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Dhodapkar MM, Patel T, Rubio DR. Imaging in spinal infections: Current status and future directions. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100275. [PMID: 37822347 PMCID: PMC10562850 DOI: 10.1016/j.xnsj.2023.100275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/27/2023] [Accepted: 09/02/2023] [Indexed: 10/13/2023]
Abstract
Imaging plays an important role in the diagnosis of spinal infections. Early diagnosis is paramount in the treatment of spinal infections and leads to improved outcomes. This article reviews the imaging and relevant clinical details of infections of the spine: pyogenic spondylodiscitis, tuberculous spondylodiscitis, septic facet arthritis, epidural abscess, and subdural abscess. Though radiographs can reveal subtle changes with infections, advanced imaging modalities have increased sensitivity to aid in early diagnosis. Magnetic resonance imaging (MRI) is emphasized given it is generally the most sensitive and specific advanced imaging modality. However, nuclear medicine imaging and computer tomography (CT) play a role diagnosis in cases where MRI is not available or contra-indicated. Additionally, CT is also important for image-guided biopsy to guide antimicrobial treatment.
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Affiliation(s)
- Meera M. Dhodapkar
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Tamanna Patel
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Daniel R. Rubio
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
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Damle N, Kaushik P, Subudhi K, Tiwari V, Sikdar S, Ranjan P, Goyal A. Tc-99m Ethambutol Scintigraphy with Single-Photon Emission Computed Tomography in Diagnosis of Tubercular Iliopsoas Abscess. Indian J Nucl Med 2023; 38:390-391. [PMID: 38390540 PMCID: PMC10880845 DOI: 10.4103/ijnm.ijnm_198_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2024] Open
Abstract
Very few imaging techniques can demonstrate the presence of Mycobacterium tuberculosis in vivo. Technitium-99m Ethambutol scintigraphy is one of them, although literature on the utility of this technique is scarce. We describe a patient with iliopsoas abscess showing increased uptake on Tc-99 m ethambutol scintigraphy which was later confirmed to be tubercular by the microbiological analysis of pus.
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Affiliation(s)
- Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Kaushik
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kishan Subudhi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Varsha Tiwari
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sunit Sikdar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Primadhi RA, Kartamihardja AHS. Subclinical ankle joint tuberculous arthritis - The role of scintigraphy: A case series. World J Orthop 2023; 14:260-267. [PMID: 37155508 PMCID: PMC10122779 DOI: 10.5312/wjo.v14.i4.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/06/2023] [Accepted: 03/23/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Tuberculosis remains a complicated problem. A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis. Delayed management, particularly in osteoarticular regions, results in unnecessary procedures, including joint-sacrificing surgery.
CASE SUMMARY Three cases of subclinical ankle joint tuberculosis without clear signs of tuberculosis were presented. The efficacy of technetium-99m-ethambutol scintigraphy in diagnosing early-stage tuberculous arthritis is reported.
CONCLUSION The reports suggested that scintigraphy is recommended to diagnose subclinical tuberculous arthritis, especially in tuberculosis endemic regions.
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Affiliation(s)
- Raden Andri Primadhi
- Department Orthopaedics and Traumatology, Universitas Padjadjaran/ Hasan Sadikin Hospital, Bandung 40161, Indonesia
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Bhattacharya B, Damle N, Ranjan P, Arora G, Prakash S, Nischal N, Jorwal P, Kumar A, Tyagi A, Wig N. 99mTc-Ethambutol Scintigraphy with Single-Photon Emission Computed Tomography/Computed Tomography in Lymph Node Tuberculosis: An Initial Experience. Indian J Nucl Med 2022; 37:323-328. [PMID: 36817210 PMCID: PMC9930455 DOI: 10.4103/ijnm.ijnm_207_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose of the Study The purpose of the study is to evaluate 99mTc-labeled ethambutol (99mTc-EMB) as a potential diagnostic agent in lymph node tuberculosis (LNTB). Materials and Methods A prospective pilot study was done at All India Institute of Medical Sciences, New Delhi. We included adult consenting patients who were diagnosed with LNTB and were either treatment naïve or had just started treatment. Patients were injected with 10-15 mCi of 99mTc-EMB. Whole-body anteroposterior planar imaging was done from 15 min after injection at serial intervals till 4-6 h along with one single-photon emission computed tomography-computed tomography (SPECT-CT) imaging with the help of a dual-head SPECT-CT gamma camera. The uptake of 99mTc-EMB was analyzed and corroborated with clinicoradiological findings. Results Between January 2019 and November 2020, we recruited 23 patients who underwent 99mTc-EMB, and 19 scans were interpretable and considered for analysis. Cervical lymphadenopathy was the most common presentation (13, 68.42%), followed by mediastinal (9, 47.36%) and abdominal (4, 21.05%) nodes. Other involvement included pulmonary (8, 42.1%), gastrointestinal (3, 15.78%), and chest wall abscess and bone marrow deposits in 1 patient each. A positive scan was noted in 7 (53.84%) patients with cervical lymphadenopathy, whereas uptake in abdominal and mediastinal lymph nodes was seen in 1 (25%) and 2 (22.22%) cases, respectively. Uptake in pulmonary lesions was noted in 3 (37.5%), but uptake in hepatic and splenic lesions was not seen. Conclusion 99mTc-EMB scan can demonstrate drug penetrance in vivo in some patients with LNTB and should be explored further with a larger sample size.
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Affiliation(s)
- Bisakh Bhattacharya
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Geetanjali Arora
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sneha Prakash
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Neeraj Nischal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Jorwal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Apoorva Tyagi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kalra S, Damle NA, Ranjan P, Sikdar S, Arora G, Goyal A, Gautam D. 99mTc-Ethambutol Scan with SPECT/CT in Knee Joint Tuberculosis. Indian J Nucl Med 2022; 37:295-296. [PMID: 36686304 PMCID: PMC9855250 DOI: 10.4103/ijnm.ijnm_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 01/24/2023] Open
Abstract
Modalities for in vivo imaging of Mycobacterium tuberculosis are limited and inadequately studied. One such modality is 99mTc-ethambutol scintigraphy which has shown promising results for diagnosis of tuberculosis (TB). Ethambutol, one of the primary antitubercular drugs, is bacteriostatic which acts on the mycolic acid cell wall synthesis of the M. tuberculosis. However, literature on its utility is scarce. The few studies that exist have reported its sensitivity and specificity between 90%- 95% and 71%-85%. We present here a case demonstrating the role of 99mTc-ethambutol scan in knee joint TB.
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Affiliation(s)
- Simran Kalra
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
| | - Nishikant Avinash Damle
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sunit Sikdar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Geetanjali Arora
- Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gautam
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Bhattacharya B, Ranjan P, Prakash S, Damle NA, Chakraborty S, Sikdar S. Antibiotic scintigraphy in tuberculosis: A new horizon? Indian J Tuberc 2022; 69:20-26. [PMID: 35074146 DOI: 10.1016/j.ijtb.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/19/2021] [Indexed: 06/14/2023]
Abstract
Tuberculosis (TB) continues to be a major cause of death worldwide that can be effectively treated with timely diagnosis and treatment. With the advent of nuclear imaging techniques like 18Fluorine Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography (18F-FDG) PET/CT, the diagnosis of tuberculosis, particularly its extrapulmonary forms, has received great impetus in cases where microbiological confirmation cannot be achieved. Although detection of mycobacteria either by staining, culture or nucleic acid amplification techniques still form the gold standard of diagnosis, newer diagnostic techniques are always welcome in the field which can expedite clinical management. Use of radiolabeled antibiotics is one such evolving sphere which needs further research. Moving ahead from radiolabeled leukocytes, antibiotics are being increasingly focused upon to act as a vehicle to locate infectious lesions. Antibiotics like ciprofloxacin have been labeled with diagnostic radionuclides such as Technetium-99m (Tc-99m) and used to image many infectious diseases with encouraging results in TB. However, the nonspecific attributes of ciprofloxacin have hindered its growth to assist the diagnosis of TB. A novel approach would be to utilize ethambutol, a specific antitubercular agent, which has been found to be safe and effective in the diagnosis of TB in the available published studies. Ethambutol is known to be taken up specifically by tubercular lesions. This forms the basis of using Tc-99m labelled ethambutol for imaging TB lesions. An added advantage would be its ability to differentiate tubercular from malignant and fungal lung lesions that are the usual differentials in patients suspected of having TB. Most of the studies involving ethambutol have been done in skeletal TB and its validation in other forms of TB is still awaited. Recently the role of PET-CT has also been explored in human studies using 11C Rifampicin to study the antibiotic uptake in tubercular lesions. This review summarizes the available evidence regarding diagnosis of TB by radiolabeled antibiotic imaging to emphasize the need for accelerated research in the fight against TB.
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Affiliation(s)
- Bisakh Bhattacharya
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Sneha Prakash
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nishikant Avinash Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sayan Chakraborty
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sunit Sikdar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
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Damle N, Khurana A, Kumar R, Ranjan P, Sikdar S, Arora G. 99mTc-ethambutol scintigraphy with single-photon emission computed tomography/computed tomography in vertebral tuberculosis. Indian J Nucl Med 2022; 37:169-171. [PMID: 35982804 PMCID: PMC9380806 DOI: 10.4103/ijnm.ijnm_162_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
Vertebral tuberculosis (TB) is a common form of extrapulmonary TB. Here, the slow-growing Mycobacterium bacillus reaches the disc space through the hematogenous route and leads to various complications. Radiological imaging and histopathology have been the mainstay of diagnosis, but radionuclide imaging techniques using radiolabeled antitubercular drugs have rarely found space in the clinical domain. Here, we present a case of vertebral TB, where a technetium-labeled antitubercular drug, ethambutol, was synthesized and used for imaging the bacteria in vivo. Thus, we demonstrate a rarely used potentially specific agent for tuberculous-infection imaging, which can be produced in-house, and provides rapid results.
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More S, Marakalala MJ, Sathekge M. Tuberculosis: Role of Nuclear Medicine and Molecular Imaging With Potential Impact of Neutrophil-Specific Tracers. Front Med (Lausanne) 2021; 8:758636. [PMID: 34957144 PMCID: PMC8703031 DOI: 10.3389/fmed.2021.758636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/03/2021] [Indexed: 01/02/2023] Open
Abstract
With Tuberculosis (TB) affecting millions of people worldwide, novel imaging modalities and tools, particularly nuclear medicine and molecular imaging, have grown with greater interest to assess the biology of the tuberculous granuloma and evolution thereof. Much early work has been performed at the pre-clinical level using gamma single photon emission computed tomography (SPECT) agents exploiting certain characteristics of Mycobacterium tuberculosis (MTb). Both antituberculous SPECT and positron emission tomography (PET) agents have been utilised to characterise MTb. Other PET tracers have been utilised to help to characterise the biology of MTb (including Gallium-68-labelled radiopharmaceuticals). Of all the tracers, 2-[18F]FDG has been studied extensively over the last two decades in many aspects of the treatment paradigm of TB: at diagnosis, staging, response assessment, restaging, and in potentially predicting the outcome of patients with latent TB infection. Its lower specificity in being able to distinguish different inflammatory cell types in the granuloma has garnered interest in reviewing more specific agents that can portend prognostic implications in the management of MTb. With the neutrophil being a cell type that portends this poorer prognosis, imaging this cell type may be able to answer more accurately questions relating to the tuberculous granuloma transmissivity and may help in characterising patients who may be at risk of developing active TB. The formyl peptide receptor 1(FPR1) expressed by neutrophils is a key marker in this process and is a potential target to characterise these areas. The pre-clinical work regarding the role of radiolabelled N-cinnamoyl –F-(D) L – F – (D) –L F (cFLFLF) (which is an antagonist for FPR1) using Technetium 99m-labelled conjugates and more recently radiolabelled with Gallium-68 and Copper 64 is discussed. It is the hope that further work with this tracer may accelerate its potential to be utilised in responding to many of the current diagnostic dilemmas and challenges in TB management, thereby making the tracer a translatable option in routine clinical care.
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Affiliation(s)
- Stuart More
- Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
- Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa
- *Correspondence: Stuart More
| | - Mohlopheni J. Marakalala
- Africa Health Research Institute, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Michael Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
- Nuclear Medicine Research Infrastructure, Steve Biko Academic Hospital, Pretoria, South Africa
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Dharmadji HP, Suwarsa O, Sutedja E, Pangastuti M, Gunawan H, Makarti K. Erythema Induratum of Bazin Accompanied by Atrophy of the Subcutaneous Fat. Int Med Case Rep J 2021; 14:777-781. [PMID: 34815719 PMCID: PMC8604635 DOI: 10.2147/imcrj.s336088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/31/2021] [Indexed: 11/23/2022] Open
Abstract
Erythema induratum of Bazin (EIB) is a predominantly lobular panniculitis with or without vasculitis due to Mycobacterium tuberculosis (MTB) infection. Atrophic scars may remain after EIB was healed. Rare cases of EIB showing sharp skin depression may mimic deep morphea and lupus profundus. A rare case of EIB was reported in a 35-year-old female with slightly tender erythematous-violaceous nodules and hyperpigmented depressed scars on both lower legs, resulting in asymmetrical lower leg shape. Histopathological examination showed lobular panniculitis without vasculitis and granulomatous inflammation consisted of caseous necrosis, epithelioid cells, and multinucleated giant cells. Polymerase chain reaction (PCR) from skin biopsy revealed deoxyribonucleic acid (DNA) of MTB. Tuberculin skin test (TST) was positive with a 20-mm induration, and nuclear 99mTc-ethambutol scintigraphy was positive for tuberculosis infection in one-third distal portion of the left lower leg. Clinical improvements were shown after 6 months of antituberculosis therapy. EIB must be considered in patient with erythematous-violaceous nodules on lower leg, especially in endemic areas of tuberculosis infection since diagnosis can be difficult and occasionally, deceptive.
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Affiliation(s)
- Hartati Purbo Dharmadji
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Miranti Pangastuti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Hendra Gunawan
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Kristina Makarti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
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Naqvi SAR. 99m Tc-labeled antibiotics for infection diagnosis: Mechanism, action, and progress. Chem Biol Drug Des 2021; 99:56-74. [PMID: 34265177 DOI: 10.1111/cbdd.13923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/08/2021] [Accepted: 06/06/2021] [Indexed: 01/01/2023]
Abstract
Discovery of penicillin marked a turning point in the history of infection therapy which also led to the emergence of bacterial resistance. It is now 100 years to fight with ever-muted variants of pathogens by developing more and more antibiotics. Since 1987 to todate, no successful class of antibiotic was introduced; this three decade period is known as "the discovery void" period. While, the clinically approved antibiotics are gradually dying in front of bacterial resistance due to which bacterial infections are appearing leading cause of death and disability. Nuclear medicine imaging technique is the strongest modality to diagnose and follow-up of deep-seated and complicated infections. However, the selection of radiolabeled antimicrobial agents plays critical role in gaining sensitivity and specificity of the imaging results. This review comprises of two main sections; first section explains antibiotic targets, and second section explains the imaging efficacy of 99m Tc-labeled antimicrobial agents against bacterial infection along with the emphasis on progress and update of 99m Tc-labeled antibiotics as infection imaging probes. The review, in conclusion, could be an acceleration for radiopharmaceutical chemists for designing and developing 99m Tc-labeled antimicrobial agents to improve infection imaging quality.
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Affiliation(s)
- Syed Ali Raza Naqvi
- Department of Chemistry, Government College University, Faisalabad, Pakistan
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Abstract
Purpose of Review The main goal of the article is to familiarize the reader with commonly and uncommonly used nuclear medicine procedures that can significantly contribute to improved patient care. The article presents examples of specific modality utilization in the chest including assessment of lung ventilation and perfusion, imaging options for broad range of infectious and inflammatory processes, and selected aspects of oncologic imaging. In addition, rapidly developing new techniques utilizing molecular imaging are discussed. Recent Findings The article describes nuclear medicine imaging modalities including gamma camera, SPECT, PET, and hybrid imaging (SPECT/CT, PET/CT, and PET/MR) in the context of established and emerging clinical applications. Areas of potential future development in nuclear medicine are discussed with emphasis on molecular imaging and implementation of new targeted tracers used in diagnostics and therapeutics (theranostics). Summary Nuclear medicine and molecular imaging provide many unique and novel options for the diagnosis and treatment of pulmonary diseases. This article reviews current applications for nuclear medicine and molecular imaging and selected future applications for radiopharmaceuticals and targeted molecular imaging techniques.
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Hutomo F, Yudistiro R, Mulyanto ID, Budiawan H. False positive finding from malignancy-like lesions on FDG PET/CT: case report of tuberculosis patients. BMC Med Imaging 2020; 20:26. [PMID: 32138682 PMCID: PMC7059263 DOI: 10.1186/s12880-020-00427-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The F-18 fluorodeoxyglucose positron emission/computed tomography (FDG PET/CT) has become an established diagnostic imaging for malignancy. However, there are other diseases that can also be identified with FDG, some of them are infections such as tuberculosis. Case presentation In this case report, two patients showed multiple hypermetabolic tuberculosis lesions on FDG PET/CT, with one of the patients having history of malignancy. The objective of the present case report is to emphasize the need to use other differential diagnosis techniques for tuberculosis especially in tuberculosis-endemic countries when interpreting FDG PET/CT. Conclusion By analyzing diagnostic imaging alone, there is a high chance of misinterpreting asymptomatic tuberculosis patient as having malignancy. Therefore, there is need for correlation with clinical data as well as other imaging modalities and PET/CT with more specific tracer in order to differentiate malignancy from benign disease such as tuberculosis.
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Affiliation(s)
- Febby Hutomo
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre Siloam Hospital, Jakarta, Indonesia
| | - Ryan Yudistiro
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre Siloam Hospital, Jakarta, Indonesia. .,Department of Nuclear Medicine, School of Medicine of Pelita Harapan University, Tangerang, Indonesia.
| | - Ivana Dewi Mulyanto
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre Siloam Hospital, Jakarta, Indonesia.,Department of Nuclear Medicine, School of Medicine of Pelita Harapan University, Tangerang, Indonesia
| | - Hendra Budiawan
- Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Centre Siloam Hospital, Jakarta, Indonesia.,Department of Nuclear Medicine and Molecular Imaging, School of Medicine of Padjadjaran University, Dr Hasan Sadikin Hospital, Bandung, Indonesia
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Giraudo C, Evangelista L, Fraia AS, Lupi A, Quaia E, Cecchin D, Casali M. Molecular Imaging of Pulmonary Inflammation and Infection. Int J Mol Sci 2020; 21:ijms21030894. [PMID: 32019142 PMCID: PMC7037834 DOI: 10.3390/ijms21030894] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Infectious and inflammatory pulmonary diseases are a leading cause of morbidity and mortality worldwide. Although infrequently used in this setting, molecular imaging may significantly contribute to their diagnosis using techniques like single photon emission tomography (SPET), positron emission tomography (PET) with computed tomography (CT) or magnetic resonance imaging (MRI) with the support of specific or unspecific radiopharmaceutical agents. 18F-Fluorodeoxyglucose (18F-FDG), mostly applied in oncological imaging, can also detect cells actively involved in infectious and inflammatory conditions, even if with a low specificity. SPET with nonspecific (e.g., 67Gallium-citrate (67Ga citrate)) and specific tracers (e.g., white blood cells radiolabeled with 111Indium-oxine (111In) or 99mTechnetium (99mTc)) showed interesting results for many inflammatory lung diseases. However, 67Ga citrate is unfavorable by a radioprotection point of view while radiolabeled white blood cells scan implies complex laboratory settings and labeling procedures. Radiolabeled antibiotics (e.g., ciprofloxacin) have been recently tested, although they seem to be quite unspecific and cause antibiotic resistance. New radiolabeled agents like antimicrobic peptides, binding to bacterial cell membranes, seem very promising. Thus, the aim of this narrative review is to provide a comprehensive overview about techniques, including PET/MRI, and tracers that can guide the clinicians in the appropriate diagnostic pathway of infectious and inflammatory pulmonary diseases.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
- Correspondence: ; Tel.: +39-049-821-2357; Fax: +39-049-821-1878
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (L.E.); (D.C.)
| | - Anna Sara Fraia
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Amalia Lupi
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Emilio Quaia
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (L.E.); (D.C.)
- Padova Neuroscience Center (PNC), University of Padova, 35131 Padova, Italy
| | - Massimiliano Casali
- Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy;
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