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Nuclear medicine imaging in tuberculosis using commercially available radiopharmaceuticals

Mike Sathekge, Alex Maes, Yves D'Asseler, Mariza Vorster and Christophe Van De Wiele UGent (2012) NUCLEAR MEDICINE COMMUNICATIONS. 33(6). p.581-590
abstract
In this paper, data available on nuclear medicine imaging using commercially available radiopharmaceuticals for the differentiation, staging, and prediction or assessment of the response to treatment in tuberculosis (TB) are reviewed. Limited available studies suggest that single photon emission computed tomography (SPECT) using either (TI)-T-201, Tc-99m-sestamibi, or Tc-99m-tetrofosmin is accurate (>= 85%) and has a high negative predictive value (>= 90%) for the differentiation of TB from carcinoma in patients presenting with a solitary pulmonary nodule (SPN). The criteria for detection of TB on (TI)-T-201 SPECT are nondepiction of the suspicious lesion in the delayed image or a negative retention index [washout on the delayed images (3-4 h postinjection) vs. the early image (5-15 min postinjection)] and a comparable-to-background uptake on Tc-99m-sestamibi or Tc-99m-tetrofosmin SPECT. Another SPECT tracer of potential interest for the differentiation of TB from malignant SPN that warrants further exploration, is N-isopropyl-p-[I-123]iodoamphetamine (I-123-IMP). In contrast, F-18-fluorodeoxyglucose (F-18-FDG) PET is unable to differentiate malignancy from TB and thus cannot be used as a tool to reduce futile biopsy/thoracotomy in these patients. A limited number of studies have reported on the potential of nuclear medicine imaging in assessment of the extent of disease in patients with extrapulmonary TB using Ga-67-citrate SPECT and F-18-FDG PET, respectively. Ga-67-citrate SPECT was shown to be as sensitive as bone scintigraphy for the detection of bone infection and was found to be complementary to computed tomography (CT) imaging. F-18-FDG PET was found to be significantly more efficient when compared with CT, respectively, in over half of patients for the identification of sites of lymph node involvement that were missed by CT and often the only sites of extrapulmonary TB identified. Unfortunately, F-18-FDG PET findings did not lead to alterations in treatment planning in any of the patients under study. Additional studies confirming these findings are urgently required. Similar to the setting of SPN, F-18-FDG PET cannot differentiate malignant lymph node involvement from lymph node involvement by TB. These results and the recent findings of Demura and colleagues using F-18-FDG PET further suggest that nuclear medicine imaging techniques could be used for the evaluation of therapeutic response. Prospective studies, focusing on specific subgroups of patients in whom such an imaging approach might be clinically relevant, for example in multidrug-resistant TB patients, are warranted. In acquired immunodeficiency syndrome patients, Ga-67 scintigraphy proved to be a reliable and sensitive method for the primary detection and follow-up of opportunistic pneumonias, including TB. Combining (TI)-T-201 scintigraphy with Ga-67 scintigraphy was shown to increase the specificity for both pulmonary and extrapulmonary TB, which is a Ga-67(+) and (TI)-T-201(-) mismatch pattern in acquired immunodeficiency syndrome patients that is specific for mycobacterial infections. Finally, the results obtained using both SPECT and PET indicate that nuclear medicine could be an important noninvasive method for the determination of disease activity, detection of extrapulmonary TB, and determination of response to therapy.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (review)
publication status
published
subject
keyword
UNITED-STATES, FUTURE-PROSPECTS, imaging, nuclear medicine, tuberculosis, EMISSION COMPUTED-TOMOGRAPHY, NEGATIVE PULMONARY TUBERCULOSIS, GA-67 SCINTIGRAPHY, EXTRAPULMONARY TUBERCULOSIS, RESISTANT TUBERCULOSIS, MULTIDRUG-RESISTANT, THORACIC LESIONS, ISOBUTYL ISONITRILE
journal title
NUCLEAR MEDICINE COMMUNICATIONS
Nucl. Med. Commun.
volume
33
issue
6
pages
581 - 590
Web of Science type
Review
Web of Science id
000304078800003
JCR category
RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
JCR impact factor
1.379 (2012)
JCR rank
74/119 (2012)
JCR quartile
3 (2012)
ISSN
0143-3636
DOI
10.1097/MNM.0b013e3283528a7c
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
3142136
handle
http://hdl.handle.net/1854/LU-3142136
date created
2013-02-25 14:37:52
date last changed
2016-12-19 15:43:45
@article{3142136,
  abstract     = {In this paper, data available on nuclear medicine imaging using commercially available radiopharmaceuticals for the differentiation, staging, and prediction or assessment of the response to treatment in tuberculosis (TB) are reviewed. Limited available studies suggest that single photon emission computed tomography (SPECT) using either (TI)-T-201, Tc-99m-sestamibi, or Tc-99m-tetrofosmin is accurate ({\textrangle}= 85\%) and has a high negative predictive value ({\textrangle}= 90\%) for the differentiation of TB from carcinoma in patients presenting with a solitary pulmonary nodule (SPN). The criteria for detection of TB on (TI)-T-201 SPECT are nondepiction of the suspicious lesion in the delayed image or a negative retention index [washout on the delayed images (3-4 h postinjection) vs. the early image (5-15 min postinjection)] and a comparable-to-background uptake on Tc-99m-sestamibi or Tc-99m-tetrofosmin SPECT. Another SPECT tracer of potential interest for the differentiation of TB from malignant SPN that warrants further exploration, is N-isopropyl-p-[I-123]iodoamphetamine (I-123-IMP). In contrast, F-18-fluorodeoxyglucose (F-18-FDG) PET is unable to differentiate malignancy from TB and thus cannot be used as a tool to reduce futile biopsy/thoracotomy in these patients. A limited number of studies have reported on the potential of nuclear medicine imaging in assessment of the extent of disease in patients with extrapulmonary TB using Ga-67-citrate SPECT and F-18-FDG PET, respectively. Ga-67-citrate SPECT was shown to be as sensitive as bone scintigraphy for the detection of bone infection and was found to be complementary to computed tomography (CT) imaging. F-18-FDG PET was found to be significantly more efficient when compared with CT, respectively, in over half of patients for the identification of sites of lymph node involvement that were missed by CT and often the only sites of extrapulmonary TB identified. Unfortunately, F-18-FDG PET findings did not lead to alterations in treatment planning in any of the patients under study. Additional studies confirming these findings are urgently required. Similar to the setting of SPN, F-18-FDG PET cannot differentiate malignant lymph node involvement from lymph node involvement by TB. These results and the recent findings of Demura and colleagues using F-18-FDG PET further suggest that nuclear medicine imaging techniques could be used for the evaluation of therapeutic response. Prospective studies, focusing on specific subgroups of patients in whom such an imaging approach might be clinically relevant, for example in multidrug-resistant TB patients, are warranted. In acquired immunodeficiency syndrome patients, Ga-67 scintigraphy proved to be a reliable and sensitive method for the primary detection and follow-up of opportunistic pneumonias, including TB. Combining (TI)-T-201 scintigraphy with Ga-67 scintigraphy was shown to increase the specificity for both pulmonary and extrapulmonary TB, which is a Ga-67(+) and (TI)-T-201(-) mismatch pattern in acquired immunodeficiency syndrome patients that is specific for mycobacterial infections. Finally, the results obtained using both SPECT and PET indicate that nuclear medicine could be an important noninvasive method for the determination of disease activity, detection of extrapulmonary TB, and determination of response to therapy.},
  author       = {Sathekge, Mike and Maes, Alex and D'Asseler, Yves and Vorster, Mariza and Van De Wiele, Christophe},
  issn         = {0143-3636},
  journal      = {NUCLEAR MEDICINE COMMUNICATIONS},
  keyword      = {UNITED-STATES,FUTURE-PROSPECTS,imaging,nuclear medicine,tuberculosis,EMISSION COMPUTED-TOMOGRAPHY,NEGATIVE PULMONARY TUBERCULOSIS,GA-67 SCINTIGRAPHY,EXTRAPULMONARY TUBERCULOSIS,RESISTANT TUBERCULOSIS,MULTIDRUG-RESISTANT,THORACIC LESIONS,ISOBUTYL ISONITRILE},
  language     = {eng},
  number       = {6},
  pages        = {581--590},
  title        = {Nuclear medicine imaging in tuberculosis using commercially available radiopharmaceuticals},
  url          = {http://dx.doi.org/10.1097/MNM.0b013e3283528a7c},
  volume       = {33},
  year         = {2012},
}

Chicago
Sathekge, Mike, Alex Maes, YVES D’ASSELER, Mariza Vorster, and Christophe Van De Wiele. 2012. “Nuclear Medicine Imaging in Tuberculosis Using Commercially Available Radiopharmaceuticals.” Nuclear Medicine Communications 33 (6): 581–590.
APA
Sathekge, M., Maes, A., D’ASSELER, Y., Vorster, M., & Van De Wiele, C. (2012). Nuclear medicine imaging in tuberculosis using commercially available radiopharmaceuticals. NUCLEAR MEDICINE COMMUNICATIONS, 33(6), 581–590.
Vancouver
1.
Sathekge M, Maes A, D’ASSELER Y, Vorster M, Van De Wiele C. Nuclear medicine imaging in tuberculosis using commercially available radiopharmaceuticals. NUCLEAR MEDICINE COMMUNICATIONS. 2012;33(6):581–90.
MLA
Sathekge, Mike, Alex Maes, YVES D’ASSELER, et al. “Nuclear Medicine Imaging in Tuberculosis Using Commercially Available Radiopharmaceuticals.” NUCLEAR MEDICINE COMMUNICATIONS 33.6 (2012): 581–590. Print.