal and
bilateral hilar lymphadenopathy with increased FDG uptake in 56-year-old woman
with biopsy-proven sarcoidosis. Axial CT image (A) shows confluent
parenchymal lung nodules (yellow arrows) and mediastinal and
bilateral hilar lymphadenopathy (blue arrows). These abnormalities
show increased FDG uptake on fused PET/CT (B) and unfused PET
(C) images.
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Fig. 6C —Confluent parenchymal lung nodules and mediastinal and
bilateral hilar lymphadenopathy with increased FDG uptake in 56-year-old woman
with biopsy-proven sarcoidosis. Axial CT image (A) shows confluent
parenchymal lung nodules (yellow arrows) and mediastinal and
bilateral hilar lymphadenopathy (blue arrows). These abnormalities
show increased FDG uptake on fused PET/CT (B) and unfused PET
(C) images.
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Fig. 7A —Splenic lesions with uptake from sarcoidosis in 43-year-old
woman with history of Hodgkin's lymphoma. Images from combined PET/CT show
low-density lesions (arrows, A and C) in spleen on
coronal CT image (A). Lesions show increased FDG uptake on fused PET/CT
(B) and unfused PET (C) images. Because of patient's history of
lymphoma, she underwent splenectomy to assess cause of lesion, and pathology
revealed noncaseating granulomas consistent with sarcoidosis. Sarcoidosis is
known to cause splenomegaly and low-density focal lesions in the spleen and
has been reported to have increased FDG uptake on PET scans
[11].
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Fig. 7B —Splenic lesions with uptake from sarcoidosis in 43-year-old
woman with history of Hodgkin's lymphoma. Images from combined PET/CT show
low-density lesions (arrows, A and C) in spleen on
coronal CT image (A). Lesions show increased FDG uptake on fused PET/CT
(B) and unfused PET (C) images. Because of patient's history of
lymphoma, she underwent splenectomy to assess cause of lesion, and pathology
revealed noncaseating granulomas consistent with sarcoidosis. Sarcoidosis is
known to cause splenomegaly and low-density focal lesions in the spleen and
has been reported to have increased FDG uptake on PET scans
[11].
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Fig. 7C —Splenic lesions with uptake from sarcoidosis in 43-year-old
woman with history of Hodgkin's lymphoma. Images from combined PET/CT show
low-density lesions (arrows, A and C) in spleen on
coronal CT image (A). Lesions show increased FDG uptake on fused PET/CT
(B) and unfused PET (C) images. Because of patient's history of
lymphoma, she underwent splenectomy to assess cause of lesion, and pathology
revealed noncaseating granulomas consistent with sarcoidosis. Sarcoidosis is
known to cause splenomegaly and low-density focal lesions in the spleen and
has been reported to have increased FDG uptake on PET scans
[11].
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Fig. 8A —Skeletal uptake in 56-year-old woman with known sarcoidosis
in neck, who presented with pelvic bone pain. Images from combined PET/CT scan
show multiple subtle sclerotic lesions (arrows) in bilateral iliac
bones on axial CT image (A). These lesions show increased FDG uptake on
fused PET/CT (B) and unfused PET (C) images. Biopsy of left
iliac bone lesion was consistent with sarcoidosis.
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Fig. 8B —Skeletal uptake in 56-year-old woman with known sarcoidosis
in neck, who presented with pelvic bone pain. Images from combined PET/CT scan
show multiple subtle sclerotic lesions (arrows) in bilateral iliac
bones on axial CT image (A). These lesions show increased FDG uptake on
fused PET/CT (B) and unfused PET (C) images. Biopsy of left
iliac bone lesion was consistent with sarcoidosis.
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Fig. 8C —Skeletal uptake in 56-year-old woman with known sarcoidosis
in neck, who presented with pelvic bone pain. Images from combined PET/CT scan
show multiple subtle sclerotic lesions (arrows) in bilateral iliac
bones on axial CT image (A). These lesions show increased FDG uptake on
fused PET/CT (B) and unfused PET (C) images. Biopsy of left
iliac bone lesion was consistent with sarcoidosis.
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Fig. 9 —Follicular lymphoma and asymptomatic pulmonary sarcoidosis in
44-year-old woman with history of grade 3 follicular lymphoma that is now in
remission. Patient underwent transbronchial biopsy to evaluate small lymph
nodes in chest, which revealed noncaseating granulomas consistent with
sarcoidosis. Whole-body PET image shows marked FDG uptake in bilateral axillae
and left paratracheal regions (upper arrows), as well as in abdomen
(lower arrows). Distribution of adenopathy is more consistent with
lymphoma than with sarcoidosis, especially because of lack of significant
hilar or mediastinal lymphadenopathy. Biopsy of left axillary lymph node
revealed follicular lymphoma.
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Copyright © 2008 by the American Roentgen Ray Society.
