Presentation is loading. Please wait.

Presentation is loading. Please wait.

Multi-technique imaging of sarcoidosis A.Balan, E.T.D.Hoey, F.Sheerin A.Balan, E.T.D.Hoey, F.Sheerin Clinical Radiology 65(2010)750-760 Clinical Radiology.

Similar presentations


Presentation on theme: "Multi-technique imaging of sarcoidosis A.Balan, E.T.D.Hoey, F.Sheerin A.Balan, E.T.D.Hoey, F.Sheerin Clinical Radiology 65(2010)750-760 Clinical Radiology."— Presentation transcript:

1 Multi-technique imaging of sarcoidosis A.Balan, E.T.D.Hoey, F.Sheerin A.Balan, E.T.D.Hoey, F.Sheerin Clinical Radiology 65(2010) Clinical Radiology 65(2010)

2 Vocabulary Sarcoidosis 肉状瘤病, 类肉状瘤病;结节病 Sarcoidosis 肉状瘤病, 类肉状瘤病;结节病 Idiopathic 先天的 Idiopathic 先天的 hall-mark 标志 hall-mark 标志 Caseate v. 干酪化, 发生干酪样变 Caseate v. 干酪化, 发生干酪样变 Collaret n. 女用围巾, 女用领巾 Collaret n. 女用围巾, 女用领巾 Insidious adj. 阴险的 Insidious adj. 阴险的 Corticosteroid n & adj.[ 生化 ] 皮质甾类 ( 的 ), 皮质类固醇 ( 的 ) Corticosteroid n & adj.[ 生化 ] 皮质甾类 ( 的 ), 皮质类固醇 ( 的 ) Pathognomonic adj. (病征)能确定诊断的 Pathognomonic adj. (病征)能确定诊断的 erythema n. 红斑, 非冻疮 erythema n. 红斑, 非冻疮 nodous 多节的 nodous 多节的 Suffice vi. 足够, 有能力 vt. 使满足 Suffice vi. 足够, 有能力 vt. 使满足 Hilar adj.[ 解 ] 门的 Hilar adj.[ 解 ] 门的 Beading n. 玻璃珠, 珠细工 bead n. 珠子, 水珠 Beading n. 玻璃珠, 珠细工 bead n. 珠子, 水珠 Conglomeration 团块, 聚集, 混合物 Conglomeration 团块, 聚集, 混合物 Dilatation n. 扩张, 扩张术 Dilatation n. 扩张, 扩张术 Syncope n. 昏厥 Syncope n. 昏厥 Mid adj. 中央的, 中部的, 中间的 Mid adj. 中央的, 中部的, 中间的 Leptomeningeal 柔脑脊膜的 Leptomeningeal 柔脑脊膜的 Paraparesis 下身轻瘫, 下肢轻瘫 Paraparesis 下身轻瘫, 下肢轻瘫

3 Avid adj. 渴望的 Avid adj. 渴望的 Myelitis n. 脊髓炎 Myelitis n. 脊髓炎 Pachymeningeal 硬脑膜的 Pachymeningeal 硬脑膜的 Ophthalmoplegia 眼肌瘫痪, 眼肌麻痹 Ophthalmoplegia 眼肌瘫痪, 眼肌麻痹 Ophthalmic adj. 眼的, 眼科的 n. 眼药 Ophthalmic adj. 眼的, 眼科的 n. 眼药 Lacrimal adj. 泪腺的, 泪的, 满是泪水的 Lacrimal adj. 泪腺的, 泪的, 满是泪水的 Subarachnoid adj.[ 解 ] 蛛网膜下的 Subarachnoid adj.[ 解 ] 蛛网膜下的 Oculomotor adj. 眼球运动的 Oculomotor adj. 眼球运动的 Proptosis n. 突出, ( 眼球等器官 ) 前垂 Proptosis n. 突出, ( 眼球等器官 ) 前垂 Tenosynovitis 腱鞘炎 Tenosynovitis 腱鞘炎 Effusion n. 流出物, 泻出, [ 医 ] 渗出 Effusion n. 流出物, 泻出, [ 医 ] 渗出 Lacy adj. 花边的 Lacy adj. 花边的 Reticular adj. 网状的, 错综的 Reticular adj. 网状的, 错综的 Conglobate v. ( 使 ) 成球状 adj. 球状的, 圆圆的 Conglobate v. ( 使 ) 成球状 adj. 球状的, 圆圆的 diaphragmatic 横隔膜的, 隔膜的 diaphragmatic 横隔膜的, 隔膜的 merate n. 汞溴红, 红药水 merate n. 汞溴红, 红药水 Evade v. 规避, 逃避, 躲避 Evade v. 规避, 逃避, 躲避

4 introduction Sarcoidosis is an idiopathic multisystem disorder, first described by Hutchinson in Sarcoidosis is an idiopathic multisystem disorder, first described by Hutchinson in The pathological hall-mark of the disease is the non-caseating sarcoid ( 肉状的 ) granuloma ( 肉 芽肿 ), which is composed of histiocytes surrounded by a collaret of lymphocytes and mononuclear cells. The pathological hall-mark of the disease is the non-caseating sarcoid ( 肉状的 ) granuloma ( 肉 芽肿 ), which is composed of histiocytes surrounded by a collaret of lymphocytes and mononuclear cells.

5 Approximately 3000 new cases of sarcoid are diagnosed each year in the United Kingdom with an incidence of 5.0 per 100,000 person-years. Approximately 3000 new cases of sarcoid are diagnosed each year in the United Kingdom with an incidence of 5.0 per 100,000 person-years. The disease most commonly presents between the ages of 20 ~ 50 years, and although there is a worldwide distribution, a geographical preponderance ( 优势 ) is recognized for African-American, Danish ( 丹 麦的 ), and Swedish populations. The disease most commonly presents between the ages of 20 ~ 50 years, and although there is a worldwide distribution, a geographical preponderance ( 优势 ) is recognized for African-American, Danish ( 丹 麦的 ), and Swedish populations.

6 The lungs and intrathoracic lymph nodes are almost always involved and although patients may be asymptomatic, sarcoidosis most often presents with insidious respiratory and systemic symptoms, such as fatigue ( 乏力 ), weight loss, and fever. The lungs and intrathoracic lymph nodes are almost always involved and although patients may be asymptomatic, sarcoidosis most often presents with insidious respiratory and systemic symptoms, such as fatigue ( 乏力 ), weight loss, and fever. Extrathoracic manifestations, present in 25 ~ 50% of cases, are usually associated with intrathoracic disease. Extrathoracic manifestations, present in 25 ~ 50% of cases, are usually associated with intrathoracic disease.

7 There is a spontaneous remission rate of 40 ~ 90% in those with limited stage disease, and systemic treatment with corticosteroids or chemotherapy is usually reserved for patients with progressive pulmonary involvement or critical organ dysfunction. There is a spontaneous remission rate of 40 ~ 90% in those with limited stage disease, and systemic treatment with corticosteroids or chemotherapy is usually reserved for patients with progressive pulmonary involvement or critical organ dysfunction.

8 confirmation of the diagnosis usually requires histological proof; occasionally, appropriate imaging features coupled with compatible clinical findings may suffice. confirmation of the diagnosis usually requires histological proof; occasionally, appropriate imaging features coupled with compatible clinical findings may suffice. Recognition of the varied radiological features of this condition not only plays a vital role in aiding diagnosis, but can also provide prognostic information as well as guiding therapy. Recognition of the varied radiological features of this condition not only plays a vital role in aiding diagnosis, but can also provide prognostic information as well as guiding therapy.

9 Figure 1 Chest radiographic findings in sarcoidosis (stage 2 disease). Chest radiographic findings in sarcoidosis (stage 2 disease). Plain chest radiograph shows bilateral symmetric hilar and right paratracheal lymphadenopathy (淋巴结病) with diffusely distributed small nodules throughout both lungs. Plain chest radiograph shows bilateral symmetric hilar and right paratracheal lymphadenopathy (淋巴结病) with diffusely distributed small nodules throughout both lungs.

10 Figure 2 Typical high-resolution CT (HRCT) findings in sarcoidosis. Typical high-resolution CT (HRCT) findings in sarcoidosis. Axial, high-resolution CT image shows nodules in a characteristic perilymphatic and subpleural distribution with “beading” of the fissures. Axial, high-resolution CT image shows nodules in a characteristic perilymphatic and subpleural distribution with “beading” of the fissures.

11 Figure 3 Advanced pulmonary sarcoidosis (stage 4 disease). (a) Plain chest radiograph shows advanced pulmonary sarcoidosis with loss of lung volume and fibrosis. (b) Axial, high-resolution CT image in the same patient depicts abnormal conglomeration of peribronchovascular structures in the upper lobes associated with tractional airways dilatation in keeping with pulmonary fibrosis.

12 Figure 4 Cardiac magnetic resonance (CMR) demonstration of endomyocardial sarcoidosis. A female patient with known pulmonary sarcoidosis was under investigation for episodes of pre-syncope. Delayed enhancement inversion recovery images obtained 12 min following a bolus of 0.1 mmol/kg intravenous gadolinium. a) Axial image showing a focus of mid wall enhancement (arrow) in the basal interventricular septum and further nodular foci in the lateral wall. a) Axial image showing a focus of mid wall enhancement (arrow) in the basal interventricular septum and further nodular foci in the lateral wall.

13 (b) Left ventricular short axis image at mid-ventricular level showing mid wall enhancement (arrow) along the interventricular septum. (b) Left ventricular short axis image at mid-ventricular level showing mid wall enhancement (arrow) along the interventricular septum. These findings in conjunction with the clinical history were sufficient to establish a diagnosis of sarcoid heart disease without the need for endomyocardial biopsy. (LV, left ventricle) These findings in conjunction with the clinical history were sufficient to establish a diagnosis of sarcoid heart disease without the need for endomyocardial biopsy. (LV, left ventricle)

14 Figure 5 Leptomeningeal sarcoid resulting in myelitis. A patient with systemic sarcoid presented with a subacute paraparesis. Contrast- enhanced T1-weighted image (a) demonstrates avid nodular infiltrate over the pial (软膜的) surface of the spinal cord and brainstem. (a) demonstrates avid nodular infiltrate over the pial (软膜的) surface of the spinal cord and brainstem. A T2-weighted image in the same plane A T2-weighted image in the same plane

15 (b) shows high signal and slight expansion of the cord due to a secondary myelitis (脊 髓炎). (b) shows high signal and slight expansion of the cord due to a secondary myelitis (脊 髓炎).

16 Figure 6 Pachymeningeal sarcoid. Pachymeningeal sarcoid. A male patient with pulmonary sarcoid presented with ophthalmoplegia and headaches. An axial contrast-enhanced, T1- weighted MRI image demonstrates marked thickening of the tentorial dura extending into the cavernous sinuses (arrows). A male patient with pulmonary sarcoid presented with ophthalmoplegia and headaches. An axial contrast-enhanced, T1- weighted MRI image demonstrates marked thickening of the tentorial dura extending into the cavernous sinuses (arrows). Appearances are typical of pachymeningeal sarcoid. Appearances are typical of pachymeningeal sarcoid.

17 Figure 7 Ophthalmic manifestations of sarcoid. Four gadolinium-enhanced T1-weighted images demonstrate the typical MRI appearances of ophthalmic sarcoid in different patients: Figure 7 Ophthalmic manifestations of sarcoid. Four gadolinium-enhanced T1-weighted images demonstrate the typical MRI appearances of ophthalmic sarcoid in different patients: (a) marked enlargement and enhancement of the lacrimal glands (thick arrows) secondary to sarcoid infiltration (a) marked enlargement and enhancement of the lacrimal glands (thick arrows) secondary to sarcoid infiltration

18 (b) expanded enhancing optic nerve (arrowhead) typical for sarcoid infiltration (the differential includes meningioma and lymphoma. (b) expanded enhancing optic nerve (arrowhead) typical for sarcoid infiltration (the differential includes meningioma and lymphoma.

19 (c) marked enhancement of the subarachnoid portion of the oculomotor nerve on the left (thin arrows) typical for sarcoid. (c) marked enhancement of the subarachnoid portion of the oculomotor nerve on the left (thin arrows) typical for sarcoid.

20 (d) mass-like enlargement of the superior and lateral rectus muscles (curved arrow) in a patient with proptosis. (d) mass-like enlargement of the superior and lateral rectus muscles (curved arrow) in a patient with proptosis. Features are typical of sarcoid, but this is indistinguishable from lymphoma and orbital pseudotumour on imaging. Features are typical of sarcoid, but this is indistinguishable from lymphoma and orbital pseudotumour on imaging.

21 Figure 8 MRI images of large joint sarcoid arthropathy. (a) Sagittal and (b) axial, T2- weighted, fat-suppressed, MRI sequences show marked tenosynovitis (arrows) and ankle arthropathy with effusion (arrowhead) in a young male with a 6-week history of bilateral ankle swelling. Ultrasound-guided biopsy confirmed the presence of multiple non-caseating granulomas consistent with sarcoid arthropathy. (a) Sagittal and (b) axial, T2- weighted, fat-suppressed, MRI sequences show marked tenosynovitis (arrows) and ankle arthropathy with effusion (arrowhead) in a young male with a 6-week history of bilateral ankle swelling. Ultrasound-guided biopsy confirmed the presence of multiple non-caseating granulomas consistent with sarcoid arthropathy.

22 Figure 9 Osseous involvement in sarcoidosis. Osseous involvement in sarcoidosis. Plain radiograph of the foot in a patient with biopsy-confirmed pulmonary sarcoidosis shows multiple lucent lesions in the phalanges, resulting in the “lacy” reticular pattern that is characteristic of osseous sarcoidosis. Plain radiograph of the foot in a patient with biopsy-confirmed pulmonary sarcoidosis shows multiple lucent lesions in the phalanges, resulting in the “lacy” reticular pattern that is characteristic of osseous sarcoidosis.

23 Figure 10 Gastrointestinal manifestations of sarcoidosis demonstrated on multidetector CT. (a) Contrast-enhanced axial CT image in a female with biopsy- proven pulmonary sarcoidosis and abnormal liver function tests shows multiple small, ill-defined, low-attenuation lesions in the liver and more conglomerate areas of low-attenuation throughout the spleen, representing coalescing (接合) granulomas. (a) Contrast-enhanced axial CT image in a female with biopsy- proven pulmonary sarcoidosis and abnormal liver function tests shows multiple small, ill-defined, low-attenuation lesions in the liver and more conglomerate areas of low-attenuation throughout the spleen, representing coalescing (接合) granulomas.

24 (b) Following completion of a course of corticosteroid therapy, there was complete resolution of the previously demonstrated abnormalities. (b) Following completion of a course of corticosteroid therapy, there was complete resolution of the previously demonstrated abnormalities.

25 Figure 11 Ultrasound features of soft-tissue sarcoidosis. Ultrasound features of soft-tissue sarcoidosis. Ultrasound shows a hypoechoic, subcutaneous nodule exhibiting colour Doppler flow in a young adult presenting with a lump on the thigh. Ultrasound shows a hypoechoic, subcutaneous nodule exhibiting colour Doppler flow in a young adult presenting with a lump on the thigh. This was histologically proven to be a sarcoid granuloma. This was histologically proven to be a sarcoid granuloma.

26 Figure 12 Disseminated sarcoidosis on FDG PET/CT. (a) FDG PET maximum intensity projection (MIP) image in a patient with biopsy-proven sarcoidosis shows moderate FDG uptake in bilateral hilar, right paratracheal, and mediastinal nodes (large arrow) as well as focal areas of increased tracer activity in the spleen (small arrow) and bilateral FDG-avid pelvic lymph nodes (arrowheads) (a) FDG PET maximum intensity projection (MIP) image in a patient with biopsy-proven sarcoidosis shows moderate FDG uptake in bilateral hilar, right paratracheal, and mediastinal nodes (large arrow) as well as focal areas of increased tracer activity in the spleen (small arrow) and bilateral FDG-avid pelvic lymph nodes (arrowheads)

27 (b) Coronal fused PET/CT image shows FDG-avid right apical lung nodules (arrow). (b) Coronal fused PET/CT image shows FDG-avid right apical lung nodules (arrow).

28 (c) Axial fused PET/CT image confirms a markedly hypermetabolic splenic lesion (arrow). (c) Axial fused PET/CT image confirms a markedly hypermetabolic splenic lesion (arrow). The splenic and sub-diaphragmatic disease had evaded detection by conventional imaging The splenic and sub-diaphragmatic disease had evaded detection by conventional imaging

29 Figure 13 Disease response assessment in sarcoidosis with FDG PET. FDG PET maximum intensity projection (MIP) images (a) before and (b) after corticosteroid therapy in a patient with biopsy-proven sarcoidosis show complete resolution of markedly hypermetabolic and extensive mediastinal nodal disease (arrows) and apical pulmonarynodules (arrowhead), representing a complete metabolic response to therapy. (a) before and (b) after corticosteroid therapy in a patient with biopsy-proven sarcoidosis show complete resolution of markedly hypermetabolic and extensive mediastinal nodal disease (arrows) and apical pulmonarynodules (arrowhead), representing a complete metabolic response to therapy.

30 Conclusion Sarcoidosis is an important multisystem disorder with protean ( 多变的 ) imaging manifestations. Sarcoidosis is an important multisystem disorder with protean ( 多变的 ) imaging manifestations. It is important for the radiologist to recognize the typical and more unusual features of this disease across a variety of imaging techniques in order to suggest the diagnosis in the appropriate clinical setting. It is important for the radiologist to recognize the typical and more unusual features of this disease across a variety of imaging techniques in order to suggest the diagnosis in the appropriate clinical setting.


Download ppt "Multi-technique imaging of sarcoidosis A.Balan, E.T.D.Hoey, F.Sheerin A.Balan, E.T.D.Hoey, F.Sheerin Clinical Radiology 65(2010)750-760 Clinical Radiology."

Similar presentations


Ads by Google