Reassessing the standard chest radiograph for intraparenchymal activity

The results concerning the activity or inactivity of the alveolitis determined with our proposed scoring system were comparable to those determined with gallium scanning in 68.2% of the patients with biopsy-proven sarcoidosis in our study. Certainly, further evaluation of a larger series of patients over a longer period of time will be required to more adequately evaluate this classification method. We also believe this methodology is reproducible and can be utilized by experienced interpreters of chest radiographs. If we closely reevaluate the 32% of the cases in which the radiographic results disagreed with the gallium assessment of activity, two points worthy of mention become evident. In one group the gallium indices were borderline for activity whereas in the other group the radiographic criteria were most likely indicative of irreversible parenchymal changes. When the radiographs for the latter group were reevaluated for signs of fibrosis such as volume loss, cystic changes, and alteration in vascular patterns, it was possible to delineate a significant false-positive group of patients. We will be reporting the long-term results of our observations over the next several years as well as adding more groups of patients to our initial study analysis. At that time, correlation with all other measurable parameters in determining high-intensity alveolitis versus low-intensity alveolitis will be compared to these new chest radiographic profiles.