18FDG-PET is sensitive tool for detection of extracranial tuberculous foci in central nervous system tuberculosis – Preliminary observations from a tertiary care center in northern India

Sequential 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scan findings in patients with extrapulmonary tuberculosis during the course of treatment—a prospective observational study

“…Patients with EPTB and PET/CT scans 147 HIV-negative patients with EPTB from eight centres, located in six countries, who completed three sequential 18 F-FDG PET/CT scans during the entire course of WHO-recommended EPTB treatment were studied. Patients were adults >18 years who fulfilled WHO criteria for EPTB, with either: positive culture for drug sensitive M. tuberculosis in any clinical specimen, positive nucleic acid amplification (GeneXpert MTB Rif/Assay; Cepheid, Sunnyvale, CA, USA), or presence of caseating granulomas with detection of acid-fast bacilli in a clinical biopsy or aspirate specimen.…”

“…Patients underwent three 18 F-FDG PET/CT scans (non-contrast CT): (i) within 2 weeks of enrolment, (ii) at 2 months into ATT treatment and (iii) at the end of ATT treatment (Table 1). 18…”

“…All 18 F-FDG PET/CT scans were performed on the same scanner as was used for the baseline study. 18 F-FDG is known to accumulate at sites of infection and inflammation. The inflammatory cells produce an excess of glycolytic enzymes and also over-express glucose transporter (GLUT) isotypes (mainly GLUT-1 and GLUT-3).…”

“…Positron emission tomography (PET) using 2-deoxy-2-[fluorine -18] fluoro-D-glucose ( 18 F-FDG) provides functional information on sites of active inflammation and, in combination with CT data, delivers functional and anatomical information in a single scan [8,9]. Preliminary studies on TB in macaques [10][11][12][13] and humans [14][15][16][17][18][19] employing 18 F-FDG PET/CT as a research tool have suggested that it might be of clinical value for localisation of disease sites and assessment of treatment response. Currently there are several ongoing research studies on the application of PET/CT as a biomarker of treatment response in new drug combination trials and for insight into pathogenesis.…”

“…Studies of EPTB patients under programmatic conditions with sequential serial scans may provide further information on the usefulness of PET-CT in monitoring response to therapy and defining cure. We recently published a study of the use of 18 F-FDG PET/CT imaging to assess the extent of disease and common sites involved at first presentation in 358 patients with EPTB [20] . Here we present imaging findings from 147 18 F-FDG PET/CT patients with EPTB for whom three sequential 18 F-FDG PET/CT scans were obtained during the entire course of WHO-recommended EPTB treatment.…”