Figure 7.

Diagnosis of granulomatous-lymphocytic interstitial lung disease (GLILD). (A) PET-CT before and 3 months after rituximab and mycophenolate treatment. Whole body images were acquired at 90 min following 285 MBq 2-[(18)F]-fluoro-2-deoxy-d-glucose (tracer). Maximum intensity projection whole body images before treatment show widespread abnormal uptake of tracer in the lung parenchyma and lymph nodes above and below the diaphragm (A); images following treatment show near resolution of all the areas of abnormal tracer uptake (B). (C,D) Axial fused positron emission tomography–computed tomography (PET–CT) images at the mid-thoracic level. The level of tracer uptake is represented by the intensity of color superimposed upon the CT image. There is a combination of interstitial septal thickening and ill-defined tracer-avid peri-bronchovascular nodules before treatment (C); post-treatment image shows improvement of the nodularity with near resolution of tracer uptake (D). Images at the level of the carina show an enlarged lymph node exhibiting intense abnormal tracer uptake prior to treatment (E), and a normalized lymph node with no abnormal tracer uptake following treatment (F). Pre-treatment images through the abdomen at the level of the right renal hilum demonstrate numerous enlarged tracer-avid retroperitoneal lymph nodes (G) which reduce in size and tracer uptake following treatment (H). Reproduced with kind permission from 2016 British Society for Immunology, Clinical and Experimental Immunology, 187: 138–145 (100). (B) Radiographic features of GLILD versus sarcoidosis. GLILD is characterized by macronodular (yellow circles) disease that is located predominantly in the lower lung zones. In contrast, micronodular (yellow circles) disease located in the upper lung zones and frequently accompanied by marked hilar adenopathy (stars) is characteristic of sarcoidosis. Reproduced from Ref. (101) with kind permission from European Respiratory Society.