Comparison of PET/CT with other imaging modalities in women with genital tuberculosis

Sharma, Jai Bhagwan; Karmakar, Debjyoti; Kumar, Rakesh; Shamim, Shamim A.; Kumar, Sunesh; Singh, Neeta; Roy, Kallol Kumar; Reddy, Ramachandra C.

doi:10.1016/j.ijgo.2012.02.020

Cited by 29 publications

(14 citation statements)

References 20 publications

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“…Laparoscopic biopsy with frozen section evaluation has also been suggested to avoid laparotomy in such cases [21,22]. Positron emission tomography with 18 F-fluorodeoxy glucose (FDG-PET) has been successfully used for the preoperative diagnosis of peritoneal tuberculosis and tuberculous tubo-ovarian masses [23,24]. Varying grades of pelvic and abdominal adhesions including perihepatic adhesions (Fitz-HughCurtis syndrome) are common in genital and peritoneal tuberculosis [25,26].…”

Section: Etiopathogenesismentioning

confidence: 99%

Current Diagnosis and Management of Female Genital Tuberculosis

Sharma

2015

J Obstet Gynecol India

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Female genital tuberculosis (FGTB) is an important cause of significant morbidity, short-and longterm sequelae especially infertility whose incidence varies from 3 to 16 % cases in India. Mycobacterium tuberculosis is the etiological agent for tuberculosis. The fallopian tubes are involved in 90-100 % cases, endometrium is involved in 50-80 % cases, ovaries are involved in 20-30 % cases, and cervix is involved in 5-15 % cases of genital TB. Tuberculosis of vagina and vulva is rare (1-2 %). The diagnosis is made by detection of acid-fast bacilli on microscopy or culture on endometrial biopsy or on histopathological detection of epithelioid granuloma on biopsy. Polymerase chain reaction may be false positive and alone is not sufficient to make the diagnosis. Laparoscopy and hysteroscopy can diagnose genital tuberculosis by various findings. Treatment is by giving daily therapy of rifampicin (R), isoniazid (H), pyrazinamide (Z) and ethambutol (E) for 2 months followed by daily 4 month therapy of rifampicin (R) and isoniazid (H). Alternatively 2 months intensive phase of RHZE can be daily followed by alternate day combination phase (RH) of 4 months. Three weekly dosing throughout therapy (RHZE thrice weekly for 2 months followed by RH thrice weekly for 4 months) can be given as directly observed treatment short-course. Surgery is rarely required only as drainage of abscesses. There is a role of in vitro fertilization and embryo transfer in women whose fallopian tubes are damaged but endometrium is healthy. Surrogacy or adoption is needed for women whose endometrium is also damaged.

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Section: Etiopathogenesismentioning

confidence: 99%

Current Diagnosis and Management of Female Genital Tuberculosis

Sharma

2015

J Obstet Gynecol India

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125

145

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“…[ 8 16 18 ] Ultrasound, CT scan, MRI, and PET scan are more useful for FGTB with tubo-ovarian mass, especially when the differential diagnosis is ovarian cancer as FGTB is known to masquerade as ovarian cancer. [ 1 10 11 19 ] Some authors have made an algorithm by combining various tests for early diagnosis of FGTB. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 9 ] Imaging modalities such as ultrasound, computerized axial tomography, magnetic resonance imaging (MRI), and positron-emission tomography (PET) have also been found to be useful in women with tubo-ovarian masses with FGTB. [ 10 11 ]…”

Section: Introductionmentioning

confidence: 99%

Effect of antitubercular treatment on ovarian function in female genital tuberculosis with infertility

et al. 2016

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AIM:To evaluate the effect of antitubercular therapy (ATT) on an ovarian function such as ovarian reserve, ovarian dimensions, and ovarian stromal blood flow.SETTINGS AND DESIGN:Prospective study design.MATERIALS AND METHODS:Fifty infertile women with female genital tuberculosis (FGTB) without tubo-ovarian masses diagnosed by positive acid-fast bacilli culture or epithelioid granuloma on endometrial aspirate or positive polymerase chain reaction with positive findings on laparoscopy or hysteroscopy were recruited. The ovarian function tests were performed on day 2/3 as follicle-stimulating hormone (FSH) levels and anti-Mullerian hormone (AMH) levels. Ovarian dimensions (length, width, and depth) were measured using a transvaginal ultrasound. Mean antral follicle count (AFC) and ovarian stromal blood flow (peak systolic velocity [PSV], pulsatility index (PI), and resistive index [RI]) were measured using a transvaginal ultrasound. All women were started on ATT for 6 months by directly observed treatment strategy. After completion of ATT, all the parameters were repeated.RESULTS:There was a significant increase in AMH (2.68 ± 0.97 ng/ml to 2.8 ± 1.03 ng/ml) pre- to post-ATT, nonsignificant increase in FSH (7.16 ± 2.34 mIU/ml to 7.26 ± 2.33 mIU/ml) post-ATT, significant increase in mean AFC (7.40 ± 2.12–8.14 ± 2.17), PSV in the right ovary (6.015–6.11 cm/s) and left ovary (6.05–6.08 cm/s), PI in the right ovary (0.935–0.951 cm/s) and left ovary (0.936–0.957 cm/s), and RI in the right ovary (0.62 ± 0.01–0.79 ± 0.02) and left ovary (0.65 ± 0.02–0.84 ± 0.01) with ATT. There was no significant change in mean ovarian dimensions (ovarian length, breadth, and width) and summed ovarian volume with ATT. On laparoscopy, tubercles were seen in 27 (54%) women. Caseous nodules and encysted ascites were seen in 8% cases each.CONCLUSION:ATT improves the ovarian function (AMH and AFC) and ovarian blood flow in women with FGTB.

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“…Unilateral or bilateral tubo-ovarian masses, hydrosalpinx, adnexal cysts or tuberculous deposits on peritoneum or liver have been reported in our study 47 . Positron-emission tomography (PET) scan shows unilateral or bilateral tubo-ovarian masses with increased fluorodeoxy glucose (FDG) uptake by TB lesion 48 49 . We observed increased FDG uptake by TB lesions in our study on 17 women of tubercular tubo-ovarian masses ( Fig.…”

Section: Diagnosismentioning

confidence: 99%

Female genital tuberculosis

Sharma

et al. 2018

Indian Journal of Medical Research

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Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases.

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Comparison of PET/CT with other imaging modalities in women with genital tuberculosis

Abstract: Imaging with (18)F-FDG-PET/CT is noninvasive and appears to be clinically useful for the diagnosis of tubercular tubo-ovarian masses.

Cited by 29 publications

References 20 publications

Current Diagnosis and Management of Female Genital Tuberculosis

Current Diagnosis and Management of Female Genital Tuberculosis

Effect of antitubercular treatment on ovarian function in female genital tuberculosis with infertility

Female genital tuberculosis

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