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Preliminary Report |

Depreotide Scanning in Sarcoidosis*: A Pilot Study

Andrew F. Shorr, MD, MPH, FCCP; Donald L. Helman, MD; Christopher J. Lettieri, MD; Jamie L. Montilla, MD; Robert S. Bridwell, MD
Author and Funding Information

*From the Pulmonary and Critical Care Medicine Service (Drs. Shorr, Helman, and Lettieri), Department of Medicine, and the Nuclear Medicine Service (Drs. Montilla and Bridwell), Department of Radiology, Walter Reed Army Medical Center, Washington, DC.

Correspondence to: Andrew F. Shorr, MD, MPH, FCCP, Pulmonary and Critical Care Medicine Service, Walter Reed Army Medical Center, 6900 Georgia Ave, NW, Washington, DC 20307; e-mail: afshorr@dnamail.com



Chest. 2004;126(4):1337-1343. doi:10.1378/chest.126.4.1337
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Study objectives: To determine whether sarcoidosis results in uptake on 99mTc-labeled depreotide (DP) scintigraphy and to generate preliminary data to guide the development of future trials exploring this imaging modality in sarcoidosis patients.

Design: Prospective cohort trial among a convenience sample of patients with sarcoidosis.

Setting: Tertiary care medical center pulmonary clinic.

Patients: Subjects in whom sarcoidosis has been diagnosed based on a biopsy revealing nonnecrotizing granulomas.

Interventions: Two hours after IV administration of 99mTc-DP, all patients underwent whole-body anterior and posterior planar imaging, followed by thoracic single-photon emission CT scanning. Images were interpreted by two nuclear medicine physicians who were blinded to the patient’s clinical status.

Measurements and results: The study cohort included 22 subjects (mean [± SD] age, 41.3 ± 9.3 years; 40% female). Approximately half of the cohort had stage I disease determined by chest radiographs (CXRs). The results of 99mTc-DP scintigraphy were positive for sarcoidosis in 18 individuals (81.8%; 95% confidence interval, 59.7 to 94.8%). Of the four persons lacking 99mTc-DP uptake, all had normalized their CXRs since the time of presentation. In the entire sample, the intraclass correlation between radiographic stage determined by CXR vs that determined by 99mTc-DP scintigraphy was robust (κ = 0.79; p = 0.0005). Among patients with positive 99mTc-DP scan findings, the correlation was stronger (κ = 0.94; p < 0.0001). Flow rates and lung volumes were lower in patients with parenchymal activity on 99mTc-DP scintigraphy (mean FEV1, 68.6 ± 13.9% predicted vs 84.5 ± 10.7% predicted, respectively [p = 0.012]; mean FVC, 74.0 ± 16.0% predicted vs 88.4 ± 12.7% predicted [p = 0.041]). 99mTc-DP scintigraphy correctly identified all sites of known nonpulmonary visceral involvement with sarcoidosis.

Conclusions: The results of 99mTc-DP imaging are often positive in sarcoidosis patients, and correlate with disease stage determined by CXR and pulmonary function. 99mTc-DP scintigraphy does not preclude the need for biopsy if this is indicated to confirm the diagnosis of sarcoidosis or to exclude the possibility of malignancy. 99mTc-DP scintigraphy merits further study in the evaluation and management of sarcoidosis.

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sarcoidosis

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