Imaging of Pulmonary Tuberculosis with 18F-Fluoro-Deoxy-Glucose and 18F-Ethylcholine

Vorster, Mariza; Stoltz, Anton; Jacobs, Aldrich; Sathekge, Mike

doi:10.2174/1876388x01406010017

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…[21][22][23][24] Other PET Tracers Preliminary data suggest a role for monitoring for other PET tracer such as Ga68 citrate, F18 ethylcholine, and C11 methionine. [107][108][109] In preclinical studies, 68 Ga labeled with triacetylfusarinine C and ferrioxamine E and [ 64 Cu] DOTA labeled Aspergillus fumigatus-specific monoclonal antibody are Aspergillus-specific tracers that may have a role in monitoring infections. 110,111 In TB, a tracer trehalose, a non-mammalian disaccharide is at the very early stage of development and has shown promise in TB imaging.…”

Section: Fdg Monitoring In Other Conditionsmentioning

confidence: 99%

Monitoring Response to Therapy

Sathekge

Ankrah

Lawal

et al. 2018

Seminars in Nuclear Medicine

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Monitoring response to treatment is a key element in the management of infectious diseases, yet controversies still persist on reliable biomarkers for noninvasive response evaluation. Considering the limitations of invasiveness of most diagnostic procedures and the issue of expression heterogeneity of pathology, molecular imaging is better able to assay in vivo biologic processes noninvasively and quantitatively. The usefulness of F-FDG-PET/CT in assessing treatment response in infectious diseases is more promising than for conventional imaging. However, there are currently no clinical criteria or recommended imaging modalities to objectively evaluate the effectiveness of antimicrobial treatment. Therapeutic effectiveness is currently gauged by the patient's subjective clinical response. In this review, we present the current studies for monitoring treatment response, with a focus on Mycobacterium tuberculosis, as it remains a major worldwide cause of morbidity and mortality. The role of molecular imaging in monitoring other infections including spondylodiscitis, infected prosthetic vascular grafts, invasive fungal infections, and a parasitic disease is highlighted. The role of functional imaging in monitoring lipodystrophy associated with highly active antiretroviral therapy for human immunodeficiency virus is considered. We also discuss the key challenges and emerging data in optimizing noninvasive response evaluation.

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Section: Fdg Monitoring In Other Conditionsmentioning

confidence: 99%

Monitoring Response to Therapy

Sathekge

Ankrah

Lawal

et al. 2018

Seminars in Nuclear Medicine

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“…In TB, however, 18 F-FDG uptake was much higher than 11 C-choline uptake. The use of only one tracer may miss extrapulmonary disease in areas where the tracers have a physiologically high bio-distribution such as the brain for 18 F-FDG and the liver for 18 F-FEC [ 106 ]. 18 F-FEC has been suggested to be useful for evaluation of TB therapy.…”

Section: Diagnosis Of Tuberculosismentioning

confidence: 99%

PET/CT imaging of Mycobacterium tuberculosis infection

Ankrah

Werf

Vries

et al. 2016

Clin Transl Imaging

104

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Tuberculosis has a high morbidity and mortality worldwide. Mycobacterium tuberculosis (Mtb) has a complex pathophysiology; it is an aerobic bacillus capable of surviving in anaerobic conditions in a latent state for a very long time before reactivation to active disease. In the latent tuberculosis infection, the individual has no clinical evidence of active disease, but exhibits a hypersensitive response to proteins of Mtb. Only some 5–10 % of latently infected individuals appear to have reactivation of tuberculosis at any one time point after infection, and neither imaging nor immune tests have been shown to predict tuberculosis reactivation reliably. The complex pathology of the organism provides multiple molecular targets for imaging the infection and targeting therapy. Positron emission tomography (PET) integrated with computer tomography (CT) provides a unique opportunity to noninvasively image the whole body for diagnosing, staging and assessing therapy response in many infectious and inflammatory diseases. PET/CT is a powerful noninvasive tool that can rapidly provide three-dimensional views of disease deep within the body and conduct longitudinal assessment over time in one particular patient. Some PET tracers, such as 18F-fluorodeoxyglucose (18F-FDG), have been found to be useful in various infectious diseases for detection, assessing disease activity, staging and monitoring response to therapy. This tracer has also been used for imaging tuberculosis. 18F-FDG PET relies on the glucose uptake of inflammatory cells as a result of the respiratory burst that occurs with infection. Other PET tracers have also been used to image different aspects of the pathology or microbiology of Mtb. The synthesis of the complex cell membrane of the bacilli for example can be imaged with 11C-choline or 18F-fluoroethylcholine PET/CT while the uptake of amino acids during cell growth can be imaged by 3′-deoxy-3′-[18F]fluoro-l-thymidine. PET/CT provides a noninvasive and sensitive method of assessing histopathological information on different aspects of tuberculosis and is already playing a role in the management of tuberculosis. As our understanding of the pathophysiology of tuberculosis increases, the role of PET/CT in the management of this disease would become more important. In this review, we highlight the various tracers that have been used in tuberculosis and explain the underlying mechanisms for their use.

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“…Other PET tracers have been used in the imaging of TB to trace different aspects of the pathophysiology of MTb. Cholinebased derivatives can image the utilisation of choline in the wall of MTb (which is composed of many complex lipids) (50,51). 2-deoxy-2-[ 18 F]fluoro-d-sorbitol (2-[ 18 F]FDS) is a tracer that was initially designed for tumour imaging but found to have limited use owing to the low accumulation of the tracer in vitro (103).…”

Section: Non-fdg Pet Tracersmentioning

confidence: 99%

Tuberculosis: Role of Nuclear Medicine and Molecular Imaging With Potential Impact of Neutrophil-Specific Tracers

Marakalala

Sathekge

2021

Front. Med.

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With Tuberculosis (TB) affecting millions of people worldwide, novel imaging modalities and tools, particularly nuclear medicine and molecular imaging, have grown with greater interest to assess the biology of the tuberculous granuloma and evolution thereof. Much early work has been performed at the pre-clinical level using gamma single photon emission computed tomography (SPECT) agents exploiting certain characteristics of Mycobacterium tuberculosis (MTb). Both antituberculous SPECT and positron emission tomography (PET) agents have been utilised to characterise MTb. Other PET tracers have been utilised to help to characterise the biology of MTb (including Gallium-68-labelled radiopharmaceuticals). Of all the tracers, 2-[18F]FDG has been studied extensively over the last two decades in many aspects of the treatment paradigm of TB: at diagnosis, staging, response assessment, restaging, and in potentially predicting the outcome of patients with latent TB infection. Its lower specificity in being able to distinguish different inflammatory cell types in the granuloma has garnered interest in reviewing more specific agents that can portend prognostic implications in the management of MTb. With the neutrophil being a cell type that portends this poorer prognosis, imaging this cell type may be able to answer more accurately questions relating to the tuberculous granuloma transmissivity and may help in characterising patients who may be at risk of developing active TB. The formyl peptide receptor 1(FPR1) expressed by neutrophils is a key marker in this process and is a potential target to characterise these areas. The pre-clinical work regarding the role of radiolabelled N-cinnamoyl –F-(D) L – F – (D) –L F (cFLFLF) (which is an antagonist for FPR1) using Technetium 99m-labelled conjugates and more recently radiolabelled with Gallium-68 and Copper 64 is discussed. It is the hope that further work with this tracer may accelerate its potential to be utilised in responding to many of the current diagnostic dilemmas and challenges in TB management, thereby making the tracer a translatable option in routine clinical care.

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Imaging of Pulmonary Tuberculosis with 18F-Fluoro-Deoxy-Glucose and 18F-Ethylcholine

Cited by 8 publications

References 10 publications

Monitoring Response to Therapy

Monitoring Response to Therapy

PET/CT imaging of Mycobacterium tuberculosis infection

Tuberculosis: Role of Nuclear Medicine and Molecular Imaging With Potential Impact of Neutrophil-Specific Tracers

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