FDG-PET–CT Enterography Helps Determine Clinical Significance of Suspected Ileocecal Thickening: A Prospective Study

Singh, Abhi K; Kumar, Rajender; Gupta, Pankaj; Kumar‐M, Praveen; Mishra, Shubhra; Mandavdhare, Harshal; Singh, Harjeet; Prasad, Kaushal Kishor; Dutta, Usha; Sharma, Vishal

doi:10.1007/s10620-020-06361-9

Cited by 10 publications

(6 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Advancements in small-bowel endoscopy including motorized spiral endoscopy could help improve the diagnosis of small-bowel TB. The other interest has been in using biomarkers including tumor markers (to discriminate TBP from peritoneal carcinomatosis), cytokines, CD4 + CD25 + FOXP3 + T-regulatory cells > 31.3% in peripheral blood (to discriminate GITB and CD), proteomic-based approaches, and nuclear medicine, including fluorodeoxyglucose (FDG)-positron emission tomography (PET) CT [90][91][92][93][94]. While some of these approaches have not been helpful, others, like the use of T-regulatory cells, appear promising but need validation at additional centers and assessment of feasibility before routine application.…”

Section: Future Aspectsmentioning

confidence: 99%

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Jha

Pathiyil

Sharma

2023

Indian J Gastroenterol

Self Cite

View full text Add to dashboard Cite

Abdominal tuberculosis is an ancient problem with modern nuances in diagnosis and management. The two major forms are tuberculous peritonitis and gastrointestinal tuberculosis (GITB), while the less frequent forms are esophageal, gastroduodenal, pancreatic, hepatic, gallbladder and biliary tuberculosis. The clinicians need to discriminate the disease from the close mimics: peritoneal carcinomatosis closely mimics peritoneal tuberculosis, while Crohn's disease closely mimics intestinal tuberculosis. Imaging modalities (ultrasound, computed tomography, magnetic resonance imaging and occasionally positron emission tomography) guide the line of evaluation. Research in diagnostics (imaging and endoscopy) has helped in the better acquisition of tissue for histological and microbiological tests. Although point-of-care polymerase chain reaction-based tests (e.g. Xpert Mtb/Rif) may provide a quick diagnosis, these have low sensitivity. In such situations, ancillary investigations such as ascitic adenosine deaminase and histological clues (granulomas, caseating necrosis, ulcers lined by histiocytes) may provide some specificity to the diagnosis. A diagnostic trial of antitubercular therapy (ATT) may be considered if all diagnostic armamentaria fail to clinch the diagnosis, especially in TB-endemic regions. Objective evaluation with clear endpoints of response is mandatory in such situations. Early mucosal response (healing of ulcers at two months) and resolution of ascites are objective criteria for early response assessment and should be sought at two months. Biomarkers, especially fecal calprotectin for intestinal tuberculosis, have also shown promise. For most forms of abdominal tuberculosis, six months of ATT is sufficient. Sequelae of GITB may require endoscopic balloon dilatation for intestinal strictures or surgical intervention for recurrent intestinal obstruction, perforation or massive bleeding.

show abstract

Section: Future Aspectsmentioning

confidence: 99%

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Jha

Pathiyil

Sharma

2023

Indian J Gastroenterol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Though dedicated prospective studies are not available, detailing the use of this technique in diagnosis of other pathologies (apart from the ones described above), evidence is available for the potential utility of this technique in the differential diagnosis of other gastrointestinal lesions like suspected ileocecal thickenings [7].…”

Section: Neuroendocrine Tumorsmentioning

confidence: 99%

PET/computed tomography enterography

Sharma

Phulia

Sethi

2021

Nuclear Medicine Communications

View full text Add to dashboard Cite

Interpretation of gastrointestinal PET/computed tomography (PET/CT) is often complicated by anatomy including bowel folds, flexures, variant redundancy, decompressed bowel segments and physiological uptake. This makes it very difficult to identify both true positives and true negatives, compromising both sensitivity and specificity. CT enterography is increasingly being integrated into the field of nuclear medicine to address these issues. This technique uses the combination of negative/neutral contrast to distend the lumen of the gut and iodinated contrast to enhance the gastrointestinal wall and pathological findings. Apart from augmentation in the diagnostic performance, the technique also improves the quality of the imaging, confidence of the reporting physician and inter-rater agreement. Therefore, this technique has found favor among nuclear medicine physicians, in the imaging of chronic inflammatory disorders and malignancies in and of the gut. It is a feasible and easily executable procedure with minimal and manageable side-effects and should be routinely recommended in cases where interference from physiologic findings is expected.

show abstract

“…A few recent CT imaging techniques (carbon dioxide enterography and positron emission tomography/CT enterography) have shown encouraging results in the differentiation of the two diseases [ 7 , 8 ]. However, these techniques are not widely available and entail high costs and a lot of time.…”

Section: Introductionmentioning

confidence: 99%

Perfusion Computed Tomography May Help in Discriminating Gastrointestinal Tuberculosis and Crohn’s Disease

et al. 2023

Self Cite

View full text Add to dashboard Cite

Gastrointestinal tuberculosis (GITB) and Crohn’s disease (CD) are close mimics. This prospective study aimed to evaluate the diagnostic performance of perfusion computed tomography (CT) in differentiating GITB from CD. Consecutive patients with ileocaecal thickening underwent perfusion CT of the ileocaecal region between January 2019 and July 2020. Two radiologists (blinded to the final diagnosis) independently assessed blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability at perfusion CT. These parameters were compared among the patients with GITB as well as active and inactive CD. Receiver operating characteristic curves were utilized for determining the diagnostic performance of perfusion CT. Interclass correlation coefficient and Bland–Altman analysis were performed to compare the observations of the two radiologists. During the study period, 34 patients underwent perfusion CT. Eight patients had diagnoses other than intestinal tuberculosis or CD. Thus, 26 patients (mean age 36 ± 14 years, 18 males) with GITB (n = 11), active CD (n = 6), and inactive CD (n = 9) were evaluated. BF, MTT, and permeability showed significant differences among the groups, while BV did not differ significantly among the groups. BF and permeability had 100% sensitivity and 100% specificity, while MTT had 61.5–100% sensitivity and 70–100% specificity for differentiating GITB from active CD and active from inactive CD. The interclass correlation coefficient for perfusion CT parameters was 0.88–1. Perfusion CT is a novel imaging technique that can improve the diagnostic performance of differentiating tuberculosis from CD.

show abstract

FDG-PET–CT Enterography Helps Determine Clinical Significance of Suspected Ileocecal Thickening: A Prospective Study

Cited by 10 publications

References 26 publications

Evidence-based approach to diagnosis and management of abdominal tuberculosis

Evidence-based approach to diagnosis and management of abdominal tuberculosis

PET/computed tomography enterography

Perfusion Computed Tomography May Help in Discriminating Gastrointestinal Tuberculosis and Crohn’s Disease

Contact Info

Product

Resources

About