Imaging
Sarcoidosis
- Preliminary Diagnosis: Sarcoidosis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosing sarcoidosis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosing sarcoidosis.
- VI. What are the contraindications for the alternative imaging techniques?
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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