Nicolas Lefebvre1, Xavier Argemi2, Nicolas Meyer3, Joy Mootien4, Nawal Douiri1, Stefania Sferrazza-Mandala1, Frédéric Schramm5, Noëlle Weingertner6, Daniel Christmann1, Yves Hansmann1, Alessio Imperiale7. 1. Department of Infectious Diseases and Tropical Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France. 2. Department of Infectious Diseases and Tropical Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France. Electronic address: xavier_argemi@hotmail.com. 3. Department of Public Health, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France. 4. Department of Intensive Care Medicine, Munchberg General Hospital, Mulhouse, France. 5. Microbiology, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France. 6. Department of Pathology, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France. 7. Department of Biophysic and Nuclear Medicine, University Hospital of Strasbourg And University of Strasbourg, Strasbourg, France.
Abstract
INTRODUCTION: Few studies have evaluated the promising role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (PET) and PET/computed tomography FDG PET/CT in evaluating and monitoring treatment response in patients with lymph node tuberculosis (LNTB). The aim of this clinical investigation was to assess the clinical usefulness of FDG PET/CT for initial tuberculosis staging and to determine the prognostic value of the decrease of 18F-FDG uptake during antibiotic treatment in LNTB patients. METHODS: We retrospectively reviewed 18 cases of LNTB admitted at a single center from 2004 to 2014. Medical records of patients who underwent two FDG PET/CT (>6 months interval), at initial staging and at the end of therapy were reviewed to determine the impact of FDG PET/CT on initial management of LNTB and response to therapy. Statistical analysis was performed using linear mixed-effects model. RESULTS: Thirteen cases of disseminated LNTB and five cases of localized LNTB were included in the study. Initial FDG PET/CT allowed guided biopsy for initial diagnosis in 5 patients and identified unknown extra-LN TB sites in 9 patients. Visual analysis follow-up of FDG PET/CT showed a complete metabolic response in 9/18 patients (all of whom were cured), a partial response in 7/18 (5 of whom were cured) and no response in 2/18 (all of whom were not cured). The semi-quantitative evaluation of 18F-FDG intensity decrease based on the maximum standardized uptake value (SUVmax), compared to targeted estimated decrease allowed to predict correctly a complete response to treatment in 14/18 cases. CONCLUSION: FDG PET/CT allows an accurate pre-therapeutic mapping of LNTB and helps for early TB confirmation. The SUVmax follow up is a potential tool for monitoring the treatment response.
INTRODUCTION: Few studies have evaluated the promising role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (PET) and PET/computed tomography FDG PET/CT in evaluating and monitoring treatment response in patients with lymph node tuberculosis (LNTB). The aim of this clinical investigation was to assess the clinical usefulness of FDG PET/CT for initial tuberculosis staging and to determine the prognostic value of the decrease of 18F-FDG uptake during antibiotic treatment in LNTB patients. METHODS: We retrospectively reviewed 18 cases of LNTB admitted at a single center from 2004 to 2014. Medical records of patients who underwent two FDG PET/CT (>6 months interval), at initial staging and at the end of therapy were reviewed to determine the impact of FDG PET/CT on initial management of LNTB and response to therapy. Statistical analysis was performed using linear mixed-effects model. RESULTS: Thirteen cases of disseminated LNTB and five cases of localized LNTB were included in the study. Initial FDG PET/CT allowed guided biopsy for initial diagnosis in 5 patients and identified unknown extra-LN TB sites in 9 patients. Visual analysis follow-up of FDG PET/CT showed a complete metabolic response in 9/18 patients (all of whom were cured), a partial response in 7/18 (5 of whom were cured) and no response in 2/18 (all of whom were not cured). The semi-quantitative evaluation of 18F-FDG intensity decrease based on the maximum standardized uptake value (SUVmax), compared to targeted estimated decrease allowed to predict correctly a complete response to treatment in 14/18 cases. CONCLUSION: FDG PET/CT allows an accurate pre-therapeutic mapping of LNTB and helps for early TB confirmation. The SUVmax follow up is a potential tool for monitoring the treatment response.
Authors: Adrián Sánchez-Montalvá; Marta Barios; Fernando Salvador; Ana Villar; Teresa Tórtola; Daniel Molina-Morant; Carles Lorenzo-Bosquet; Juan Espinosa-Pereiro; Israel Molina Journal: PLoS One Date: 2019-08-27 Impact factor: 3.240