Spinal Tuberculosis Evaluated by Means of 18F-FDG PET/CT: Pilot Study

Abstract

Abstract:Introduction: Spinal tuberculosis is a serious health care problem and diagnosis is often difficult because many diseases may have similar imaging findings. Hence the need to describe findings of spinal tuberculosis with 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) when compared to CT. Materials and Methods:Sixteen consecutive patients who underwent 18F-FDG PET/CT and known to have or subsequently were proven to have spinal tuberculosis were analyzed. All patients included underwent whole-body 18F-FDG PET imaging; none of the patients were on tuberculostatics at the time of the PET investigation. We evaluated 18F-FDG uptake visually and semiquantitatively using standardized uptake values (SUVmax) and the ratio of lesion to normal liver (S/L ratio), respectively. The presence of spinal and extraspinal lesions was evaluated histopathologically and by the radiologic findings noted on diagnostic CT. Diagnostic Computed Tomographic (CT) findings were reviewed and compared to 18F-FDG PET/CT.Results: Only 4 patients had one spinal lesion, while 12 (75%) patients had 2 or more lesions. Those patients that had three or more lesions demonstrated intense FDG uptake with a median of 11.34 (3.8-20.9). Ten (62%) of the patients had both spinal and extraspinal lesions. In most of the cases (75%), the lumbar spine was involved as opposed to the thoracic vertebrae. 18F-FDG PET detected all 39/39 (100%) clinically (sites of disease that resulted in symptoms or signs such as pain, swelling, neurological fallout etc.) and histologically (as reported by the laboratory) observed spinal sites. The median of the SUVmax for spinal lesions was 6.06 (ranging from 2.63 to 16.78). Diagnostic CT reported corresponding morphological changes in only 27 (69%) of the spinal sites identified on 18F-FDG PET/CT. 18F-FDG PET/CT detected 60 of 60 (100%) clinically observed extraspinal sites including pulmonary TB, nodal disease and other musculoskeletal sites versus the 43 of 60 (71%) detected by diagnostic CT only. The median of the SUVmax was 3.61 for nodal sites (ranging from 1.71 to 10.79) and 3.38 for pulmonary sites (ranging from 1.23 to 5.93). Conclusion:The results suggest that 18F-FDG PET/CT is more effective compared to diagnostic CT only in the identification of sites of active disease and contributes to a better evaluation of extraspinal involvement in TB patients. It also appears to be a very promising imaging modality for the identification of the most appropriate biopsy site, staging disease, predicting multi-drug resistance and monitoring response to therapy.

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

“…17 It has further been reported that patients with three or more vertebral lesions affected demonstrated intense FDG uptake, almost three times more that of a single spinal lesion. 7 Additionally, in the present study, most participants (80%) in the positive PET/CT scan group were HIV positive, with the majority (60%) having had a history of previous PTB. The relationship between HIV and TB is well known and often described as a co-epidemic, and in 2014 the WHO estimated the risk of contracting TB to be 26 to 31 times greater in HIV-positive individuals.…”

“…A good example of this is in patients with HIV infection, who, due also to a weaker immune system, have a 20-fold increased risk of contracting TB. 7 Other cytological, microbiological and DNA-based tests are also used in the diagnosis of TB spine. To confirm the diagnosis of spinal TB, it is necessary to either demonstrate acid-fast bacilli (AFB) on microscopy, grow bacilli in culture or have histological evidence of granulomatous inflammation.…”

“…14 Further, recent literature suggests that the 18F-FDG PET/CT scan can be used as a functional imaging technique to evaluate the extent of spinal TB, and can also be used to assess response to treatment. 7,15 Zinn et al 7 concluded in their work that 18F-FDG PET/CT appears to be a very promising imaging modality in spinal TB, especially for identifying the most appropriate biopsy site, evaluating the disease extent, predicting possible multidrug resistance and monitoring the response to treatment.…”

Studi Kasus Ketidakpatuhan Orang Kontak Serumah terhadap Anjuran Pemeriksaan Tuberkulosis

“…Perasaan takut tertular ini menunjukkan bahwa orang kontak serumah meyakini bahwa mereka mempunyai risiko tertular. Partisipan memahami bahwa risiko merupakan suatu bahaya, kehilangan, kerusakan atau ancaman (Zinn, 2008). Adanya perubahan perhatian dari kerentanan menjadi faktor risiko, ini akan menjadi sumber kesehatan seseorang (Dorthe, dkk., 2009).…”

Could an increase in vigilance for spinal tuberculosis at primary health care level, enable earlier diagnosis at district level in a tuberculosis endemic country?

“… 4 These findings suggest that people living with HIV and STB may have less evidence on plain radiography despite more vertebral sites being affected. 9 Antiretroviral therapy (ART) decreases TB risk by 65%. 10 However, immune reconstitution syndrome (IRIS) also plays a role in STB, as those who are unknowingly co-infected and initiating ART, are at risk of developing active symptoms of TB.…”