A predictive tool for an effective use of 18F-FDG PET in assessing activity of sarcoidosis

BMC Pulmonary Medicine

Marjolein Drent⁶  Petal AHM Wijnen⁴  Patty J Nelemans³  Marinus JPG van Kroonenburgh⁵  Johny A Verschakelen¹  Sander MJ Van Kuijk³  Rémy LM Mostard² 

[1]Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium

[2]Department of Respiratory Medicine, Atrium Medical Centre, Heerlen, The Netherlands

[3]Department of Epidemiology, University Maastricht, Maastricht, The Netherlands

[4]Department of Clinical Chemistry, Maastricht University Medical Centre, Maastricht, The Netherlands

[5]Department of Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands

[6]Faculty of Health, Medicine and Life Sciences

[7] UNS 40 room 4.550, University Maastricht The Netherlands, PO Box 3100, 6202 NC, Maastricht, The Netherlands

关键词: Sarcoidosis;    PET;    Soluble interleukin-2 receptor;    High-resolution computed tomography;    Clinical prediction rule;   

Others  :  1136352
DOI  :  10.1186/1471-2466-12-57

 received in 2012-04-07, accepted in 2012-07-12,  发布年份 2012

【 摘 要 】

Background

¹⁸F-FDG PET/CT (PET) is useful in assessing inflammatory activity in sarcoidosis. However, no appropriate indications are available. The aim of this study was to develop a prediction rule that can be used to identify symptomatic sarcoidosis patients who have a high probability of PET-positivity.

Methods

We retrospectively analyzed a cohort of sarcoidosis patients with non organ specific persistent disabling symptoms (n = 95). Results of soluble interleukin-2 receptor (sIL-2R) assessment and high-resolution computed tomography (HRCT) were included in the predefined model. HRCT scans were classified using a semi-quantitative scoring system and PET findings as positive or negative, respectively. A prediction model was derived based on logistic regression analysis. We quantified the model’s performance using measures of discrimination and calibration. Finally, we constructed a prediction rule that should be easily applicable in clinical practice.

Results

The prediction rule showed good calibration and good overall performance (goodness-of-fit test, p = 0.78, Brier score 20.1%) and discriminated between patients with positive and negative PET findings (area under the receiver-operating characteristic curve, 0.83). If a positive predictive value for the presence of inflammatory activity of ≥90% is considered acceptable for clinical decision-making without referral to PET, PET would be indicated in only 29.5% of the patients. Using a positive predictive value of 98%, about half of the patients (46.3%) would require referral to PET.

Conclusions

The derived and internally validated clinical prediction rule, based on sIL-2R levels and HRCT scoring results, appeared to be useful to identify sarcoidosis patients with a high probability of inflammatory activity. Using this rule may enable a more effective use of PET scan for assessment of inflammatory activity in sarcoidosis.

【 授权许可】

   
2012 Mostard et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

Figure 2 .

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