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Cilj ove prospektivne studije je da proceni korisnost pozitronske emisione tomografije u detekciji inflamacije, kliničkom odlučivanju i evaluaciji terapijskog odgovora kod pacijenata sa hroničnom sarkoidozom. Specifični ciljevi su bili: da se utvrdi razlika između nalaza 18-fluor deoksi glukoze sa pozitronskom emisionom tomografijom i sa kompjuterizovanom tomografijom (18F-FDG PET/CT) i multi detektorskog skenera (MDCT); da se uporede nalazi 18F-FDG PET/CT sa nivoima serumskog angiotenzin konvertujućeg enzima (ACE); da se utvrdi značaj 18F-FDG PET/CT rezultata na dalju odluku o promeni terapije; da se uoče razlike između prvog i kontrolnog nalaza 18F- FDG PET/CT i da se koreliraju rezultati kontrolnog 18F-FDG PET/CT i kontrolnih vrednosti ACE sa kliničkim simptomima bolesti. Metodologija: Studijsku populaciju je činilo 90 pacijenata sa hroničnom sarkoidozom (47 ± 12 god. ; 32 muškarca i 58 žena) sa perzistentnim simptomima bolesti koji su upućeni na 18F-FDG PET/CT pregled radi evaluacije raširenosti bolesti. Svi pacijenti su takođe uradili MDCT i biohemijske analize serumskog ACE. Nakon 12 ± 6, 5 meseci od prvog 18F-FDG PET/CT pregleda, obavljen je kontrolni pregled kod pulmologa i prikupljani su podaci o simptomima bolesti, promeni terapije i vrednostima ACE kod ovih pacijenata. Na kontrolni 18F-FDG PET/CT pregled je došlo 30 pacijenata (45 ± 11 god; 10 muškaraca i 20 žena) sa prethodnim patološkim nalazom na prvom 18F-FDG PET/CT, kojima je nakon toga bila promenjena terapija. Rezultati: 18F-FDG PET/CT je detektovao aktivnu inflamaciju kod 74 pacijenta (82%) (SUV max 8,1 ± 3,9). MDCT je bio pozitivan kod još 6 pacijenata (80, 89%). Razlika među ovim dijagnostičkim metodama nije bila značajna (P = 0,238, McNemar-ov test), a njihovo slaganje je bilo osrednje (k = 0,198). Iako je ACE bio značajno viši kod pacijenata sa pozitivnim od onih sa negativnim 18F-FDG PET/CT rezultatom (P = 0,002, Mann–Whitney test), 38 pacijenenata (51%) sa pozitivnim 18F-FDG PET/CT rezultatom je imalo normalne vrednosti ACE. Terapija je uvedena ili promenjena kod 73 pacijenta (81%) koji su imali pozitivan nalaz 18F-FDG PET/CT. I univarijantna i multivarijantna logistička regresija su pokazale da je pozitivan nalaz 18F-FDG PET/CT značajno uticao na promenu terapije (P < 0,001) dok starost, pol, nivo ACE, MDCT rezultat, prethodna terapija nisu imali uticaja... The purpose of this prospective study was to assess the utility of positron emission tomography with 18-fluor fluorodeoxyglucose and with computed tomography (18F-FDG PET/CT) in detection of inflammation, clinical management and evaluation of treatment response of patients with chronic sarcoidosis. Specific aims were to determine differences between 18F-FDG PET/CT and multidetector computed tomography (MDCT) findings, to compare 18F-FDG PET/CT results with serum levels of angiotensinconverting enzyme (ACE), assess whether 18F-FDG PET/CT findings are associated with the decision to change therapy; to asses difference between first and follow up 18F-FDG PET/CT results in order to detect residual activity of the disease and to correlate 18F-FDG PET/CT findings and ACE levels with clinical symptoms of disease. Methods: We studied 90 sarcoidosis patients (47 ± 12 yr. ; 32 men and 58 women) with persistent symptoms who were referred for 18F-FDG PET/CT evaluation to assess the extent of inflammation. They also underwent MDCT and measurement of serum ACE level. After the followup (12 ± 6, 5 mo. after 18F-FDG PET/CT), the clinical status and changes in therapy were analyzed, and 30 patients (45 ± 11 yr. ;10 men and 20 women) with previous positive findings and changed therapy came to follow up 18F-FDG PET/CT examination. Results: 18F-FDG PET/CT detected inflammation in 74 patients (82%), (SUV max 8,1 ± 3,9). MDCT was positive for sarcoidosis in 6 additional patients (80, 89%). The difference between the 2 methods was not significant (P = 0,238, McNemar test), and their agreement was fair (k = 0,198). Although ACE levels were significantly higher in patients with positive than negative 18F-FDG PET/CT results (P = 0,002, Mann– Whitney test), 38 patients (51%) with positive 18F-FDG PET/CT results had normal ACE levels. The therapy was initiated or changed in 73 patients (81%) who showed positive 18F-FDG PET/CT results. Both univariate and multivariate logistic regression analyses indicated that positive 18F-FDG PET/CT results were significantly (P < 0,001) associated with changes in therapy, with no contribution from age, sex, ACE level, CT results, or previous therapy...

Cilj: Koronarna angiografija pomoću kompjuterizovane tomografije (MSCT) omogućava uvid u morfološke karakteristike koronarne okluzivne bolesti, ali sa otežanom preciznom kvantifikacijom aterosklerotskih lezija. Transtorakalna Doppler ehokardiografija (TTDE) procenjuje funkcionalni značaj aterosklerotskih lezija. Tokom studije smo pokušali da procenimo aditivni dijagnostički i prognostički značaj koronarne rezerve protoka (CFR) određene putem TTDE kod bolesnika sa prethodno detektovanim aterosklerotskim lezijama putem MSCT na prednje descedentoj arteriji (LAD) i desnoj koronaroj arteriji (RCA), koristeći invazivnu koronarografiju (IK) kao referenti metod. Metode: Prospektivna studija je obuhvatila 84 bolesnika, u stabilnom kardijalnom statusu, sa prethodno verfikovanim koronarnim stenozama na LAD i/ili RCA putem MSCT. TTDE procena CFR-a sa adenozinom je izvršena na LAD (n=75); RCA (n=61), ukupno 136 arterija, IK je sprovedena kod svih bolesnika 24 do 48 sati posle TTDE-CFR-a. Rezultati: Analiza Cochran Q testom je uočila statistički značajnu razliku između tehnika pri detekciji signifikantnih stenoza na LAD i RCA (p0.05). MSCT je imala senzitivnost za LAD:88.00%; RCA:86.21, specifičnost LAD:57.63%; RCA:69.10%, pozitivna LAD:46.81%; RCA:59.52% i negativna predikativna vrednost LAD:91.19%; RCA:90.48%, dijagnostička pouzdanost LAD:66.67%; RCA:75.00% pri detekciji signifikatnih stenoza... Purpose: Multi-slice computed coronary angiography (MSCT) provides morphological information about coronary artery disease, but precise quantification of stenosis remains difficult. Transthoracic color Doppler Echocardiography (TDE) gives insight into the functional significance of coronary stenosis. We have tried to assess the additive diagnostic and prognostic value of coronary flow reserve (CFR) determined by TDE over MSCT in prediction of significant stenosis on the left anterior descending artery (LAD) and right coronary artery (RCA) using invasive coronary angiography (ICA) as reference method. Methods: This prospective study included 84 patients, in stable cardiac status, with previously detected atherosclerotic lesions on LAD and/or RCA by MSCT. CFR assessment by TDE with adenosine was obtained in LAD (n=75); RCA (n=61), resulting in 136 vessels for analysis. ICA was preformed to all 24 to 48 hours after CFR. Results: Cochrans Q test found a significant statistical difference between these techniques in detection of a significant stenosis on LAD and RCA (p0.05). MSCT had sensitivity LAD:88.00%; RCA:86.21, specificity LAD:57.63%; RCA:69.10%, positive LAD:46.81%; RCA:59.52% and negative predictive value LAD:91.19%; RCA:90.48%, diagnostic accuracy LAD:66.67%; RCA:75.00% in detection of significant stenosis. When the results of both methods were agreed diagnostic accuracy was improved LAD 97.33%; RCA 90.00%.