18F-FDG PET/CT in Tuberculosis

Sood, Apurva; Mittal, Bhagwant Rai; Modi, Manish; Chhabra, Rajesh; Verma, Roshan; Rana, Nivedita; Parihar, Ashwin Singh; Satapathy, Sujata; Kumar, Rajender

doi:10.1097/rlu.0000000000002968

Cited by 18 publications

(8 citation statements)

References 16 publications

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“…After one year of treatment, there were continuous dynamic reduction of lesions’ activity demonstrated by FDG-PET/CT imaging 82 . Ultimately, FDG-PET/CT technique is of great value in determining TB progression, evaluating the efficacy of midterm treatment 83 , 84 , and in the detection of post-treatment disease recurrence 85 .…”

Section: Tuberculosis Infectionsmentioning

confidence: 99%

FDG-PET/CT of COVID-19 and Other Lung Infections

Eibschutz

Rabiee

Asadollahi

et al. 2022

Seminars in Nuclear Medicine

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While not conventionally used as the first-line modality, [ 18 F]-2-fluoro-2-deoxy-D-glucose (FDG) - positron emission tomography/computed tomography (PET/CT) can identify infection and inflammation both earlier and with higher sensitivity than anatomic imaging modalities [including chest X-ray (CXR), computed tomography (CT), and magnetic resonance imaging (MRI)]. The extent of inflammation and, conversely, recovery within the lungs, can be roughly quantified on FDG-PET/CT using maximum standardized uptake value (SUVmax) values. The Coronavirus disease 2019 (COVID-19) pandemic has highlighted the value of FDG-PET/CT in diagnosis, elucidation of acute pulmonary and extra-pulmonary manifestations, and long-term follow up. Similarly, many other pulmonary infections such as previously documented coronaviruses, Aspergillosis, Blastomycosis, Candidiasis, Coccidioidomycosis, Cryptococcosis, Histoplasmosis, Mucormycosis, and typical/atypical Mycobacterial infections have all been identified and characterized using FDG-PET/CT imaging. The goal of this review is to summarize the actual and potential benefits of FDG-PET/CT in the imaging of COVID-19 and other lung infections. Further research is necessary to determine the best indications and clinical applications of FDG-PET/CT, improve its specificity, and ultimately ascertain how this modality can best be utilized in the diagnostic work up of infectious pathologies.

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Section: Tuberculosis Infectionsmentioning

confidence: 99%

FDG-PET/CT of COVID-19 and Other Lung Infections

Eibschutz

Rabiee

Asadollahi

et al. 2022

Seminars in Nuclear Medicine

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“…Currently, diagnosis of PH-FM mainly relies on CT pulmonary angiogram (CTPA), while it can recognize hyperplastic soft lesions only by tissue density with low specificity. By contrast, PET/CT imaging has shown 18 F-FDG-avid in active TB-FM lesions but not in non-active lesions . Due to the non-specificity of 18 F-FDG, it still has limitations in the diagnosis of fibrous diseases.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, PET/CT imaging has shown 18 F-FDGavid in active TB-FM lesions 34 but not in non-active lesions. 35 Due to the non-specificity of 18 F-FDG, it still has limitations in the diagnosis of fibrous diseases. It has been reported that 18 F-FAPI-74 PET/CT is more sensitive than 18 F-FDG PET/CT for fibrous-rich tissue imaging.…”

Section: ■ Discussionmentioning

confidence: 99%

Potential Value of FAPI PET/CT in the Detection and Treatment of Fibrosing Mediastinitis: Preclinical and Pilot Clinical Investigation

et al. 2023

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Fibrosing mediastinitis (FM) is a rare proliferative disease within the mediastinum that leads to pulmonary hypertension, which has been regarded as a major cause of death. This study aims to evaluate the potential value of fibroblast activation protein inhibitor (FAPI)-PET/CT in the integration of diagnosis and treatment of FM through targeting FAPI in fibrosis rats and provide a theoretical basis for clinical management of FM patients. By performing a 18 F-FAPI PET/CT scan, the presence of FAPIavid in the fibrotic lesion was determined. Through a fibrosis rat model, 18 F-FAPI-74 was used for lesion imaging and 177 Lu-FAPI-46 was utilized to investigate the potential therapeutic effect on FM in vivo. In addition, biodistribution analysis and radiation dosimetry were carried out. With the 177 Lu-FAPI-46 pharmacokinetic data of rats as the input, the estimated dose for female adults was computed, which can provide some useful information for the safe application of radiolabeled FAPI in the detection and treatment of FM in patients. Then, major findings on the use of FAPI PET/CT and SPECT/CT in FM were presented. 18 F-FAPI-74 showed a high-level uptake in FM lesions of patients (SUVmax 7.94 ± 0.26), which was also observed in fibrosis rats (SUVmax 2.11 ± 0.23). Consistently, SPECT/CT imaging of fibrosis rats also revealed that 177 Lu-FAPI-46-avid was active for up to 60 h in fibrotic lesions. In addition to this robust diagnostic performance, a possible therapeutic impact was evaluated as well. It turned out that no spontaneous healing of lesions was observed in the control group, whereas there was complete healing on day 9, day 11, and day 14 in the 30, 100, and 300 MBq groups, respectively. With a significant difference in the free of event rate in the Kaplan−Meier curve among four groups (P < 0.001), a dose of 300 MBq displayed the best therapeutic effect, and no obvious damage was observed in the kidney. Furthermore, organ-absorbed doses and an effective dose (0.4320 mSv/MBq) of 177 Lu-FAPI-46 presumed for patients were assumed to give a preliminary indication of its safe use in clinical practice. In conclusion, 18 F-FAPI-46 PET/CT can be a potentially valuable tool for the diagnosis of FM. Of note, 177 Lu-FAPI-46 may be a novel and safe radiolabeled reagent for the integration of diagnosis and treatment of FM.

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“…Furthermore, we used only biomarkers obtained from blood analysis, and therefore, it was not possible to analyze specific biomarkers associated with an immune response in the lung. In addition, the extent of lung involvement was not evaluated (42).…”

Section: Limitationsmentioning

confidence: 99%

Pre-Treatment Neutrophil Count as a Predictor of Antituberculosis Therapy Outcomes: A Multicenter Prospective Cohort Study

et al. 2021

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BackgroundNeutrophils have been associated with lung tissue damage in many diseases, including tuberculosis (TB). Whether neutrophil count can serve as a predictor of adverse treatment outcomes is unknown.MethodsWe prospectively assessed 936 patients (172 HIV-seropositive) with culture-confirmed pulmonary TB, enrolled in a multicenter prospective cohort study from different regions in Brazil, from June 2015 to June 2019, and were followed up to two years. TB patients had a baseline visit before treatment (month 0) and visits at month 2 and 6 (or at the end of TB treatment). Smear microscopy, and culture for Mycobacterium tuberculosis (MTB) were performed at TB diagnosis and during follow-up. Complete blood counts were measured at baseline. Treatment outcome was defined as either unfavorable (death, treatment failure or TB recurrence) or favorable (cure or treatment completion). We performed multivariable logistic regression, with propensity score regression adjustment, to estimate the association between neutrophil count with MTB culture result at month 2 and unfavorable treatment outcome. We used a propensity score adjustment instead of a fully adjusted regression model due to the relatively low number of outcomes.ResultsAmong 682 patients who had MTB culture results at month 2, 40 (5.9%) had a positive result. After regression with propensity score adjustment, no significant association between baseline neutrophil count (103/mm3) and positive MTB culture at month 2 was found among either HIV-seronegative (OR = 1.06, 95% CI = [0.95;1.19] or HIV-seropositive patients (OR = 0.77, 95% CI = [0.51; 1.20]). Of 691 TB patients followed up for at least 18 months and up to 24 months, 635 (91.9%) were either cured or completed treatment, and 56 (8.1%) had an unfavorable treatment outcome. A multivariable regression with propensity score adjustment found an association between higher neutrophil count (103/mm3) at baseline and unfavorable outcome among HIV-seronegative patients [OR= 1.17 (95% CI= [1.06;1.30]). In addition, adjusted Cox regression found that higher baseline neutrophil count (103/mm3) was associated with unfavorable treatment outcomes overall and among HIV-seronegative patients (HR= 1.16 (95% CI = [1.05;1.27]).ConclusionIncreased neutrophil count prior to anti-TB treatment initiation was associated with unfavorable treatment outcomes, particularly among HIV-seronegative patients. Further prospective studies evaluating neutrophil count in response to drug treatment and association with TB treatment outcomes are warranted.

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18F-FDG PET/CT in Tuberculosis

Cited by 18 publications

References 16 publications

FDG-PET/CT of COVID-19 and Other Lung Infections

FDG-PET/CT of COVID-19 and Other Lung Infections

Potential Value of FAPI PET/CT in the Detection and Treatment of Fibrosing Mediastinitis: Preclinical and Pilot Clinical Investigation

Pre-Treatment Neutrophil Count as a Predictor of Antituberculosis Therapy Outcomes: A Multicenter Prospective Cohort Study

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