Ghent University Academic Bibliography

Advanced

Use of 18F-FDG PET to predict response to first-line tuberculostatics in HIV-associated tuberculosis

Mike Sathekge, Alex Maes, Mpho Kgomo, Anton Stoltz and Christophe Van De Wiele UGent (2011) JOURNAL OF NUCLEAR MEDICINE. 52(6). p.880-885
abstract
This prospective pilot study examined the relationship between the severity and extent of tuberculosis as assessed by F-18-FDG PET at the time of diagnosis and response to treatment or treatment failure at 4 mo. Methods: Twenty-four consecutive HIV patients with newly diagnosed tuberculosis were prospectively included in the study after providing written informed consent. Seventeen patients had pulmonary tuberculosis, and 7 patients had extrapulmonary tuberculosis. All patients underwent whole-body F-18-FDG PET; none were receiving tuberculostatics at the time of the PET investigation. After undergoing F-18-FDG PET, the patients were given tuberculosis treatment (the classic triad: isoniazid, rifampicin, and ethambutol) and reevaluated for treatment response: monthly assessment of sputum, smears, and cultures in patients who proved positive at the time of diagnosis, and clinical and radiologic (when relevant) assessment 4 mo after treatment instigation in all patients. Quantitative F-18-FDG PET results (averaged F-18-FDG maximum standardized uptake value [SUVmax] derived from early and delayed imaging), percentage change in SUVmax, and number of involved lymph node bastions were related to treatment response or failure. Results: Age, sex, viral load, CD4 status, duration of HIV treatment, SUVmax of lung and splenic lesions (early and delayed), and percentage change in SUVmax of lymph nodes were not significantly different between responders and nonresponders (P >= 0.3). In contrast, SUVmax of involved lymph node bastions (both early and delayed) and number of involved lymph node bastions were significantly higher in nonresponders than in responders (respective P values were 0.03, 0.04, and 0.002). Using a cutoff of 5 or more involved lymph node bastions, responders could be separated from nonresponders with a sensitivity, specificity, and positive and negative predictive value of, respectively, 88%, 81%, 70%, and 93%. Using a cutoff of 8.15 for early SUVmax of lymph node bastions and of 10 for late SUVmax of lymph node bastions, a comparable sensitivity of 88% came at the cost of a lower specificity: 73% and 67%, respectively. Conclusion: In this pilot study, a cutoff of 5 or more involved lymph node bastions allowed for separation of tuberculostatic responsive and nonresponsive tuberculosis-infected HIV patients with a sensitivity of 88%, a specificity of 81%, and a negative predictive value of 93%. These findings warrant confirmation by additional studies on larger cohorts of patients.
Please use this url to cite or link to this publication:
author
organization
alternative title
Use of F-18-FDG PET to predict response to first-line tuberculostatics in HIV-associated tuberculosis
year
type
journalArticle (original)
publication status
published
subject
keyword
MDR, TBC, FDG PET, HIV, HUMAN-IMMUNODEFICIENCY-VIRUS, DRUG-RESISTANT TUBERCULOSIS, MYCOBACTERIUM-TUBERCULOSIS, PULMONARY TUBERCULOSIS, MULTIDRUG-RESISTANT, INFECTED PATIENTS, EPIDEMIOLOGY, EXPRESSION, MANAGEMENT
journal title
JOURNAL OF NUCLEAR MEDICINE
J. Nucl. Med.
volume
52
issue
6
pages
880 - 885
Web of Science type
Article
Web of Science id
000291030000016
JCR category
RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
JCR impact factor
6.381 (2011)
JCR rank
1/116 (2011)
JCR quartile
1 (2011)
ISSN
0161-5505
DOI
10.2967/jnumed.110.083709
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2141707
handle
http://hdl.handle.net/1854/LU-2141707
date created
2012-06-13 11:11:08
date last changed
2016-12-19 15:42:06
@article{2141707,
  abstract     = {This prospective pilot study examined the relationship between the severity and extent of tuberculosis as assessed by F-18-FDG PET at the time of diagnosis and response to treatment or treatment failure at 4 mo. Methods: Twenty-four consecutive HIV patients with newly diagnosed tuberculosis were prospectively included in the study after providing written informed consent. Seventeen patients had pulmonary tuberculosis, and 7 patients had extrapulmonary tuberculosis. All patients underwent whole-body F-18-FDG PET; none were receiving tuberculostatics at the time of the PET investigation. After undergoing F-18-FDG PET, the patients were given tuberculosis treatment (the classic triad: isoniazid, rifampicin, and ethambutol) and reevaluated for treatment response: monthly assessment of sputum, smears, and cultures in patients who proved positive at the time of diagnosis, and clinical and radiologic (when relevant) assessment 4 mo after treatment instigation in all patients. Quantitative F-18-FDG PET results (averaged F-18-FDG maximum standardized uptake value [SUVmax] derived from early and delayed imaging), percentage change in SUVmax, and number of involved lymph node bastions were related to treatment response or failure. Results: Age, sex, viral load, CD4 status, duration of HIV treatment, SUVmax of lung and splenic lesions (early and delayed), and percentage change in SUVmax of lymph nodes were not significantly different between responders and nonresponders (P {\textrangle}= 0.3). In contrast, SUVmax of involved lymph node bastions (both early and delayed) and number of involved lymph node bastions were significantly higher in nonresponders than in responders (respective P values were 0.03, 0.04, and 0.002). Using a cutoff of 5 or more involved lymph node bastions, responders could be separated from nonresponders with a sensitivity, specificity, and positive and negative predictive value of, respectively, 88\%, 81\%, 70\%, and 93\%. Using a cutoff of 8.15 for early SUVmax of lymph node bastions and of 10 for late SUVmax of lymph node bastions, a comparable sensitivity of 88\% came at the cost of a lower specificity: 73\% and 67\%, respectively. Conclusion: In this pilot study, a cutoff of 5 or more involved lymph node bastions allowed for separation of tuberculostatic responsive and nonresponsive tuberculosis-infected HIV patients with a sensitivity of 88\%, a specificity of 81\%, and a negative predictive value of 93\%. These findings warrant confirmation by additional studies on larger cohorts of patients.},
  author       = {Sathekge, Mike and Maes, Alex and Kgomo, Mpho and Stoltz, Anton and Van De Wiele, Christophe},
  issn         = {0161-5505},
  journal      = {JOURNAL OF NUCLEAR MEDICINE},
  keyword      = {MDR,TBC,FDG PET,HIV,HUMAN-IMMUNODEFICIENCY-VIRUS,DRUG-RESISTANT TUBERCULOSIS,MYCOBACTERIUM-TUBERCULOSIS,PULMONARY TUBERCULOSIS,MULTIDRUG-RESISTANT,INFECTED PATIENTS,EPIDEMIOLOGY,EXPRESSION,MANAGEMENT},
  language     = {eng},
  number       = {6},
  pages        = {880--885},
  title        = {Use of 18F-FDG PET to predict response to first-line tuberculostatics in HIV-associated tuberculosis},
  url          = {http://dx.doi.org/10.2967/jnumed.110.083709},
  volume       = {52},
  year         = {2011},
}

Chicago
Sathekge, Mike, Alex Maes, Mpho Kgomo, Anton Stoltz, and Christophe Van De Wiele. 2011. “Use of 18F-FDG PET to Predict Response to First-line Tuberculostatics in HIV-associated Tuberculosis.” Journal of Nuclear Medicine 52 (6): 880–885.
APA
Sathekge, M., Maes, A., Kgomo, M., Stoltz, A., & Van De Wiele, C. (2011). Use of 18F-FDG PET to predict response to first-line tuberculostatics in HIV-associated tuberculosis. JOURNAL OF NUCLEAR MEDICINE, 52(6), 880–885.
Vancouver
1.
Sathekge M, Maes A, Kgomo M, Stoltz A, Van De Wiele C. Use of 18F-FDG PET to predict response to first-line tuberculostatics in HIV-associated tuberculosis. JOURNAL OF NUCLEAR MEDICINE. 2011;52(6):880–5.
MLA
Sathekge, Mike, Alex Maes, Mpho Kgomo, et al. “Use of 18F-FDG PET to Predict Response to First-line Tuberculostatics in HIV-associated Tuberculosis.” JOURNAL OF NUCLEAR MEDICINE 52.6 (2011): 880–885. Print.