Typical and atypical pattern of pulmonary sarcoidosis at high-resolution CT: Relation to clinical evolution and therapeutic procedures

Aim This study was done to evaluate the importance of
high-resolution CT (HRCT) in defining pattern and extent
of disease and establishing the clinical and therapeutic
pathway in sarcoidosis.
Materials and methods A retrospective analysis of 56
patients with pulmonary involvement of sarcoidosis was
performed. Two groups were identified: 39 patients
exhibiting a typical HRCT pattern and 17 patients with an
atypical pattern. Inclusion criteria were the presence of
radiological documentation (HRCT) of disease, clinical
and radiological follow-up of 1 year and the beginning of
any therapy within 1 month from the diagnosis.
Results Among subjects not receiving therapy, the comparison
between the two groups showed that the radiological
findings remained stable in subjects with a typical
pattern, while they worsened in more than 70 % of cases
with atypical appearance. Therapy was more effective in
patients with a typical pattern. Recurrences occurred in
both groups, but more often in patients with a typical
pattern. One patient not receiving treatment experienced
clinical worsening. Re-evaluation of HRCT within 1 year
revealed no correlation between clinical deterioration and
radiological changes.
Conclusions The findings of this study suggest that persistence
of the inflammatory process rather than the radiological
pattern at onset is a prognostic factor for recurrence.