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Aoki H, Miyazaki Y, Anzai T, Yokoyama K, Tsuchiya J, Shirai T, Shibata S, Sakakibara R, Mitsumura T, Honda T, Furusawa H, Okamoto T, Tateishi T, Tamaoka M, Yamamoto M, Takahashi K, Tateishi U, Yamaguchi T. Deep convolutional neural network for differentiating between sarcoidosis and lymphoma based on [ 18F]FDG maximum-intensity projection images. Eur Radiol 2024; 34:374-383. [PMID: 37535157 DOI: 10.1007/s00330-023-09937-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/10/2023] [Accepted: 01/29/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES To compare the [18F]FDG PET/CT findings of untreated sarcoidosis and malignant lymphoma (ML) and develop convolutional neural network (CNN) models to differentiate between these diseases using maximum intensity projection (MIP) [18F]FDG PET images. METHODS We retrospectively collected data on consecutive patients newly diagnosed with sarcoidosis and ML who underwent [18F]FDG PET/CT before treatment. Two nuclear radiologists reviewed the images. CNN models were created using MIP PET images and evaluated with k-fold cross-validation. The points of interest were visualized using gradient-weighted class activation mapping (Grad-CAM). RESULTS A total of 56 patients with sarcoidosis and 62 patients with ML were included. Patients with sarcoidosis had more prominent FDG accumulation in the mediastinal lymph nodes and lung lesions, while those with ML had more prominent accumulation in the cervical lymph nodes (all p < 0.001). For the mediastinal lymph nodes, sarcoidosis patients had significant FDG accumulation in the level 2, 4, 7, and 10 lymph nodes (all p < 0.01). Otherwise, the accumulation in ML patients tended to be in the level 1 lymph nodes (p = 0.08). The CNN model using frontal and lateral MIP images achieved an average accuracy of 0.890 (95% CI: 0.804-0.977), a sensitivity of 0.898 (95% CI: 0.782-1.000), a specificity of 0.907 (95% CI: 0.799-1.000), and an area under the curve of 0.963 (95% CI: 0.899-1.000). Grad-CAM showed that the model focused on the sites of abnormal FDG accumulation. CONCLUSIONS CNN models based on differences in FDG accumulation sites archive high performance in differentiating between sarcoidosis and ML. CLINICAL RELEVANCE STATEMENT We developed a CNN model using MIP images of [18F]FDG PET/CT to distinguish between sarcoidosis and malignant lymphoma. It achieved high performance and could be useful in diagnosing diseases with involvement across organs and lymph nodes. KEY POINTS • There are differences in FDG distribution when comparing whole-body [18F]FDG PET/CT findings in patients with sarcoidosis and malignant lymphoma before treatment. • Convolutional neural networks, a type of deep learning technique, trained with maximum-intensity projection PET images from two angles showed high performance. • A deep learning model that utilizes differences in FDG distribution may be helpful in differentiating between diseases with lesions that are characteristically widespread among organs and lymph nodes.
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Affiliation(s)
- Hikaru Aoki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan.
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kota Yokoyama
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tsuyoshi Shirai
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Sho Shibata
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Rie Sakakibara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Takahiro Mitsumura
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Takayuki Honda
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Haruhiko Furusawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Meiyo Tamaoka
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Tokyo, Bunkyo-ku, 113-8510, Japan
| | - Masahide Yamamoto
- Department of Hematological Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Yamaguchi
- Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan
- Shinjuku Tsurukame Clinic, Tokyo, Japan
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Sabri YY, Mahmoud NMM, Abd El–Mageed MR, Onsy MMM, Mohamed SA, Onsy MMM, Khairy MA. Mediastinal lymphadenopathy in sarcoidosis: Can diffusion MRI play a role in its evaluation? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-01000-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Sarcoidosis is a multisystem disease defined by non-caseous epithelioid cell granulomas that can affect virtually all organs. Lung, mediastinal and hilar lymph node involvement is prevalent, occurring in around 90% of the patients, and is responsible for the majority of the morbidity and mortality related to the disorder. Sarcoidosis is one of the differential diagnoses of the benign mediastinal lymphadenopathy. This research aimed to detect the diagnostic value of magnetic resonance imaging (MRI) diffusion in evaluation of mediastinal lymphadenopathy in sarcoid patients.
Results
This cross study involved a total of 30 patients known to have sarcoidosis: 6 males and 24 females aged between 18 and 50 years (with a mean age 38.97 ± 8.67); all of them presented with mediastinal lymphadenopathy. For all patients, each lymph node group was evaluated for the average size and average ADC value. The mean ADC measured was (1.76 ± 0.28) × 10−3 mm2/s. Eight patients showed concurrent activity with poor response to the treatment, and they showed different ADC values with one of them showing low ADC with pattern of diffusion restriction displaying mean ADC value of 1.28 × 10−3 mm2/s.
Conclusions
Diffusion-weighted MRI is an established imaging technique that could be utilized to evaluate mediastinal lymphadenopathy in sarcoidosis as the benign counterpart of mediastinal lymphadenopathy.
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Fujimoto K, Norikane T, Yamamoto Y, Takami Y, Murota M, Shimada H, Dobahi H, Nishiyama Y. Cardiac Sarcoidosis Mimicking Lymphoma in a Patient With Sjogren’s Syndrome. Korean Circ J 2022; 52:715-716. [PMID: 35927038 PMCID: PMC9470492 DOI: 10.4070/kcj.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/18/2022] [Accepted: 06/01/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kengo Fujimoto
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yasukage Takami
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Makiko Murota
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiromi Shimada
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroaki Dobahi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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18F-FDG PET/CT helps in unmasking the great mimicker: A case of neurosarcoidosis with isolated involvement of the spinal cord. Rev Esp Med Nucl Imagen Mol 2017; 37:172-174. [PMID: 28526323 DOI: 10.1016/j.remn.2017.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/22/2017] [Indexed: 11/20/2022]
Abstract
A 36 year-old male with no significant past medical history presented with lower extremity numbness, gait instability, and urinary and bowel retention of 4 weeks onset. Spine MRI revealed diffuse oedema of cervicothoracic spinal cord with several solid enhancing intramedullary lesions, suggestive of metastases. The 18F-FDG PET/CT performed to identify the primary malignancy demonstrated mild hypermetabolic foci within the cervicothoracic cord, as well as a mildly hypermetabolic bilateral hilar lymphadenopathy and a mildly hypermetabolic pulmonary nodule, suggestive of sarcoidosis versus metastasis. The diagnosis of sarcoidosis was supported by identifying non-caseating granuloma in the biopsy of the pulmonary nodule. The patient responded well to steroid-therapy, with the symptoms being resolved within 3 weeks.
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Birnbaum MR, Ma MW, Fleisig S, Packer S, Amin BD, Jacobson M, McLellan BN. Nivolumab-related cutaneous sarcoidosis in a patient with lung adenocarcinoma. JAAD Case Rep 2017; 3:208-211. [PMID: 28443311 PMCID: PMC5394200 DOI: 10.1016/j.jdcr.2017.02.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mathew R. Birnbaum
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Michelle W. Ma
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Sarah Fleisig
- Department of Medicine, Division of Hematology/Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Stuart Packer
- Department of Medicine, Division of Hematology/Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Bijal D. Amin
- Department of Pathology, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Mark Jacobson
- Department of Pathology, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Beth N. McLellan
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Arbind A, D'souza M, Jaimini A, Saw S, Solanki Y, Sharma R. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging in response monitoring of extra-pulmonary tuberculosis. Indian J Nucl Med 2016; 31:59-61. [PMID: 26917899 PMCID: PMC4746846 DOI: 10.4103/0972-3919.172365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) using 2-deoxy-2-(fluorine-18) fluoro-D-glucose (18F-FDG) has become a standard diagnostic modality in oncological practice. F18-FDG PET/CT is sensitive in detecting malignancy; however, specificity is low in differentiating infections or inflammatory diseases from tumor. In the present case study, we report a patient with postoperative carcinoma of tongue presenting with cervical lymphadenopathy and fever. The PET/CT scan showed metabolically active generalized lymphadenopathy, and a possibility of lymphoma was suggested. Fine needle aspiration cytology showed the Ziehl–Neelsen staining to be strongly positive for acid-fast bacilli and first line of antitubercular drug was administrated. Six months later after the initiation of therapy, a follow-up PET/CT showed remarkable improvement of the disease status. This case study illustrates that tubercular infection can be a pitfall in F18-FDG PET/CT imaging. PET positive lesions do not always indicate malignancy, and histological confirmation of lesions with biopsy should always be performed. Once diagnosed to be tubercular, FDG PET/CT is a powerful imaging tool in monitoring the therapy.
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Affiliation(s)
- Arpana Arbind
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Maria D'souza
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Abhinav Jaimini
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Sanjeev Saw
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Yachna Solanki
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Rajnish Sharma
- Division of PET Imaging, Molecular Imaging and Research Centre, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
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Sarcoidosis mimicking metastatic papillary thyroid cancer. Int J Surg Case Rep 2015; 16:71-2. [PMID: 26432997 PMCID: PMC4643452 DOI: 10.1016/j.ijscr.2015.09.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 09/20/2015] [Indexed: 11/21/2022] Open
Abstract
Sarcoidosis is a multisystemic, idiopathic disease. Thyroid cancer is rarely reported in the literature. We present a case with sarcoidosis mimicking metastatic papillary thyroid cancer.
Introduction Sarcoidosis is a multisystemic, idiopathic disease. It has a highly variable clinical course. It has been reported to present in association with malignancy. Coexistence of sarcoidosis and thyroid cancer is rarely reported in the literature. Presentatioin of the case We present a case with neck swelling for 3 months, and symmetrical painless thyroid enlargement without fixation to deep tissues of the neck. Multiple nodules on the both thyroid lobes, hard irregular, grade two goiter with lymphadenopathy all over anterior neck compartments. Fine needle aspiration cytology was done under ultrasound guide from right thyroid nodule and showed papillary thyroid carcinoma. Excisional biopsy of the neck lymphnode showed picture typical for sarcoidosis. Discussion Most researchers believe that patients with pulmonary sarcoidosis are predisposed to develop malignancies, less than a dozen of cases are reported in the literature to be associated with PTC with a very wide range of presentations and clincal coarses. An interesting finding of our case is that in contrast to what is reported, both diseases were not known by the physician until the time of presentation. Conclusion Cervical lymphadenopathy in association with goiter could be metastasis, sarcoidosis or mixed, therefore should be seperately biopsied.
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