A Prospective Study of 18F-FDG PET-CT Application in Therapeutic Monitoring of Osteoarticular Tuberculosis
DOI:
https://doi.org/10.31584/jhsmr.20241027Keywords:
18F-Fluoro-deoxy-glucose, latent tuberculosis, positron emission tomography, treatment response, TuberculosisAbstract
Objective: Confident diagnosis, identification of occult sites, assessing treatment response, and precisely ascertaining the duration and endpoint of treatment in skeletal tuberculosis is often challenging. magnetic resonance imaging (MRI) and computed tomography (CT) are less dependable owing to low sensitivity and the inability to discern current illness and old changes. 18F-FDG PET/CT utilizes variations in glycolysis rates between healthy and diseased tissue to quantitatively estimate the maximal standard uptake value (SUVmax) of 18F-FDG to assess disease activity.
Material and Methods: 32 patients who presented to the department with a clinicoradiological suspicion and pathologically proven diagnosis of skeletal tuberculosis were prospectively analyzed. All patients underwent a whole body 18F-FDG PET-CT scan before initiation of anti-tubercular therapy (ATT), and then treatment was started as per the Revised National Tuberculosis Control Program (RNTCP) guidelines. All patients were followed up with repeat PET-CT scans and relevant clinical investigations at 2, 6, and 12 months.
Results: A gradual decrease in SUVmax values, as the treatment courses progressed indicated a decrease in disease activity with treatment. There was an overall mean decrease of 6.5 units in the SUVmax values when compared to the pre-treatment levels, which was statistically significant (p-value<0.001). At 2 months of anti-tubercular treatment, the mean SUVmax values decreased by 39%, and at 6 and 12 months of ATT, they were reduced by 60% and 81%, respectively.
Conclusion: 18F-FDG PET-CT helps to determine the prevalence of occult multifocal activity elsewhere in the body. The gradual decrease in SUVmax values during the course of ATT is a useful tool to assess disease response and to precisely decide the endpoint of ATT.
References
Global Tuberculosis Report 2022. [homepage on the Internet]. Geneva: World Health Organization; 2021. License: CC BY-NC-SA 3.0 IGO. [cited 2016 Jan 20]. Available from https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022
Horsburgh CR, Barry CE, Lange C. Treatment of Tuberculosis. N Engl J Med 2015;373:2149-60.
Chrétien J, Papillon F. La tuberculose et les mycobactérioses à l’ère du SIDA [Tuberculosisand mycobacterioses in the AIDS era]. Rev Prat 1990;40:709-14.
Alvarez S, McCabe WR. Extrapulmonary tuberculosis revisited: a review of experience at Boston city and other hospitals. Medicine (Baltimore) 1984;63:25-55.
Hardoff R, Efrat M, Gips S. Multifocal osteoarticular tuberculosis resembling skeletal metastatic disease. Evaluation with Tc-99m MDP and Ga-67 citrate. Clin Nucl Med 1995;20:279-81. doi: 10.1097/00003072-199503000-00023.
Tuli SM. General principles of osteoarticular tuberculosis. Clin Orthop Relat Res 2002:11-9. doi: 10.1097/00003086-200205000-00003.
Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake--the role of PET/CT. Eur Radiol 2006;16:1054-65. doi: 10.1007/s00330-005-0088-y.
Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med 2011;34:440-54. doi: 10.1179/2045772311Y.0000000023.
Ramachandran S, Clifton IJ, Collyns TA, Watson JP, Pearson SB. The treatment of spinal tuberculosis: a retrospective study. Int J Tuberc Lung Dis 2005;9:541-2.
Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN et al, American thoracic society/centers for disease control and prevention/infectious diseases society of America: treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-62. doi: 10.1164/rccm.167.4.603.
Schmitz A, Risse JH, Grünwald F, Gassel F, Biersack HJ, Schmitt O. Fluorine-18 fluorodeoxyglucose positron emission tomography findings in spondylodiscitis: preliminary results. Eur Spine J 2001:534-9. doi: 10.1007/s005860100339.
Kim SJ, Kim IJ, Suh KT, Kim YK, Lee JS. Prediction of residual disease of spine infection using F-18 FDG PET/CT. Spine (Phila Pa 1976) 2009;34:2424-30. doi: 10.1097/BRS.0b013e3181b1fd33.
Vorster M, Sathekge MM, Bomanji J. Advances in imaging of tuberculosis: the role of ¹⁸F FDG PET and PET/CT. Curr Opin Pulm Med 2014;20:287-93. doi:10.1097/MCP.0000000000000043.
Dureja S, Sen IB, Acharya S. Potential role of F18 FDG PET-CT as an imaging biomarker for the noninvasive evaluation in uncomplicated skeletal tuberculosis: a prospective clinical observational study. Eur Spine J 2014;23:2449–54.
Wani RT. Socioeconomic status scales modified Kuppuswamy and Udai Pareekh’s scale updated for 2019. J Family Med Prim Care 2019:1846-9.
Davidson PT, Horowitz I. Skeletal tuberculosis. A review with patient presentations and discussion. Am J Med 1970;48:77-84. doi: 10.1016/0002-9343(70)90101-4.
Sankaran B. Tuberculosis of bones & joints-oration. Indian J Tuberc 1993;40:109–18.
Jutte PC, van Loenhout-Rooyackers JH, Borgdorff MW, van Horn JR. Increase of bone and joint tuberculosis in The Netherlands. J Bone Joint Surg Br 2004;86:901-4. doi:10.1302/0301-620x.86b6.14844.
Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004;120:316–353.
Haider ALM. Bones and Joints Tuberculosis. Bahrain Medical Bulletin 2007;29:1–9.
Chopra R, Bhatt R, Biswas SK, Bhalla R. Epidemiological features of skeletal tuberculosis at an urban district tuberculosis center. Indian J Tuberc 2016;63:91-5.
Sinan T, Al-Khawari H, Ismail M, Ben-Nakhi A, Sheikh M. Spinal tuberculosis: CT and MRI features. Ann Saudi Med 2004;24:437-41.
Watts HG, Lifeso RM. Tuberculosis of bones and joints. J Bone Joint Surg Am 1996;78:288-98. doi: 10.2106/00004623-199602000-00019.
Vaughan KD. Extraspinal osteoarticular tuberculosis: a forgotten entity? West Indian Med J 2005;54:202-6. doi: 10.1590/s0043-31442005000300009.
Rasool MN. Osseous manifestations of tuberculosis in children. J Pediatr Orthop 2001;21:749-55.
C Martins, AC de Castro Gama, DValcarenghi, A Paula de Borba Batschauer. Markers of acute-phase response in the treatment of pulmonary tuberculosis. J Bras Patol Med Lab 2014;50:428-33.
Jain AK, Amit Srivastava, Namita Singh Saini1, Ish K Dhammi, Ravi Sreenivasan, Sudhir Kumar. Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status. Indian J Orthop 2012;46:633-9.
Breen RA, Smith CJ, Bettinson H, Dart S, Bannister B, Johnson MA, Lipman MC. Paradoxical reactions during tuberculosis treatment in patients with and without HIV coinfection. Thorax 2004;59:704-7.
Varghese M. Drug therapy for Spinal Tuberculosis, In AO Spine Masters Series: Spinal Infection. Thieme Medical Publishers: New York; 2018;p.75-87.
Harkirat S, Anand SS, Indrajit IK, Dash AK, Pictorial essay PET/CT in tuberculosis. Indian J Radiol Imaging 2008;18:141–7.
National Tuberculosis Elimination Program. [homepage on Internet]. New Delhi: Central Tuberculosis Division;2023 [cited 2023 Mar 24]. Available From https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=4571&lid=3176
Bass JB, Farer LS, Hopewell PC, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society. Am J Respir Crit Care Med 1994;149:1359–74.
Stevenson R. Chemotherapy and management of tuberculosis in the United Kingdom: recommendations 1998. Joint Tuberculosis Committee of the British Thoracic Society. Thorax 1998;53:536-48.
Donald PR. The chemotherapy of osteo-articular tuberculosis with recommendations for treatment of children. J Infect 2011;62:411-39. doi: 10.1016/j.jinf.2011.04.239.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
