Potential role of F18 FDG PET-CT as an imaging biomarker for the noninvasive evaluation in uncomplicated skeletal tuberculosis: a prospective clinical observational study

Dureja, Sugandha; Sen, Ishita; Acharya, Shankar

doi:10.1007/s00586-014-3483-8

Cited by 54 publications

(44 citation statements)

References 7 publications

(6 reference statements)

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“…In these cases, 18 F-FDG PET/CT imaging may help, as the changes in glycolytic activity within the inflammatory lesion, measured by 18 F-FDG uptake, correlate well with the clinical markers of response. 49 Several studies have confirmed the value of 18 F-FDG PET/CT in the follow-up and evaluation of the treatment response, especially in patients with extrapulmonary involvement and when drug resistance is prevalent. 57,[59][60][61][62][63] In pulmonary and extrapulmonary TB, a decrease of approximately one-third in SUV max has been reported after 1 month of anti-TB treatment when there is a good response.…”

Section: Assessment Of Treatment Responsementioning

confidence: 93%

“…[45][46][47][48] An interesting finding was that 63.6% of patients with spinal TB had clinically occult noncontiguous multifocal skeletal involvement at the time of whole-body 18 F-FDG PET/CT scan. 49 Besides the spine, any part of the musculoskeletal system can become involved, but the large joints of the lower limbs are most commonly affected. Imaging findings in musculoskeletal TB are often non-specific.…”

Section: Musculoskeletal Tuberculosismentioning

confidence: 99%

“…62 Other authors have aimed to monitor the metabolic changes in spinal TB during the course of therapy. 49 The mean changes in SUV max at various time points -from baseline to 6, 12, and 18 months, from 6 to 12 months, from 6 to 18 months, and from 12 to 18 months -were calculated and found to be highly significant (pvalue <0.001). 49 18 F-FDG PET/CT also shows encouraging results for the prognosis and detection of residual disease in patients with spinal infection, particularly when MRI is unconvincing in distinguishing between degenerative changes and infection.…”

Section: Assessment Of Treatment Responsementioning

confidence: 99%

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Imaging in tuberculosis

Skoura

Zumla

Bomanji

2015

International Journal of Infectious Diseases

239

182

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Early diagnosis of tuberculosis (TB) is necessary for effective treatment. In primary pulmonary TB, chest radiography remains the mainstay for the diagnosis of parenchymal disease, while computed tomography (CT) is more sensitive in detecting lymphadenopathy. In post-primary pulmonary TB, CT is the method of choice to reveal early bronchogenic spread. Concerning characterization of the infection as active or not, CT is more sensitive than radiography, and (18)F-fluorodeoxyglucose positron emission tomography/CT ((18)F-FDG PET/CT) has yielded promising results that need further confirmation. The diagnosis of extrapulmonary TB sometimes remains difficult. Magnetic resonance imaging (MRI) is the preferred modality in the diagnosis and assessment of tuberculous spondylitis, while (18)F-FDG PET shows superior image resolution compared with single-photon-emitting tracers. MRI is considered superior to CT for the detection and assessment of central nervous system TB. Concerning abdominal TB, lymph nodes are best evaluated on CT, and there is no evidence that MRI offers added advantages in diagnosing hepatobiliary disease. As metabolic changes precede morphological ones, the application of (18)F-FDG PET/CT will likely play a major role in the assessment of the response to anti-TB treatment.

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Section: Assessment Of Treatment Responsementioning

confidence: 93%

Section: Musculoskeletal Tuberculosismentioning

confidence: 99%

Section: Assessment Of Treatment Responsementioning

confidence: 99%

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Imaging in tuberculosis

Skoura

Zumla

Bomanji

2015

International Journal of Infectious Diseases

239

182

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“…Human studies have also shown FDG PET-CT to be promising in monitoring the effect of treatment in pulmonary and extra-pulmonary TB [22,28,[36][37][38][39][40][41]. While most of the studies used simple descriptive techniques, two small trials aimed at the treatment of drug-resistant TB, implemented whole lung quantification of PET (using fixed thresholds) and semiquantified CT reader scores.…”

mentioning

confidence: 99%

Quantitative 18F-FDG PET-CT scan characteristics correlate with tuberculosis treatment response

et al. 2020

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Background: There is a growing interest in the use of F-18 FDG PET-CT to monitor tuberculosis (TB) treatment response. Tuberculosis lung lesions are often complex and diffuse, with dynamic changes during treatment and persisting metabolic activity after apparent clinical cure. This poses a challenge in quantifying scan-based markers of burden of disease and disease activity. We used semi-automated, whole lung quantification of lung lesions to analyse serial FDG PET-CT scans from the Catalysis TB Treatment Response Cohort to identify characteristics that best correlated with clinical and microbiological outcomes.Results: Quantified scan metrics were already associated with clinical outcomes at diagnosis and 1 month after treatment, with further improved accuracy to differentiate clinical outcomes after standard treatment duration (month 6). A high cavity volume showed the strongest association with a risk of treatment failure (AUC 0.81 to predict failure at diagnosis), while a suboptimal reduction of the total glycolytic activity in lung lesions during treatment had the strongest association with recurrent disease (AUC 0.8 to predict pooled unfavourable outcomes). During the first year after TB treatment lesion burden reduced; but for many patients, there were continued dynamic changes of individual lesions. Conclusions: Quantification of FDG PET-CT images better characterised TB treatment outcomes than qualitative scan patterns and robustly measured the burden of disease. In future, validated metrics may be used to stratify patients and help evaluate the effectiveness of TB treatment modalities.

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“…Though overall ESR levels in the present study decreased from diagnosis to 12 months and eventually to completion of treatment, they were still on average above 40 mm/hr at the final measurement. A prospective observational study performed in India between 2009 and 2013 25 reported no significant correlation between the ESR levels over time, as measured at presentation and then again at 6, 12 and 18 months, and concluded that ESR does not provide any objective evidence of response to treatment. This is in agreement with the findings of the current study, which highlights that this blood marker is unreliable when used as a response monitoring tool, especially in patients with HIV co-infection.…”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET/CT as a modality for the evaluation of persisting raised infective markers in patients with spinal tuberculosis

et al. 2020

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The aim of the study was to investigate the differences in participant characteristics between positive and negative, positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) activity at the spinal tuberculosis (TB) site following 12 months of the appropriate chemotherapy therapy for spinal TB. A secondary aim of the study was to determine whether erythrocyte sedimentation rate (ESR) levels could be used as a reliable marker of TB activity and/or treatment success of spinal TB, especially in a high HIV-positive population. Patients and methods: All patients who were treated for spinal TB and underwent an 18F-FDG PET/CT scan were considered for inclusion. PET/CT positive patients underwent a spinal biopsy which was sent for microscopy, Gram staining, Gene Xpert (GXP) polymerase chain reaction (PCR) and histology. Patients in the PET/CT positive group underwent a repeat MRI scan and biopsy at the completion of treatment to investigate the potential presence of resistance or ongoing active spinal TB. Results: A total of 18 patients were included in the study: five patients were allocated to the PET/CT positive group and 13 to the PET/CT negative group. The PET/CT negative group was significantly older (p=0.016) and had significantly fewer TB-infected vertebrae (p=0.010) than the PET/CT positive group. Two patients, one in each group, were found to have drug-resistant spinal TB. At the 12-month follow-up visit, two patients (40%) in the PET/CT positive group and three patients (30%) in the PET/CT negative group were still complaining of back pain. All smear microscopy results of the PET/CT positive patients who underwent a repeat biopsy were negative after the conclusion of treatment; culture results (n=4/4) were also negative. GXP PCR results were positive in four and negative in one case. Only one of four samples showed classic TB signs on histology. Conclusion: This study is the first to report on biopsies done from a PET/CT positive site, after 12 months of anti-tubercular treatment. It is not unlikely that PET/CT is over-sensitive and can show metabolic activity in areas of sterile inflammation, and future studies are necessary to evaluate this.

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Potential role of F18 FDG PET-CT as an imaging biomarker for the noninvasive evaluation in uncomplicated skeletal tuberculosis: a prospective clinical observational study

Abstract: SUVmax can be taken as a reliable marker for serial quantification of metabolic activity in spinal tuberculosis. This may translate into a potential role for FDG as an imaging biomarker for noninvasive response evaluation in skeletal tuberculosis.

Cited by 54 publications

References 7 publications

Imaging in tuberculosis

Imaging in tuberculosis

Quantitative 18F-FDG PET-CT scan characteristics correlate with tuberculosis treatment response

18F-FDG PET/CT as a modality for the evaluation of persisting raised infective markers in patients with spinal tuberculosis

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