Preliminary Diagnosis: Sarcoidosis
I. What imaging technique is first-line for this diagnosis?
Plain radiography.
II. Describe the advantages and disadvantages of this technique for diagnosing sarcoidosis.
Advantages
- Highly portable and quick imaging modality.
- Exposes patients to negligible ionizing radiation.
Disadvantages
- Poorly sensitive and limited specificity in evaluating for sarcoidosis.
- Does not help in treatment, therapy, or percutaneous intervention.
- Limited in evaluating the surrounding soft tissues, osseous structures, and vasculature.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant women.
IV. What alternative imaging techniques are available?
- CT imaging with IV contrast.
- MR imaging with IV contrast.
- Nuclear medicine scan, including Gallium 67 nuclear medicine imaging.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing sarcoidosis.
CT imaging with IV contrast
Advantages
- Highly sensitive and specific in evaluating for sarcoidosis.
- Offers better evaluation of the surrounding soft tissues, osseous structures, and vasculature than other imaging modalities.
- CT imaging with contrast may better evaluate the extension of disease.
- Helps guide percutaneous intervention, treatment, and therapy.
Disadvantages
- Exposes patients to larger amounts of ionizing radiation than plain radiography.
MR imaging with IV contrast
Advantages
- Offers exquisite visualization of the surrounding soft tissues.
- MR imaging with contrast offers exquisite visualization of the extension of soft tissue abnormality.
- Does not expose patients to ionizing radiation.
Disadvantages
- Limited in evaluating the surrounding osseous structures.
- Less adept in guiding percutaneous intervention, treatment, and therapy.
- Less adept in detailing subtle areas of mineralization to suggest granulomatous disease.
- Expensive.
- Time consuming.
- Requires significant patient cooperation to minimize motion artifact.
Nuclear medicine scan including Gallium 67 nuclear medicine imaging
Advantages
- Moderately sensitive and moderately specific in diagnosing and detecting sarcoidosis affecting the salivary glands and the intrathoracic lymph nodes (panda and lambda signs).
Disadvantages
- Offers limited detail of the surrounding soft tissues, osseous structures, and vasculature.
- Less adept in guiding percutaneous intervention, treatment, and therapy than other imaging modalities.
- Exposes patients to ionizing radiation.
- May be contraindicated in pregnant patients or those that are breastfeeding.
VI. What are the contraindications for the alternative imaging techniques?
CT imaging with IV contrast
- May be contraindicated in pregnant patients.
- Relative contraindication of IV contrast in patients with renal failure or contrast allergy.
MR imaging with IV contrast
- Contraindicated in patients with non-MR compatible hardware.
Nuclear medicine scan including Gallium 67 nuclear medicine imaging
- May be contraindicated in patients who are pregnant or those that are breastfeeding.
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