CT assessment of bronchi in sarcoidosis: endoscopic and pathologic correlations.

PURPOSE: To evaluate the computed tomographic (CT) appearance of bronchi in patients with sarcoidosis and to correlate CT, endoscopy, and bronchial biopsy findings. MATERIALS AND METHODS: Sixty patients with sarcoidosis underwent CT and tracheobronchial endoscopy. CT findings of abnormalities of the bronchial walls and lumina were compared with endoscopic and biopsy findings. RESULTS: CT scans showed bronchial abnormalities in 39 patients (65%). CT and endoscopic findings were concordant in only 35 cases. However, CT showed abnormal lumina in 14 patients and endoscopy showed mucosal thickening in 12 of these 14 patients. CT findings of bronchial abnormalities were associated with the presence of bronchial granulomas (P < .0001). CT scans showed that, of the 37 patients with biopsy results of granulomatosis, 84% had thickened bronchial walls and 35% had luminal abnormalities. Eight CT findings were false-positive, and six were false-negative for the presence of granulomas. CONCLUSION: Bronchial involvement in sarcoidosis was detected at CT in 65% of cases. CT can help predict whether bronchial granulomas will be found in cases of sarcoidosis.

Pulmonary sarcoidosis: CT assessment of lesion reversibility.

By comparing serial computed tomographic (CT) scans obtained when sarcoidosis was clinically active and after the onset of remission, an attempt was made to differentiate inflammatory from fibrotic lesions in the lungs of patients with sarcoidosis. Twenty patients with pulmonary infiltration seen on their chest radiographs were studied. For each patient, lesions found on the first CT scan were assessed by two observers as being decreased or increased on the second CT scan. Nodules (n = 8), irregularly marginated nodules (n = 5), and alveolar or pseudoalveolar consolidation (n = 5) always disappeared or clearly decreased. Septal lines (n = 10), nonseptal lines (n = 9), and lung distortion (n = 7) remained unchanged or increased. Some findings varied among patients: Micronodules (n = 9) and subpleural thickening (n = 5) disappeared or decreased in sarcoidosis of recent origin. Many findings of pulmonary infiltration seen on the first CT scan can be considered expressions of either inflammatory (reversible CT findings) or fibrotic (irreversible CT findings) lesions.

Urinary neopterin in pulmonary sarcoidosis. Relationship to clinical and biologic assessment of the disease.

Neopterin is a metabolite of guanosine-triphosphate, released in vitro by macrophages under the control of gamma-interferon and described as a marker of T cell activation in vivo. We have compared the urinary neopterin/creatinine ratio (mumol/mol) in patients with pulmonary sarcoidosis (n = 66), interstitial lung diseases other than sarcoidosis (nonsarcoid ILD, n = 35), and 45 normal control subjects. For the sarcoid population as a whole, urinary neopterin was higher (496 +/- 52 mumol/mol [mean +/- SEM]) than in control subjects (126 +/- 5 mumol/mol) (p less than 0.001). In patients with nonsarcoid ILD, urinary neopterin was frequently higher in granulomatous and/or lymphoproliferative diseases (hypersensitivity pneumonitis, tuberculosis, primitive Sjögren's syndrome, and malignant lymphomas) (781 +/- 193 mumol/mol, n = 10) but remained normal in other types of nonsarcoid ILD [( 163 +/- 14 mumol/mol, n = 25]: histiocytosis X, idiopathic pulmonary fibrosis, lung collagen-vascular diseases, diffuse neoplasms, pneumoconiosis; p less than 0.001 compared with sarcoidosis). We have also evaluated the relationship between urinary neopterin and the clinical or biologic markers currently used to assess sarcoidosis: alveolar lymphocytosis in lavage fluid (ALY), 67-gallium scan semiquantitative index (67Ga), or serum angiotensin-converting enzyme (SACE). Sarcoid patients with the highest urinary neopterin were those in whom mean values of these markers were the highest (p less than 0.05, all comparisons). Patients with positive markers (i.e., either clinical expression of sarcoidosis-ALY greater than 30%-67Ga greater than 20-SACE greater than 60 U/ml) had significantly higher urinary neopterin levels than did other sarcoid patients (p less than 0.05, all comparisons).