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Eigner S, Kleynhans J, Beckford Vera DR, Sathekge MM, Henke KE, Ebenhan T. Visualisation of in vivo protein synthesis during mycobacterial infection through [ 68Ga]Ga-DOTA-puromycin µPET/MRI. Sci Rep 2024; 14:19250. [PMID: 39164329 PMCID: PMC11335739 DOI: 10.1038/s41598-024-70200-4] [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: 09/28/2023] [Accepted: 08/13/2024] [Indexed: 08/22/2024] Open
Abstract
Radiolabelled puromycin analogues will allow the quantification of protein synthesis through nuclear medicine-based imaging. A particularly useful application could be the non-invasive longitudinal visualisation of mycobacterial activity through direct quantification of puromycin binding. This study assesses the value of [68Ga]Ga-DOTA-puromycin in the visualisation of mycobacteria through positron emission tomography combined with magnetic resonance imaging (µPET/MRI). The radiopharmaceutical was produced by previously published and validated methods. [68Ga]Ga-DOTA-Puromycin imaging was performed on severe immunodeficient mice infected with Bacille Calmette-Guérin-derived M. Bovis (BCG). Acute and chronic infection stages were examined by µPET/MRI. A follow-up group of animals acted as controls (animals bearing S. aureus-derived infection and sterile inflammation) to assess tracer selectivity. [68Ga]Ga-DOTA-puromycin-µPET/MRI images revealed the acute, widespread infection within the right upper shoulder and armpit. Also, [68Ga]Ga-DOTA-puromycin signal sensitivity measured after a 12-week period was lower than that of [18F]FDG-PET in the same animals. A suitable correlation between normalised uptake values (NUV) and gold standard histopathological analysis confirms accurate tracer accumulation in viable bacteria. The radiopharmaceutical showed infection selectivity over inflammation but accumulated in both M. Bovis and S. Aureus, lacking pathogen specificity. Overall, [68Ga]Ga-DOTA-puromycin exhibits potential as a tool for non-invasive protein synthesis visualization, albeit without pathogen selectivity.
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Affiliation(s)
- Sebastian Eigner
- Department of Radiopharmaceuticals, Nuclear Physics Institute of the Academy of Sciences of the Czech Republic, Husinec-Rez 130, 25068, Husinec-Rez, Czech Republic
- Department of Radiopharmacy, Charles University Prague, 11000, Prague, Czech Republic
| | - Janke Kleynhans
- Nuclear Medicine Research Infrastructure NPC, Pretoria, 0001, South Africa
| | - Dennis R Beckford Vera
- Department of Radiopharmaceuticals, Nuclear Physics Institute of the Academy of Sciences of the Czech Republic, Husinec-Rez 130, 25068, Husinec-Rez, Czech Republic
| | - Mike M Sathekge
- Nuclear Medicine Research Infrastructure NPC, Pretoria, 0001, South Africa
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa
| | - Katerina Eigner Henke
- Department of Radiopharmacy, Charles University Prague, 11000, Prague, Czech Republic
- Clinical for Nuclear Medicine, University Hospital RWTH Aachen, 52074, Aachen, Germany
| | - Thomas Ebenhan
- Nuclear Medicine Research Infrastructure NPC, Pretoria, 0001, South Africa.
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa.
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Garcia JR, Olivero R, Arrieta-Aldea I, Romero JA, Riera E, Cañas-Ruano E, Garrido N, Du J, Guerri R. Association between cardiovascular inflammation and alterations in immune system induced by HIV infection detected on [ 18F]FDG PET/MRI. Rev Esp Med Nucl Imagen Mol 2024:500042. [PMID: 39127392 DOI: 10.1016/j.remnie.2024.500042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/09/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To assess by [18F]FDG PET/MR the biomarkers of HIV-induced inflammation at baseline and 1 year post-antiretroviral therapy (ART). METHODS Prospective study, 14 patients, newly diagnosed HIV-positive, asymptomatic. [18F]FDG PET/MRI (PET/MR-3.0T, Signa.GE) whole body and heart was performed, baseline and 1 year post-ART. Qualitative vascular assessment (hepatic reference). Quantitative assessment (SUVmax) of the whole body. T1 and T2 value estimation in 16 myocardial segments. RESULTS Baseline CMR showed in 3 (21.4%) a decreased LVEF, normalising post-TAR. Fibrosis was ruled out (T1), with no signs of myocardial oedema (T2) at baseline or post-TAR. Four (28.6%) showed baseline vascular [18F]FDG uptake, two in ascending thoracic aorta and two in ascending and descending thoracic aorta, normalising post-TAR. All (100%) showed basal lymph-nodes activity; supra (n:14) and infradiaphragmatic (n:13), laterocervical (n:14) and inguinal (n:13), with variable number of territories (9 patients >6;64.3%). Post-ART, 7 patients (50%) showed resolution and the other 7 reduction in extension (0 patients >5): 7 supra (100%) and 2 infradiaphragmatic (28.6%), 5 in the axilla and 2 in the groin. All (100%) had persistent basal adenoid uptake post-ART, 9 (64.3%) splenic all resolved post-ART and 7 (50.5%) gastric, persistent 3 post-ART. CONCLUSIONS Cardiovascular biomarkers by [18F]FDG PET/MR have shown baseline 28.6% of patients with large vessel activity and 21.4% with low LVEF, normalising post-ART. Inflammatory/immune biomarkers showed baseline activity in 100% of lymph-nodes, 100% adenoids, 64.3% splenic and 50.5% gastric. Post-TAR the reduction was 50% lymph-nodes, 0% adenoid, 100% splenic and 57.1% gastric.
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Affiliation(s)
| | | | | | | | - E Riera
- Unidad PET/RM, CETIR ASCIRES, Spain
| | - E Cañas-Ruano
- Servicio de Infecciosas, Hospital del Mar, Barcelona, Spain
| | | | - J Du
- Instituto de Investigaciones Médicas, Hospital del Mar, Barcelona, Spain
| | - R Guerri
- Servicio de Infecciosas, Hospital del Mar, Barcelona, Spain
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Manzarbeitia-Arroba B, Ruiz-Solis S, Vega-Perez D, Garcia-Alonso P, Tabuenca MJ. 18 F-FDG PET/CT Findings in Monkeypox Infection in an HIV Patient. Clin Nucl Med 2023; 48:e574. [PMID: 37796188 DOI: 10.1097/rlu.0000000000004872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
ABSTRACT A 29-year-old man diagnosed with monkeypox infection underwent an 18 F-FDG PET/CT for the study of organic involvement in the context of a nonsatisfactory clinical evolution. He had a history of HIV (with undetectable viral load). FDG PET/CT showed multiple hypermetabolic lymphadenopathies and bilateral pulmonary nodules with mild 18 F-FDG uptake.
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Affiliation(s)
| | - Sebastian Ruiz-Solis
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Diana Vega-Perez
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pilar Garcia-Alonso
- From the Nuclear Medicine Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Maria Jose Tabuenca
- Nuclear Medicine Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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Mamidi RS, Ayubcha C, Rigney G, Kirschner J, Gerke O, Werner TJ, Tebas P, Alavi A, Revheim ME. A prospective 18 F-fluorodeoxyglucose positron emission tomography/computed tomography study of the neurometabolic effects in cocaine use and HIV infection. AIDS 2023; 37:905-912. [PMID: 36727840 PMCID: PMC10090338 DOI: 10.1097/qad.0000000000003485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/25/2022] [Accepted: 01/11/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES HIV affects 36 million people globally with prevalence decreasing due to antiretroviral therapy (ART) and social awareness; transmission occurs during substance use. Cocaine usage independently affects brain activity and may result in reduced ART adherence. This study evaluates brain glucose metabolism measured by 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) in cocaine users with HIV infection. DESIGN Sixty-three participants were categorized into groups: 36 HIV infected (HIV+) and 27 non-HIV infected (HIV-) individuals. Each group was further split into cocaine users (CO+) and non-cocaine users (CO-). Of the HIV+, half were cocaine users and half were not. Of the HIV-, 14 were cocaine users and 13 were not. 18 F-FDG-PET and low dose CT scans were performed on all participants. METHODS Brain glucose metabolism was evaluated by 18 F-FDG uptake in the whole brain, cortex, basal ganglia, and cerebellum 120 min after injection. ROVER software was used for image analysis and regions of interest masks were applied via an adaptive threshold system. ANOVA tests and t -tests were performed to assess the respective differences between the four groups. RESULTS Generally, the HIV+/CO+ group (group A) displayed the lowest levels of uptake whereas the HIV-/CO- group (group D) showed the highest; the HIV+/CO- and HIV-/CO+ groups (groups B and C) showed intermediate levels of activity across the whole brain, cortex, basal ganglia, and cerebellum. CONCLUSION HIV infection and cocaine usage were independently associated with a decrease in brain glucose uptake as measured by 18 F-FDG PET/CT. When combined, positive HIV status and cocaine patients showed the most decreased 18 F-FDG uptake.
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Affiliation(s)
- Ramya S. Mamidi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Jason Kirschner
- Division of Infectious Diseases/Clinical Trials Unit, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Thomas J. Werner
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pablo Tebas
- Division of Infectious Diseases/Clinical Trials Unit, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mona-Elisabeth Revheim
- Division of Radiology and Nuclear Medicine, Oslo University Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Shen YY, Jiang J, Zhao J, Song J. Lung squamous cell carcinoma presenting as rare clustered cystic lesions: A case report and review of literature. World J Clin Cases 2022; 10:13006-13014. [PMID: 36569005 PMCID: PMC9782924 DOI: 10.12998/wjcc.v10.i35.13006] [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: 08/27/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death. Early diagnosis is critical to improving a patient’s chance of survival. However, lung cancer associated with cystic airspaces is often misdiagnosed or underdiagnosed due to the absence of clinical symptoms, poor imaging specificity, and high risk of biopsy-related complications.
CASE SUMMARY We report an unusual case of cancer in a 55-year-old man, in which the lesion evolved from a small solitary thin-walled cyst to lung squamous cell carcinoma (SCC) with metastases in both lungs. The SCC manifested as rare clustered cystic lesions, detected on chest computed tomography. There were air-fluid levels, compartments, and bronchial arteries in the cystic lesions. Additionally, there was no clear extrathoracic metastasis. After chemotherapy, the patient achieved a partial response, type I respiratory failure was relieved, and the lung lesions became a clustered thin-walled cyst.
CONCLUSION Pulmonary cystic lesions require regular imaging follow-up. Lung SCC should be a diagnostic consideration in cases of thin-walled cysts as well as multiple clustered cystic lesions.
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Affiliation(s)
- Yu-Yao Shen
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
| | - Jing Jiang
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
| | - Jing Zhao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jie Song
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
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Tatar G, Çermik T, Alçın G, Erol Fenercioğlu Ö, İnci A, Beyhan E, Ergül N. Contribución de las imágenes PET/TC con 18F-FDG en el diagnóstico y manejo de pacientes VIH positivos. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen D, Zhu Y, Chen Y, Zhu D, Liu Z, Li T, Liu Y, Zhao K, Su X, Li L. Clinical features and 18F-FDG PET/CT for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients. BMC Infect Dis 2022; 22:646. [PMID: 35896979 PMCID: PMC9327211 DOI: 10.1186/s12879-022-07640-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/21/2022] [Indexed: 12/18/2022] Open
Abstract
Background It is vital to distinguish between inflammatory and malignant lymphadenopathy in human immunodeficiency virus (HIV) infected individuals. The purpose of our study was to differentiate the variations in the clinical characteristics of HIV patients, and apply 18F-FDG PET/CT parameters for distinguishing of malignant lymphoma and inflammatory lymphadenopathy in such patients. Methods This retrospective cross-sectional study included 59 consecutive HIV-infected patients who underwent whole-body 18F-FDG PET/CT. Of these patients, 37 had biopsy-proven HIV-associated lymphoma, and 22 with HIV-associated inflammatory lymphadenopathy were used as controls. The determined parameters were the maximum of standard uptake value (SUVmax), SUVmax of only lymph nodes (SUVLN), the most FDG-avid lesion-to-liver SUVmax ratio (SURmax), laboratory examinations and demographics. The optimal cut-off of 18F-FDG PET/CT value was analyzed by receiver operating characteristic curve (ROC). Results Considering the clinical records, the Karnofsky Performance Status (KPS) scores in patients with inflammatory lymphadenopathy were obviously higher than those in patients with malignant lymphoma (P = 0.015), whereas lymphocyte counts and lactate dehydrogenase (LDH) were obviously lower (P = 0.014 and 0.010, respectively). For the 18F-FDG PET/CT imaging, extra-lymphatic lesions, especially digestive tract and Waldeyer’s ring, occurred more frequently in malignant lymphoma than inflammatory lymphadenopathy. Furthermore, the SURmax and SUVLN in malignant lymphoma were markedly higher than those in inflammatory lymphadenopathy (P = 0.000 and 0.000, respectively). The cut-off point of 3.1 for SURmax had higher specificity (91.9%) and relatively reasonable sensitivity (68.2%) and the cut-off point of 8.0 for the SUVLN had high specificity (89.2%) and relatively reasonable sensitivity (63.6%). Conclusion Our study identified the distinctive characteristics of the clinical manifestations, the SURmax, SUVLN and detectability of extra-lymphatic lesions on 18F-FDG PET, and thus provides a new basis for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients.
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Affiliation(s)
- Donghe Chen
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yunqi Zhu
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Danhua Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Zhengfeng Liu
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Tiancheng Li
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Yinuo Liu
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Kui Zhao
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Xinhui Su
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
| | - Lanjuan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Essential roles of surgical and pathological evaluations in the management of foreign bodies or inflammatory granulomas mimicking cervical cancer recurrence: A report of two cases. Taiwan J Obstet Gynecol 2022; 61:391-394. [DOI: 10.1016/j.tjog.2022.02.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/17/2022] Open
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9
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PET imaging in HIV patients. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Eibschutz LS, Rabiee B, Asadollahi S, Gupta A, Assadi M, Alavi A, Gholamrezanezhad A. FDG-PET/CT of COVID-19 and Other Lung Infections. Semin Nucl Med 2022; 52:61-70. [PMID: 34246449 PMCID: PMC8216878 DOI: 10.1053/j.semnuclmed.2021.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
While not conventionally used as the first-line modality, [18F]-2-fluoro-2-deoxy-D-glucose (FDG) - positron emission tomography/computed tomography (PET/CT) can identify infection and inflammation both earlier and with higher sensitivity than anatomic imaging modalities [including chest X-ray (CXR), computed tomography (CT), and magnetic resonance imaging (MRI)]. The extent of inflammation and, conversely, recovery within the lungs, can be roughly quantified on FDG-PET/CT using maximum standardized uptake value (SUVmax) values. The Coronavirus disease 2019 (COVID-19) pandemic has highlighted the value of FDG-PET/CT in diagnosis, elucidation of acute pulmonary and extrapulmonary manifestations, and long-term follow up. Similarly, many other pulmonary infections such as previously documented coronaviruses, aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, mucormycosis, and typical/atypical mycobacterial infections have all been identified and characterized using FDG-PET/CT imaging. The goal of this review is to summarize the actual and potential benefits of FDG-PET/CT in the imaging of COVID-19 and other lung infections. Further research is necessary to determine the best indications and clinical applications of FDG-PET/CT, improve its specificity, and ultimately ascertain how this modality can best be utilized in the diagnostic work up of infectious pathologies.
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Affiliation(s)
- Liesl S. Eibschutz
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA
| | - Behnam Rabiee
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA,Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Shadi Asadollahi
- Professor of Radiology, Director of Research Education, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Amit Gupta
- Department of Radiology, University Hospital Cleveland Medical Center, Cleveland, OH
| | - Majid Assadi
- Department of Nuclear Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abass Alavi
- Professor of Radiology, Director of Research Education, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA,Address reprint requests to Ali Gholamrezanezhad, MD, Department of Radiology, Division of Emergency Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo Street, Los Angeles, CA 90033
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Vorster M, Sathekge MM. Positron Emission Tomography (PET) Imaging in Tuberculosis. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00097-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Tatar G, Çermik TF, Alçın G, Erol Fenercioglu O, İnci A, Beyhan E, Ergül N. Contribution of 18F-FDG PET/CT imaging in the diagnosis and management of HIV-positive patients. Rev Esp Med Nucl Imagen Mol 2021; 41:275-283. [PMID: 34794914 DOI: 10.1016/j.remnie.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/06/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES The human immunodeficiency virus [HIV] is a lentevirus, primarily infects certain cells of the immune system, thereby greatly weakens the body's own defenses against diseases. This study was aimed to explore the value and significance of 18F-FDG PET/CT in the assessment of patients with HIV infection and to examine the presence of quantitative alterations in 18F-FDG uptake among patients with HIV-related infections or malignant diseases in HIV-positive patients. PATIENTS AND METHODS Forty patients with HIV infection were scanned on PET/CT system. The data were registered according to immune status, antiretroviral therapy, and definitive diagnosis. All pathologic lesions and disease related areas were described, 18F-FDG uptake patterns were evaluated. Semiquantitative analysis of 18F-FDG uptake was performed and SUVmax were calculated. RESULTS Twenty-eight patients [70%] were diagnosed with HIV-related infection or malignant diseases. The sensitivity of PET/CT was shown to be 100% and the specificity 92% for concomitant diseases requiring additional treatment to antiretroviral therapy. The SUVmax and CD4 counts were not statistically different between HIV-related reactive lymphadenopathy, HIV-related malignancy, and HIV-related infections. CONCLUSIONS The pattern of distribution of nodal/extranodal uptake on 18F-FDG PET/CT may facilitate distinction between HIV-related generalized lymphadenopathies, HIV-related opportunistic infections, and malignancies. In this context, 18F-FDG PET/CT should be preferred for routine use in the management of patients infected with HIV.
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Affiliation(s)
- Gamze Tatar
- University of Health Sciences, Istanbul Bagcılar Training and Research Hospital, Department of Nuclear Medicine, Istanbul, Turkey.
| | - Tevfik Fikret Çermik
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Nuclear Medicine, Istanbul, Turkey
| | - Göksel Alçın
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Nuclear Medicine, Istanbul, Turkey
| | - Ozge Erol Fenercioglu
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Nuclear Medicine, Istanbul, Turkey
| | - Ayşe İnci
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Infectious Disease, Istanbul, Turkey
| | - Ediz Beyhan
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Nuclear Medicine, Istanbul, Turkey
| | - Nurhan Ergül
- University of Health Sciences, Istanbul Training and Research Hospital, Department of Nuclear Medicine, Istanbul, Turkey
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Mann TN, Warwick J, Chegou NN, Davis JH, Beltran CGG, Griffith-Richards S, Kidd M, du Toit J, Lamberts RP, Walzl G. Biomarkers to predict FDG PET/CT activity after the standard duration of treatment for spinal tuberculosis: An exploratory study. Tuberculosis (Edinb) 2021; 129:102107. [PMID: 34261033 DOI: 10.1016/j.tube.2021.102107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/28/2021] [Accepted: 07/04/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography- Computed Tomography (PET/CT) scans can be used to assess healing following treatment for spinal tuberculosis (TB) but have limited accessibility and high cost. This study investigated the association between immune biomarkers and FDG-PET/CT activity after ≥9 months of treatment for spinal TB. METHODS Patients who had completed ≥9 months of treatment for spinal TB were recruited from a major hospital in the Western Cape, South Africa. Participants underwent a FDG-PET/CT scan and FDG- PET/CT activity was quantified for all spinal and extra-spinal sites. Participants also provided a blood sample, which was evaluated for 19 cytokines along with erythrocyte sedimentation rate (ESR). Correlations and multiple regression analyses were used to investigate the association between biomarkers and PET/CT measures. RESULTS Twenty-eight patients were recruited, of whom 24 (86%) had spinal and/or extra-spinal FDG-PET/CT activity. In the strongest multiple regression model, CXCL10/IP-10, VEGFA, IFN-γ, CRP and Factor D/Adipsin explained 52% of the variation in overall maximal FDG uptake. Conventional monitoring marker ESR showed no significant association with PET/CT measures. CONCLUSIONS The current findings offered encouragement that biomarkers to predict FDG-PET/CT activity may show some promise and identified candidate biomarkers for further investigation in this regard.
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Affiliation(s)
- Theresa N Mann
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa; Institute of Orthopaedics and Rheumatology, Mediclinic Winelands Orthopaedic Hospital, Cnr Rokewood & Saffraan Ave, Die Boord, Stellenbosch, 7600, South Africa.
| | - James Warwick
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Novel N Chegou
- DST/NRF Centre of Excellence for Biomedical TB Research and SAMRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Johan H Davis
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa; Institute of Orthopaedics and Rheumatology, Mediclinic Winelands Orthopaedic Hospital, Cnr Rokewood & Saffraan Ave, Die Boord, Stellenbosch, 7600, South Africa.
| | - Caroline G G Beltran
- DST/NRF Centre of Excellence for Biomedical TB Research and SAMRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Stephanie Griffith-Richards
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, Faculty of Economic and Management Sciences, Stellenbosch University, Van Der Sterr Building, Bosman St, Stellenbosch, 7599, South Africa.
| | - Jacques du Toit
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Gerhard Walzl
- DST/NRF Centre of Excellence for Biomedical TB Research and SAMRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
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Molecular Imaging of a Zirconium-89 Labeled Antibody Targeting Plasmodium falciparum-Infected Human Erythrocytes. Mol Imaging Biol 2021; 22:115-123. [PMID: 31004274 DOI: 10.1007/s11307-019-01360-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Nuclear imaging is an important preclinical research tool to study infectious diseases in vivo and could be extended to investigate complex aspects of malaria infections. As such, we report for the first time successful radiolabeling of a novel antibody specific to Plasmodium-infected erythrocytes (IIIB6), its in vitro assessment and molecular imaging in nude mice. PROCEDURES In vitro confocal microscopy was used to determine the stage-specificity of Plasmodium-infected erythrocytes recognised by IIIB6. To enable micro-positron emission tomography (PET)/X-ray computed tomography (CT) imaging, IIIB6 was conjugated to Bz-DFO-NCS and subsequently radiolabeled with zirconium-89. Healthy nude mice were injected with [89Zr]IIIB6, and pharmacokinetics and organ uptake were monitored over 24 h. This was followed by post-mortem animal dissection to determine the biodistribution of [89Zr]IIIB6. RESULTS IIIB6 recognised all the relevant stages of Plasmodium falciparum-infected erythrocytes (trophozoites, schizonts and gametocytes) that are responsible for severe malaria pathology. [89Zr]IIIB6-radiolabeling yields were efficient at 84-89 %. Blood pool imaging analysis indicated a pharmacological half-life of 9.6 ± 2.5 h for [89Zr]IIIB6. The highest standard uptake values were determined at 2-6 h in the liver followed by the spleen, kidneys, heart, stomach and lung, respectively. Minimal activity was present in muscle and bone tissues. CONCLUSION In vitro characterization of IIIB6 and pharmacokinetic characterization of [89Zr]IIIB6 revealed that this antibody has potential for future use in Plasmodium-infected mouse models to study malaria in a preclinical in vivo setting with PET/CT imaging.
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Henrich TJ, Jones T, Beckford-Vera D, Price PM, VanBrocklin HF. Total-Body PET Imaging in Infectious Diseases. PET Clin 2020; 16:89-97. [PMID: 33160926 DOI: 10.1016/j.cpet.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Total-body PET enables high-sensitivity imaging with dramatically improved signal-to-noise ratio. These enhanced performance characteristics allow for decreased PET scanning times acquiring data "total-body wide" and can be leveraged to decrease the amount of radiotracer required, thereby permitting more frequent imaging or longer imaging periods during radiotracer decay. Novel approaches to PET imaging of infectious diseases are emerging, including those that directly visualize pathogens in vivo and characterize concomitant immune responses and inflammation. Efforts to develop these imaging approaches are hampered by challenges of traditional imaging platforms, which may be overcome by novel total-body PET strategies.
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Affiliation(s)
- Timothy J Henrich
- Division of Experimental Medicine, University of California San Francisco, 1001 Potrero Avenue, Building 3, Room 525A, San Francisco, CA 94110, USA.
| | - Terry Jones
- Department of Radiology, University of California Davis Medical Center, Sacramento, CA, USA
| | - Denis Beckford-Vera
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | | | - Henry F VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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16
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Abstract
FDG PET-CT is one the main investigations for squamous cell (Sq) head and neck (H&N) cancer patients. FDG PET-CT has a key role for the staging of patients with T4 cancer of the hypopharynx and nasopharynx and patients with N3 nodal disease. It is effective in detecting recurrent disease accurately. In addition, it has an emerging role in the surveillance of Sq H&N cancer survivors. In patients with advanced neck nodal disease treated with chemoradiotherapy, there is compelling evidence that patients with no FDG uptake in the neck 12 weeks following completion of treatment do not require neck dissection. There is considerable interest in using FDG PET-CT for develop more effective clinical pathways for the surveillance of Sq H&N cancer. Currently, the detection rate of recurrence in patients who attend regular clinical follow-up is poor, less than 1% in asymptomatic patients. FDG PET-CT may enable survivors to be stratified into groups based on the likelihood of having recurrent disease. Optimal surveillance pathways can be developed, reserving most intense imaging regimes and most frequent follow-up for survivors at high risk of recurrence. FDG PET CT is sometimes considered for patients with non Sq H&N cancer. If used in this context, a baseline FDG PET-CT should be done to ensure that the tumour is avid. Most H&N malignant tumours are avid. However, salivary gland cancers, and tumours with muco-epidermoid, adenoid cystic and clear cell histology show paucity of FDG avidity, especially when they recur. In addition, peri-neural invasion cannot be detected reliably with FDG PET-CT.
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Affiliation(s)
- Wai Lup Wong
- Consultant Radiologist (Nuclear Medicine) Mount Vernon Hospital, Northwood, UK; PET-CT Clinical Lead Strickland Scanner Centre, Northwood, UK.
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17
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Nikpanah M, Katal S, Christensen TQ, Werner TJ, Hess S, Malayeri AA, Gholamrezanezhad A, Alavi A, Saboury B. Potential Applications of PET Scans, CT Scans, and MR Imaging in Inflammatory Diseases: Part II: Cardiopulmonary and Vascular Inflammation. PET Clin 2020; 15:559-576. [PMID: 32792228 DOI: 10.1016/j.cpet.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Detecting inflammation is among the most important aims of medical imaging. Inflammatory process involves immune system activity and local tissue response. The role of PET with fludeoxyglucose F 18 has been expanded. Systemic vasculitides and cardiopulmonary inflammatory disorders constitute a wide range of diseases with multisystemic manifestations. PET with fludeoxyglucose F 18 is useful in their diagnosis, assessment, and follow-up. This article provides an overview of the current status and potentials of hybrid molecular imaging in evaluating cardiopulmonary and vascular inflammatory diseases focusing on the potential for PET with fludeoxyglucose F 18/MR imaging and PET/CT scans.
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Affiliation(s)
- Moozhan Nikpanah
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Sanaz Katal
- Department of Nuclear Medicine/PET-CT, Kowsar Hospital, Shiraz, Iran
| | - Thomas Q Christensen
- Department of Clinical Engineering, Region of Southern Denmark, Esbjerg, Denmark 5000
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark 6700; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ashkan A Malayeri
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Health Sciences Campus, 1500 San Pablo Street, Los Angeles, California 90033, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
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18
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Abstract
Antiretroviral therapies efficiently block HIV-1 replication but need to be maintained for life. Moreover, chronic inflammation is a hallmark of HIV-1 infection that persists despite treatment. There is, therefore, an urgent need to better understand the mechanisms driving HIV-1 pathogenesis and to identify new targets for therapeutic intervention. In the past few years, the decisive role of cellular metabolism in the fate and activity of immune cells has been uncovered, as well as its impact on the outcome of infectious diseases. Emerging evidence suggests that immunometabolism has a key role in HIV-1 pathogenesis. The metabolic pathways of CD4+ T cells and macrophages determine their susceptibility to infection, the persistence of infected cells and the establishment of latency. Immunometabolism also shapes immune responses against HIV-1, and cell metabolic products are key drivers of inflammation during infection. In this Review, we summarize current knowledge of the links between HIV-1 infection and immunometabolism, and we discuss the potential opportunities and challenges for therapeutic interventions.
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Katal S, Gholamrezanezhad A, Nikpanah M, Christensen TQ, Werner TJ, Saboury B, Alavi A, Hess S. Potential Applications of PET/CT/MR Imaging in Inflammatory Diseases: Part I: Musculoskeletal and Gastrointestinal Systems. PET Clin 2020; 15:547-558. [PMID: 32768367 DOI: 10.1016/j.cpet.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
During the past decades, the role of fludeoxyglucose (FDG)-PET and hybrid PET/computed tomography (CT) has been established clinically in the diagnostic workup of a multitude of infectious and inflammatory disorders. In recent years, the fusion of MR imaging to PET has also been increasingly explored, and this may be especially useful in musculoskeletal and gastrointestinal inflammatory diseases due to exceptional soft tissue contrast and reduced radiation dose. This article outlines the current potential for hybrid molecular imaging in the musculoskeletal system and the gastrointestinal tract with special focus on the potential for fused PET/CT/MR imaging.
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Affiliation(s)
- Sanaz Katal
- Department of Nuclear Medicine/PET-CT, Kowsar Hospital, Shiraz, Iran
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Health Sciences Campus, 1500 San Pablo Street, Los Angeles, California 90033, USA.
| | - Moozhan Nikpanah
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Thomas Q Christensen
- Department of Clinical Engineering, Region of Southern Denmark, Esbjerg, Denmark 5000
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark 6700
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Abstract
The role of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in tuberculosis (TB) continues to expand in disease detection, assessment of the extent of the disease, and treatment response monitoring. This article reviews available data regarding the use of FDG-PET/CT in patients with TB. A new method of quantification for patients with TB is introduced. This method produces robust parameters that represent the total disease burden.
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21
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Expert Consensus on clinical application of FDG PET/CT in infection and inflammation. Ann Nucl Med 2020; 34:369-376. [DOI: 10.1007/s12149-020-01449-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/09/2020] [Indexed: 12/12/2022]
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22
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Malherbe ST, Chen RY, Dupont P, Kant I, Kriel M, Loxton AG, Smith B, Beltran CGG, van Zyl S, McAnda S, Abrahams C, Maasdorp E, Doruyter A, Via LE, Barry CE, Alland D, Richards SG, Ellman A, Peppard T, Belisle J, Tromp G, Ronacher K, Warwick JM, Winter J, Walzl G. Quantitative 18F-FDG PET-CT scan characteristics correlate with tuberculosis treatment response. EJNMMI Res 2020; 10:8. [PMID: 32040770 PMCID: PMC7010890 DOI: 10.1186/s13550-020-0591-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is a growing interest in the use of F-18 FDG PET-CT to monitor tuberculosis (TB) treatment response. Tuberculosis lung lesions are often complex and diffuse, with dynamic changes during treatment and persisting metabolic activity after apparent clinical cure. This poses a challenge in quantifying scan-based markers of burden of disease and disease activity. We used semi-automated, whole lung quantification of lung lesions to analyse serial FDG PET-CT scans from the Catalysis TB Treatment Response Cohort to identify characteristics that best correlated with clinical and microbiological outcomes. RESULTS Quantified scan metrics were already associated with clinical outcomes at diagnosis and 1 month after treatment, with further improved accuracy to differentiate clinical outcomes after standard treatment duration (month 6). A high cavity volume showed the strongest association with a risk of treatment failure (AUC 0.81 to predict failure at diagnosis), while a suboptimal reduction of the total glycolytic activity in lung lesions during treatment had the strongest association with recurrent disease (AUC 0.8 to predict pooled unfavourable outcomes). During the first year after TB treatment lesion burden reduced; but for many patients, there were continued dynamic changes of individual lesions. CONCLUSIONS Quantification of FDG PET-CT images better characterised TB treatment outcomes than qualitative scan patterns and robustly measured the burden of disease. In future, validated metrics may be used to stratify patients and help evaluate the effectiveness of TB treatment modalities.
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Affiliation(s)
- Stephanus T. Malherbe
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ray Y. Chen
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ilse Kant
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Magdalena Kriel
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - André G. Loxton
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bronwyn Smith
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Caroline G. G. Beltran
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan van Zyl
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shirely McAnda
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Charmaine Abrahams
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elizna Maasdorp
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Tuberculosis Bioinformatics Initiative (SATBBI), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alex Doruyter
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- Node for Infection Imaging, Central Analytical Facilities, Stellenbosch University, Cape Town, South Africa
| | - Laura E. Via
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Clifton E. Barry
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - David Alland
- Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Rutgers Biomedical and Health Sciences, Newark, NJ USA
| | - Stephanie Griffith- Richards
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annare Ellman
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - John Belisle
- Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO USA
| | - Gerard Tromp
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Tuberculosis Bioinformatics Initiative (SATBBI), Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Katharina Ronacher
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Mater Research Institute – The University of Queensland, Translational Research Institute, Brisbane, QLD Australia
| | - James M. Warwick
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jill Winter
- Catalysis Foundation for Health, San Ramon, CA USA
| | - Gerhard Walzl
- Department of Science and Technology/National Research Foundation, Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Li G, Yang F, He X, Liu Z, Pi J, Zhu Y, Ke X, Liu S, Ou M, Guo H, Zhang Z, Zeng G, Zhang G. Anti-tuberculosis (TB) chemotherapy dynamically rescues Th1 and CD8+ T effector levels in Han Chinese pulmonary TB patients. Microbes Infect 2019; 22:119-126. [PMID: 31678658 DOI: 10.1016/j.micinf.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 12/16/2022]
Abstract
CD4+/CD8+ T cells play a major role in conferring immune protection against tuberculosis (TB), but it remains unknown how the immune responses of CD4+/CD8+ T cells exactly correlate with the clinical variables and disease statuses during anti-TB chemotherapy. To address this, several major immune parameters of CD4+/CD8+ T cells in peripheral blood derived from pulmonary TB patients and healthy volunteers were evaluated. We observed that active TB infection induced lower CD3+ T cell and CD4+ T cell levels but higher CD8+T cell levels, while anti-TB chemotherapy reversed these effects. Also, anti-TB treatment induced enhanced production of IL-2 and IFN-γ but reduced expression of IL-10 and IL-6. Moreover, the dynamic changes of CD3, CD4, and CD8 levels did not show a significant association with sputum smear positivity. However, the frequencies of IL-2+CD4+ or IL-10 + CD4+ T effector subpopulation or IL-1β production in peripheral blood showed significant difference between patients positive for sputum smear and patients negative for sputum smear after anti-TB treatment. These findings implicated that recovery of Th1/CD8+T cell effector levels might be critical immunological events in pulmonary TB patients after treatment and further suggested the importance of these immunological parameters as potential biomarkers for prediction of TB progress and prognosis.
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Affiliation(s)
- Guobao Li
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Fang Yang
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xing He
- National Clinical Research Center for Tuberculosis, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Zhi Liu
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Jiang Pi
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, 510080, China; Department of Microbiology and Immunology, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Yuzhen Zhu
- Guangdong Key Laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, 524023, China
| | - Xue Ke
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Shuyan Liu
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Min Ou
- Department of Tuberculosis, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen 518112, China
| | - Huixin Guo
- National Clinical Research Center for Tuberculosis and Guangdong Center for Tuberculosis Control, Guangzhou, 510430, China
| | - Zhuoran Zhang
- Beckman Research Institute, City of Hope National Cancer Center, Duarte, CA, 92618, USA
| | - Gucheng Zeng
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Guoliang Zhang
- National Clinical Research Center for Tuberculosis, Guangdong Key Laboratory for Emerging Infectious Diseases, Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China.
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Henrich TJ, Hsue PY, VanBrocklin H. Seeing Is Believing: Nuclear Imaging of HIV Persistence. Front Immunol 2019; 10:2077. [PMID: 31572355 PMCID: PMC6751256 DOI: 10.3389/fimmu.2019.02077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022] Open
Abstract
A major obstacle to HIV eradication is the presence of infected cells that persist despite suppressive antiretroviral therapy (ART). HIV largely resides outside of the peripheral circulation, and thus, numerous anatomical and lymphoid compartments that have the capacity to harbor HIV are inaccessible to routine sampling. As a result, there is a limited understanding of the tissue burden of HIV infection or anatomical distribution of HIV transcriptional and translational activity. Novel, non-invasive, in vivo methods are urgently needed to address this fundamental gap in knowledge. In this review, we discuss past and current nuclear imaging approaches that have been applied to HIV infection with an emphasis on current strategies to implement positron emission tomography (PET)-based imaging to directly visualize and characterize whole-body HIV burden. These imaging approaches have various limitations, such as the potential for limited PET sensitivity and specificity in the setting of ART suppression or low viral burden. However, recent advances in high-sensitivity, total-body PET imaging platforms and development of new radiotracer technologies that may enhance anatomical penetration of target-specific tracer molecules are discussed. Potential strategies to image non-viral markers of HIV tissue burden or focal immune perturbation are also addressed. Overall, emerging nuclear imaging techniques and platforms may play an important role in the development of novel therapeutic and HIV reservoir eradication strategies.
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Affiliation(s)
- Timothy J Henrich
- Division of Experimental Medicine, Department of Medicine, University of San Francisco, San Francisco, CA, United States
| | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, University of San Francisco, San Francisco, CA, United States
| | - Henry VanBrocklin
- Radiopharmaceutical Research Program, Center for Molecular and Functional Imaging, University of San Francisco, San Francisco, CA, United States
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25
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Cussó L, Musteanu M, Mulero F, Barbacid M, Desco M. Effects of a Ketogenic Diet on [ 18F]FDG-PET Imaging in a Mouse Model of Lung Cancer. Mol Imaging Biol 2019; 21:279-285. [PMID: 29968182 DOI: 10.1007/s11307-018-1233-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Myocardial uptake can hamper visualization of lung tumors, atherosclerotic plaques, and inflammatory diseases in 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) studies because it leads to spillover in adjacent structures. Several preparatory pre-imaging protocols (including dietary restrictions and drugs) have been proposed to decrease physiological [18F]FDG uptake by the heart, although their effect on tumor glucose metabolism remains largely unknown. The objective of this study was to assess the effects of a ketogenic diet (as an alternative protocol to fasting) on tumor glucose metabolism assessed by [18F]FDG positron emission tomography (PET) in a mouse model of lung cancer. PROCEDURES PET scans were performed 60 min after injection of 18.5 MBq of [18F]FDG. PET data were collected for 45 min, and an x-ray computed tomograph (CT) image was acquired after the PET scan. A PET/CT study was obtained for each mouse after fasting and after the ketogenic diet. Quantitative data were obtained from regions of interest in the left ventricular myocardium and lung tumor. RESULTS Three days on a ketogenic diet decreased mean standard uptake value (SUVmean) in the myocardium (SUVmean 0.95 ± 0.36) more than one night of fasting (SUVmean 1.64 ± 0.93). Tumor uptake did not change under either dietary condition. CONCLUSIONS These results show that 3 days on high-fat diets prior to [18F]FDG-PET imaging does not change tumor glucose metabolism compared with one night of fasting, although high-fat diets suppress myocardial [18F]FDG uptake better than fasting.
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Affiliation(s)
- Lorena Cussó
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avenida de la Universidad 30, 28911, Leganés, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
| | - Mónica Musteanu
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Francisca Mulero
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Mariano Barbacid
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
| | - Manuel Desco
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Avenida de la Universidad 30, 28911, Leganés, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
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Snoeckx A, Reyntiens P, Carp L, Spinhoven MJ, El Addouli H, Van Hoyweghen A, Nicolay S, Van Schil PE, Pauwels P, van Meerbeeck JP, Parizel PM. Diagnostic and clinical features of lung cancer associated with cystic airspaces. J Thorac Dis 2019; 11:987-1004. [PMID: 31019789 DOI: 10.21037/jtd.2019.02.91] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
"Lung cancer associated with cystic airspaces" is an uncommon manifestation, in which lung cancer presents on imaging studies with a cystic area with associated consolidation and/or ground glass. With the widespread use of computed tomography (CT), both in clinical practice and for lung cancer screening, these tumors are being more frequently recognized. An association of this entity with smoking has been established with the majority of cases reported being in former and current smokers. The true pathogenesis of the cystic airspace is not yet fully understood. Different causes of this cystic airspace have been described, including a check-valve mechanism obstructing the small airways, lepidic growth of adenocarcinoma on emphysematous lung parenchyma, cyst formation of tumor and tumor growth along the wall of a pre-existing bulla. Adenocarcinoma is the commonest histological type, followed by squamous cell carcinoma. Two classification systems have been described, based on morphological features of the lesion, taking into account both the cystic airspace as well as the morphology of the surrounding consolidation or ground glass. The cystic component may mislead radiologists to a benign etiology and the many different faces on imaging can make early diagnosis challenging. Special attention should be made to focal or diffuse wall thickening and consolidation or ground glass abutting or interspersed with cystic airspaces. Despite their atypical morphology, staging and management currently are still similar to that of other lung cancer types. Although the rarity of this entity will hamper larger studies, numerous aspects regarding this particular lung cancer type still need to be unraveled. This manuscript reviews the CT-imaging findings and gives an overview of available data in the English literature on pathogenesis, histopathology and clinical findings. Differential diagnosis and pitfalls are discussed as well as future directions regarding staging and management.
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Affiliation(s)
- Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Pieter Reyntiens
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Maarten J Spinhoven
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Haroun El Addouli
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Astrid Van Hoyweghen
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Patrick Pauwels
- Department of Pathology Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jan P van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Kuno H, Garg N, Qureshi MM, Chapman MN, Li B, Meibom SK, Truong MT, Takumi K, Sakai O. CT Texture Analysis of Cervical Lymph Nodes on Contrast-Enhanced [ 18F] FDG-PET/CT Images to Differentiate Nodal Metastases from Reactive Lymphadenopathy in HIV-Positive Patients with Head and Neck Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2019; 40:543-550. [PMID: 30792253 DOI: 10.3174/ajnr.a5974] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/05/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating nodal metastases from reactive adenopathy in HIV-infected patients with [18F] FDG-PET/CT can be challenging because lymph nodes in HIV-positive patients often show increased [18F] FDG uptake. The purpose of this study was to assess CT textural analysis characteristics of HIV-positive and HIV-negative lymph nodes on [18F] FDG-PET/CT to differentiate nodal metastases from disease-specific nodal reactivity. MATERIALS AND METHODS Nine HIV-positive patients with head and neck squamous cell carcinoma (7 men, 2 women; 29-62 years of age; median age, 48 years) with 22 lymph nodes (≥1 cm) who underwent contrast-enhanced CT with [18F] FDG-PET followed by pathologic evaluation of cervical lymph nodes were retrospectively reviewed. Twenty-six HIV-negative patients with head and neck squamous cell carcinoma with 61 lymph nodes were evaluated as a control group. Each lymph node was manually segmented, and an in-house-developed Matlab-based texture analysis program extracted 41 texture features from each segmented volume. A mixed linear regression model was used to compare the pathologically proved malignant lymph nodes with benign nodes in the 2 enrolled groups. RESULTS Thirteen (59%) lymph nodes in the HIV-positive group and 22 (36%) lymph nodes in the HIV-negative control group were confirmed as positive for metastases. There were 7 histogram features (P = .017-0.032), 3 gray-level co-occurrence features (P = .009-.025), and 9 gray-level run-length features (P < .001-.033) that demonstrated a significant difference in HIV-positive patients with either benign or malignant lymph nodes. CONCLUSIONS CT texture analysis may be useful as a noninvasive method of obtaining additional quantitative information to differentiate nodal metastases from disease-specific nodal reactivity in HIV-positive patients with head and neck squamous cell carcinoma.
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Affiliation(s)
- H Kuno
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).,Department of Diagnostic Radiology (H.K.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - N Garg
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.)
| | - M M Qureshi
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - M N Chapman
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.)
| | - B Li
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.)
| | - S K Meibom
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.)
| | - M T Truong
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - K Takumi
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.).,Department of Radiology (K.T.), Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - O Sakai
- From the Departments of Radiology (H.K., N.G., M.M.Q., M.N.C., B.L., S.K.M., M.T.T., K.T., O.S.) .,Radiation Oncology (M.M.Q., M.T.T., O.S.).,Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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28
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Hammoud DA, Boulougoura A, Papadakis GZ, Wang J, Dodd LE, Rupert A, Higgins J, Roby G, Metzger D, Laidlaw E, Mican JM, Pau A, Lage S, Wong CS, Lisco A, Manion M, Sheikh V, Millo C, Sereti I. Increased Metabolic Activity on 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Human Immunodeficiency Virus-Associated Immune Reconstitution Inflammatory Syndrome. Clin Infect Dis 2019; 68:229-238. [PMID: 30215671 PMCID: PMC6321853 DOI: 10.1093/cid/ciy454] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/23/2018] [Indexed: 12/17/2022] Open
Abstract
Background Immune reconstitution inflammatory syndrome (IRIS) represents an unexpected inflammatory response shortly after initiation of antiretroviral therapy (ART) in some human immunodeficiency virus (HIV)-infected patients with underlying neoplasia or opportunistic infections, including tuberculosis. We hypothesized that IRIS is associated with increased glycolysis and that 18F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) could help identify high-risk subjects. Methods In this prospective cohort study, 30 HIV-infected patients (CD4+ count <100 cells/µL) underwent FDG-PET/CT scans at baseline and 4-8 weeks after ART initiation. Ten patients developed IRIS (6 mycobacterial). Results At baseline, total glycolytic activity, total lesion volume, and maximum standardized uptake values (SUVs) of pathologic FDG uptake (reflective of opportunistic disease burden) were significantly higher in IRIS vs non-IRIS (P = .010, .017, and .029, respectively) and significantly correlated with soluble inflammatory biomarkers (interferon-γ, myeloperoxidase, tumor necrosis factor, interleukin 6, soluble CD14). Baseline bone marrow (BM) and spleen FDG uptake was higher in mycobacterial IRIS specifically. After ART initiation, BM and spleen mean SUV decreased in non-IRIS (P = .004, .013) but not IRIS subjects. Our results were supported by significantly higher glucose transporter 1 (Glut-1) expression of CD4+ cells and monocytes after ART initiation in IRIS/mycobacterial IRIS compared with non-IRIS patients. Conclusions We conclude that increased pathologic metabolic activity on FDG-PET/CT prior to ART initiation is associated with IRIS development and correlates with inflammatory biomarkers. Abnormally elevated BM and spleen metabolism is associated with mycobacterial IRIS, HIV viremia, and Glut-1 expression on CD4+ cells and monocytes. Clinical Trials Registration NCT02147405.
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Affiliation(s)
- Dima A Hammoud
- Center for Infectious Diseases Imaging, Clinical Center, National Institutes of Health (NIH)
| | - Afroditi Boulougoura
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Georgios Z Papadakis
- Center for Infectious Diseases Imaging, Clinical Center, National Institutes of Health (NIH)
| | - Jing Wang
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc, National Cancer Institute, Frederick
| | - Lori E Dodd
- Biostatistics Research Branch, NIAID, NIH, Bethesda
| | - Adam Rupert
- Leidos Biomedical Research Inc, Frederick National Laboratory for Cancer Research
| | - Jeanette Higgins
- Leidos Biomedical Research Inc, Frederick National Laboratory for Cancer Research
| | - Gregg Roby
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Dorinda Metzger
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Elizabeth Laidlaw
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - JoAnn M Mican
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Alice Pau
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Silvia Lage
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Chun-Shu Wong
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Andrea Lisco
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Maura Manion
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Virginia Sheikh
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
| | - Corina Millo
- Positron Emission Tomography Department, Clinical Center, NIH, Bethesda, Maryland
| | - Irini Sereti
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda
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29
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18F-FDG Uptake in Subcutaneous Fat Preceding Clinical Diagnosis of Human Immunodeficiency Virus-Associated Lipodystrophy. Clin Nucl Med 2018; 43:e475-e476. [PMID: 30325831 DOI: 10.1097/rlu.0000000000002298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A 62-year-old man with human immunodeficiency virus (HIV) on long-standing highly active antiretroviral therapy presented for F-FDG PET/CT evaluation of a pulmonary nodule. The examination showed unusual radiotracer distribution accumulating in the subcutaneous and visceral fat with low cerebral and skeletal muscle uptake. Imaging features were consistent with HIV-associated lipodystrophy, an unsuspected diagnosis that was later confirmed on physical examination. Recognition of HIV-associated lipodystrophy by the nuclear medicine physician is critical as altered biodistribution may affect diagnostic yield or be mistaken for infectious pathology.
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30
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Hodgkin lymphoma at Groote Schuur Hospital, South Africa: the effect of HIV and bone marrow infiltration. Ann Hematol 2018; 98:381-389. [PMID: 30397846 DOI: 10.1007/s00277-018-3533-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/19/2018] [Indexed: 12/14/2022]
Abstract
Human immunodeficiency virus (HIV) is associated with an increased risk of developing Hodgkin lymphoma (HL). South Africa (SA) has the highest HIV prevalence rate in the world. There is currently no outcome-based data for HIV-associated HL from SA. A bone marrow database was compiled of all bone marrow biopsies (BMB) reported at National Health Laboratory Service (NHLS) Groote Schuur Hospital (GSH) between January 2005 and December 2012. Patients who had a BMB performed for staging of HL or where HL was diagnosed on the BMB were included for further analysis. Clinical and laboratory data was extracted from medical and laboratory records. Primary outcome measures included histological subtype, bone marrow infiltration (BMI) by HL, CD4 count, HIV-viral load (HIV-VL), tuberculosis (TB) data, treatment with chemotherapy and 5-year overall survival (OS). The database included 6569 BMB and 219 patients of these had HL and were included for analysis. The median age at presentation (32 years) was similar in the HIV+ and HIV- populations. While males predominated in the HIV- group, females predominated in the HIV+ group (male:female ratio of 1.5:1 vs 0.7:1, respectively). The majority of patients (71%) were HIV negative (HIV-) and 29% were HIV positive (HIV+). The diagnosis of HL was made on BMB in 17% of cases. BMI was seen in 37% (82/219) overall, and was found in more HIV+ patients (61%; 39/64) than HIV- patients (28%; 43/155; p = 0.03). The histological subtype varied according to HIV status with nodular sclerosis classical Hodgkin lymphoma (NSCHL) being most frequent in the HIV- group and classical Hodgkin lymphoma (CHL)-unclassifiable the most frequent in the HIV+ group. HIV+ patients had a median CD4 count of 149 × 106/L and 39% were anti-retroviral therapy (cART) naive at HL diagnosis. HIV+ patients had received anti-TB therapy more frequently than HIV- patients (72% vs 17%; p = 0.007). More HIV+ patients did not receive chemotherapy than HIV- patients (31% vs 3%; p = 0.001). The 5-year OS was 56%. HIV+ patients with BMI had a 5-year OS of 18%. BMI, HIV status, low CD4 count, histological subtype and TB therapy had a statistical significant impact on 5-year OS (p < 0.01). The 5-year OS was 56%, with both BMI and HIV+ status being associated with poor survival. BMB provided the diagnosis of HL in 17% of cases, confirming its diagnostic utility in our setting. Our cohort showed similar survival outcomes to other countries in Africa, Asia and Central America with comparable socio-economic constraints to SA.
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Malherbe ST, Kleynhans L, Walzl G. The potential of imaging tools as correlates of infection and disease for new TB vaccine development. Semin Immunol 2018; 39:73-80. [PMID: 29914653 DOI: 10.1016/j.smim.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 06/07/2018] [Indexed: 12/17/2022]
Abstract
The development of an improved vaccine to stimulate an effective response against Mycobacterium tuberculosis (MTB) infection and disease will be a major breakthrough in the fight against TB. A lack of tools to adequately track the progression or resolution of events in TB pathogenesis that occur at bacterial loads below the threshold for culture in human samples seriously hampers vaccine development and evaluation. In this review we discuss recent studies that use new imaging applications, modalities and analysis techniques to provide insight into the dynamic processes of MTB infection and disease that are challenging to monitor. These include early infection, the spectrum of latency and subclinical disease, the paucibacillary state induced by treatment, and events leading to recurrence, including relapse.
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Affiliation(s)
- Stephanus T Malherbe
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Léanie Kleynhans
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerhard Walzl
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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What, where and why: exploring fluorodeoxyglucose-PET's ability to localise and differentiate infection from cancer. Curr Opin Infect Dis 2018; 30:552-564. [PMID: 28922285 DOI: 10.1097/qco.0000000000000405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW To review the utility of FDG-PET imaging in detecting the cause of fever and infection in patients with cancer. RECENT FINDINGS FDG-PET has been shown to have high sensitivity and accuracy for causes of neutropenic fever, leading to higher diagnostic certainty in this group. Recent advances in pathogen-specific labelling in PET to identify Aspergillus spp. and Yersinia spp. infections in mice, as well as differentiating between Gram-positive, Gram-negative and mycobacterial infections are promising. SUMMARY Patients with cancer are vulnerable to infection and fever, and the causes of these are frequently unclear using conventional diagnostic methods leading to high morbidity and mortality, length of stay and costs of care. FDG-PET/CT, with its unique complementary functional and anatomical information as well as its whole-body imaging capability, has demonstrated use in detecting occult infection in immunocompromised patients, including invasive fungal and occult bacterial infections, as well as defining extent of infection. By demonstrating disease resolution following treatment and allowing earlier cessation of therapy, FDG-PET acts as a key tool for antimicrobial and antifungal stewardship. Limitations include at times poor differentiation between infection, malignancy and sterile inflammation, however, exciting new technologies specific to infectious pathogens may help alleviate that issue. Further prospective randomised research is needed to explore these benefits in a nonbiased fashion.
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Nedelcovych MT, Gadiano AJ, Wu Y, Manning AA, Thomas AG, Khuder SS, Yoo SW, Xu J, McArthur JC, Haughey NJ, Volsky DJ, Rais R, Slusher BS. Pharmacokinetics of Intranasal versus Subcutaneous Insulin in the Mouse. ACS Chem Neurosci 2018; 9:809-816. [PMID: 29257872 PMCID: PMC5906198 DOI: 10.1021/acschemneuro.7b00434] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Insulin delivery to the brain has emerged as an important therapeutic target for cognitive disorders associated with abnormal brain energy metabolism. Although insulin is transported across the blood-brain barrier, peripheral routes of administration are problematic due to systemic effects of insulin on blood glucose. Intranasal (IN) administration is being investigated as an alternative route. We conducted a head-to-head comparison of subcutaneous (SC) and IN insulin, assessing plasma and brain pharmacokinetics and blood glucose levels in the mouse. SC insulin (2.4 IU) achieved therapeutically relevant concentrations in the brain (AUCbrain = 2537 h·μIU/mL) but dramatically increased plasma insulin (AUCplasma = 520 351 h·*μIU/mL), resulting in severe hypoglycemia and in some cases death. IN administration of the same dose resulted in similar insulin levels in the brain (AUCbrain = 3442 h·μIU/mL) but substantially lower plasma concentrations (AUCplasma = 354 h·μIU/mL), amounting to a ∼ 2000-fold increase in the AUCbrain:plasma ratio relative to SC. IN dosing also had no significant effect on blood glucose. When administered daily for 9 days, IN insulin increased brain glucose and energy metabolite concentrations (e.g., adenosine triphosphate and phosphocreatine) without causing overt toxicity, suggesting that IN insulin may be a safe therapeutic option for cognitively impaired patients.
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Affiliation(s)
- Michael T. Nedelcovych
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Alexandra J. Gadiano
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Ying Wu
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Arena A. Manning
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Ajit G. Thomas
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Saja S. Khuder
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Neuroimmunology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Seung-Wan Yoo
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Jiadi Xu
- Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Justin C. McArthur
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Norman J. Haughey
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - David J. Volsky
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Rana Rais
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
| | - Barbara S. Slusher
- Johns Hopkins Drug Discovery, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
- Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, United States
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Evaluating the Role of F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Staging of Patients With Stage IIIB Cervical Carcinoma and the Impact on Treatment Decisions. Int J Gynecol Cancer 2018; 28:379-384. [DOI: 10.1097/igc.0000000000001174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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35
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Sohn S, Shi HJ, Wang SH, Lee SK, Park SY, Lee JS, Eom JS. Mycobacterium avium Complex Infection-Related Immune Reconstitution Inflammatory Syndrome Mimicking Lymphoma in an Human Immunodeficiency Virus-Infected Patient. Infect Chemother 2018; 50:350-356. [PMID: 30600659 PMCID: PMC6312901 DOI: 10.3947/ic.2018.50.4.350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022] Open
Abstract
In acquired immunodeficiency syndrome (AIDS) patients, immune reconstitution inflammatory syndrome (IRIS) due to Mycobacterium avium complex (MAC) infection is one of the most difficult IRIS types to manage. We report an unusual case of MAC-associated IRIS. At first the patient was diagnosed human immunodeficiency virus (HIV) infection after he was admitted with pneumocystis pneumonia. After starting antiretroviral therapy he presented unmasked IRIS with MAC infection. Next, he was hospitalized with continuous loose stools and new-onset fever. Investigation included computed tomography (CT), which showed homogeneous enhancement and enlargement of the lymph nodes (LN), elevation of ferritin (>1,650 ng/mL) and lactate dehydrogenase (306 IU/L) levels, and F- fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan, which showed increased FDG uptake. These findings were highly indicative of lymphoma. We performed laparoscopic biopsy of the mesenteric LN, and the biopsy culture grew MAC. So we made a diagnosis of MAC-associated. Therefore, IRIS must be considered as a possible diagnosis when AIDS patients develop new symptoms or exhibit exacerbations of existing symptoms. Furthermore the biopsies should be conducted.
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Affiliation(s)
- Sungmin Sohn
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical College, Seoul, Korea
| | - Hye Jin Shi
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical College, Seoul, Korea
| | - Sung Ho Wang
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical College, Seoul, Korea
| | - Sang Ki Lee
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical College, Seoul, Korea
| | - So Yeon Park
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical College, Seoul, Korea
| | - Jin Seo Lee
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical College, Seoul, Korea
| | - Joong Sik Eom
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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Ankrah AO, Glaudemans AWJM, Maes A, Van de Wiele C, Dierckx RAJO, Vorster M, Sathekge MM. Tuberculosis. Semin Nucl Med 2017; 48:108-130. [PMID: 29452616 DOI: 10.1053/j.semnuclmed.2017.10.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tuberculosis (TB) is currently the world's leading cause of infectious mortality. Imaging plays an important role in the management of this disease. The complex immune response of the human body to Mycobacterium tuberculosis results in a wide array of clinical manifestations, making clinical and radiological diagnosis challenging. 18F-FDG-PET/CT is very sensitive in the early detection of TB in most parts of the body; however, the lack of specificity is a major limitation. 18F-FDG-PET/CT images the whole body and provides a pre-therapeutic metabolic map of the infection, enabling clinicians to accurately assess the burden of disease. It enables the most appropriate site of biopsy to be selected, stages the infection, and detects disease in previously unknown sites. 18F-FDG-PET/CT has recently been shown to be able to identify a subset of patients with latent TB infection who have subclinical disease. Lung inflammation as detected by 18F-FDG-PET/CT has shown promising signs that it may be a useful predictor of progression from latent to active infection. A number of studies have identified imaging features that might improve the specificity of 18F-FDG-PET/CT at some sites of extrapulmonary TB. Other PET tracers have also been investigated for their use in TB, with some promising results. The potential role and future perspectives of PET/CT in imaging TB is considered. Literature abounds on the very important role of 18F-FDG-PET/CT in assessing therapy response in TB. The use of 18F-FDG for monitoring response to treatment is addressed in a separate review.
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Affiliation(s)
- Alfred O Ankrah
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Alex Maes
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa; Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Morphology and Medical Imaging, University Hospital Leuven, Leuven, Belgium
| | - Christophe Van de Wiele
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa; Department of Nuclear Medicine and Radiology, University of Ghent, Ghent, Belgium
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa.
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Abstract
Monitoring response to treatment is a key element in the management of infectious diseases, yet controversies still persist on reliable biomarkers for noninvasive response evaluation. Considering the limitations of invasiveness of most diagnostic procedures and the issue of expression heterogeneity of pathology, molecular imaging is better able to assay in vivo biologic processes noninvasively and quantitatively. The usefulness of 18F-FDG-PET/CT in assessing treatment response in infectious diseases is more promising than for conventional imaging. However, there are currently no clinical criteria or recommended imaging modalities to objectively evaluate the effectiveness of antimicrobial treatment. Therapeutic effectiveness is currently gauged by the patient's subjective clinical response. In this review, we present the current studies for monitoring treatment response, with a focus on Mycobacterium tuberculosis, as it remains a major worldwide cause of morbidity and mortality. The role of molecular imaging in monitoring other infections including spondylodiscitis, infected prosthetic vascular grafts, invasive fungal infections, and a parasitic disease is highlighted. The role of functional imaging in monitoring lipodystrophy associated with highly active antiretroviral therapy for human immunodeficiency virus is considered. We also discuss the key challenges and emerging data in optimizing noninvasive response evaluation.
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Affiliation(s)
- Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa..
| | - Alfred O Ankrah
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa.; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Ismaheel Lawal
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa
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The role of F-18 FDG PET/CT in evaluating the impact of HIV infection on tumor burden and therapy outcome in patients with Hodgkin lymphoma. Eur J Nucl Med Mol Imaging 2017; 44:2025-2033. [PMID: 28660348 DOI: 10.1007/s00259-017-3766-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND To evaluate the impact of HIV infection on tumor burden and therapy outcome following treatment with chemotherapy in patients with Hodgkin lymphoma. METHODS A total of 136 patients with classical Hodgkin lymphoma were studied (mean age ± SD = 32.31 ± 1.39 years, male = 86, female = 50). Advanced disease (stage III and IV) was present in 64% of patients. HIV infection was present in 57 patients while 79 patients were HIV-negative. Baseline F-18 FDG PET/CT was obtained in all patients. SUVmax, MTV and TLG were determined on the baseline scan to evaluate for tumor burden. All patients completed a standard regimen of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). After a median period of 8 weeks (range = 6 to 17 weeks), a repeat F-18 FDG PET/CT scan was obtained to evaluate response to therapy using Deauville 5-point scoring system. RESULTS The HIV-positive and HIV-negative groups were similar with regards to age and disease stage. The groups were heterogeneous with respect to gender (p = 0.029). The SUVmax, MTV and TLG of lesions were not significant different between the two groups. Complete response was seen in 72.8% of the study population. Presence of HIV infection was associated with higher rate of treatment failure with 40.4% of the HIV-positive patients having treatment failure while only 17.7% of the HIV-negative patients had treatment failure (p = 0.0034). HIV infection was a significant predictor of response to chemotherapy. Effects of SUVmax, MTV, TLG and Ann Arbor stage of the disease were not statistically significant as predictors of therapy outcome. In a multiple logistic regression, presence of HIV infection still remained an independent predictor of therapy outcome in the presence of other factors such as SUVmax, MTV, TLG and the Ann Arbor stage of the disease. CONCLUSIONS HIV infection is not associated with a higher tumor burden in patients with Hodgkin lymphoma. HIV infection is, however, a strong predictor of poor therapy outcome in patients treated with standard regimen of ABVD.
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Mattila JT, Beaino W, Maiello P, Coleman MT, White AG, Scanga CA, Flynn JL, Anderson CJ. Positron Emission Tomography Imaging of Macaques with Tuberculosis Identifies Temporal Changes in Granuloma Glucose Metabolism and Integrin α4β1-Expressing Immune Cells. THE JOURNAL OF IMMUNOLOGY 2017; 199:806-815. [PMID: 28592427 DOI: 10.4049/jimmunol.1700231] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/08/2017] [Indexed: 12/19/2022]
Abstract
Positron emission tomography and computed tomography imaging (PET/CT) is an increasingly valuable tool for diagnosing tuberculosis (TB). The glucose analog [18F]fluoro-2-deoxy-2-d-glucose ([18F]-FDG) is commonly used in PET/CT that is retained by metabolically active inflammatory cells in granulomas, but lacks specificity for particular cell types. A PET probe that could identify recruitment and differentiation of different cell populations in granulomas would be a useful research tool and could improve TB diagnosis and treatment. We used the Mycobacterium-antigen murine inflammation model and macaques with TB to identify [64Cu]-labeled CB-TE1A1P-PEG4-LLP2A ([64Cu]-LLP2A), a high affinity peptidomimetic ligand for very late Ag-4 (VLA-4; also called integrin α4β1) binding cells in granulomas, and compared [64Cu]-LLP2A with [18F]-FDG over the course of infection. We found that [64Cu]-LLP2A retention was driven by macrophages and T cells, with less contribution from neutrophils and B cells. In macaques, granulomas had higher [64Cu]-LLP2A uptake than uninfected tissues, and immunohistochemical analysis of granulomas with known [64Cu]-LLP2A uptake identified significant correlations between LLP2A signal and macrophage and T cell numbers. The same cells coexpressed integrin α4 and β1, further supporting that macrophages and T cells drive [64Cu]-LLP2A avidity in granulomas. Over the course of infection, granulomas and thoracic lymph nodes experienced dynamic changes in affinity for both probes, suggesting metabolic changes and cell differentiation or recruitment occurs throughout granuloma development. These results indicate [64Cu]-LLP2A is a PET probe for VLA-4, which when used in conjunction with [18F]-FDG, may be a useful tool for understanding granuloma biology in TB.
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Affiliation(s)
- Joshua T Mattila
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15213.,Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 15261
| | - Wissam Beaino
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213
| | - Pauline Maiello
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15213
| | - M Teresa Coleman
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15213
| | - Alexander G White
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15213
| | - Charles A Scanga
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15213
| | - JoAnne L Flynn
- Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, PA 15213;
| | - Carolyn J Anderson
- Department of Radiology, University of Pittsburgh, Pittsburgh, PA 15213; .,Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15213; and.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260
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Pelletier-Galarneau M, Martineau P, Zuckier LS, Pham X, Lambert R, Turpin S. 18 F-FDG-PET/CT Imaging of Thoracic and Extrathoracic Tuberculosis in Children. Semin Nucl Med 2017; 47:304-318. [DOI: 10.1053/j.semnuclmed.2016.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Lawal I, Sathekge M. F-18 FDG PET/CT imaging of cardiac and vascular inflammation and infection. Br Med Bull 2016; 120:55-74. [PMID: 27613996 DOI: 10.1093/bmb/ldw035] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Inflammation forms an important core of the aetiopathogenic process involved in many diseases affecting the heart and the blood vessels. These diseases include infections as well as inflammatory non-infectious cardiovascular conditions. The common feature of this is invasion of the heart or blood vessel by inflammatory cells. F-18 2-fluoro 2-deoxy-D glucose (FDG) is an analogue of glucose and like glucose it is taken up by activated inflammatory cells that accumulate at the site of infection. This has formed the basis of the use of F-18 FDG PET/CT in the non-invasive evaluation of human inflammatory diseases. SOURCES OF DATA This review is based on the published academic articles as well as our clinical experience. AREAS OF AGREEMENT F-18 FDG PET/CT is a useful imaging modality in the evaluation of cardiovascular inflammatory disorders. Accumulation and distribution of F-18 FDG at the site of inflammation/infection corresponds to severity of the inflammation/infection and extent of involvement. AREAS OF CONTROVERSY Most studies evaluating utility of F-18 FDG PET/CT in imaging cardiovascular inflammation are small observational studies hence are potentially prone to bias. GROWING POINTS Being a hybrid metabolic and morphologic imaging technique, F-18 FDG PET/CT offers combined advantage of complementary anatomic and metabolic information in disease process. This makes it a useful modality in the diagnosis, determination of extent of disease, prognostication as well as treatment monitoring. AREAS TIMELY FOR DEVELOPING RESEARCH Larger prospective studies are needed to validate the superiority of F-18 FDG PET/CT imaging over conventional anatomic imaging modalities.
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Affiliation(s)
- Ismaheel Lawal
- Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa
| | - Mike Sathekge
- Department of Nuclear Medicine, Steve Biko Academic Hospital, University of Pretoria, Private Bag X169, Pretoria 0001, South Africa
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Gambhir S, Ravina M, Rangan K, Dixit M, Barai S, Bomanji J. Imaging in extrapulmonary tuberculosis. Int J Infect Dis 2016; 56:237-247. [PMID: 27838445 DOI: 10.1016/j.ijid.2016.11.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022] Open
Abstract
Tuberculosis (TB) remains a major global public health problem, with 1.5 million deaths annually worldwide. One in five cases of TB present as extrapulmonary TB (EPTB), posing major diagnostic and management challenges. Mycobacterium tuberculosis adapts to a quiescent physiological state and is notable for its complex interaction with the host, producing poorly understood disease states ranging from latent infection to active clinical disease. New tools in the diagnostic armamentarium are urgently required for the rapid diagnosis of TB and monitoring of TB treatments, and to gain new insights into pathogenesis. The typical and atypical imaging features of EPTB are reviewed herein, and the roles of several imaging modalities for the diagnosis and management of EPTB are discussed.
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Affiliation(s)
- Sanjay Gambhir
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India.
| | - Mudalsha Ravina
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Kasturi Rangan
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Manish Dixit
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Sukanta Barai
- Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Rae Bareli Road, Lucknow, India
| | - Jamshed Bomanji
- Department of Nuclear Medicine, of Nuclear Medicine, UCLH NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK.
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18F-FDG PET/CT in the Initial Assessment and for Follow-up in Patients With Tuberculosis. Clin Nucl Med 2016; 41:e187-94. [PMID: 26704732 DOI: 10.1097/rlu.0000000000001102] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this retrospective study was to assess the value of 18F-FDG PET/CT in the initial evaluation and follow-up of patients with tuberculosis (TB). PATIENTS AND METHODS Thirty-five patients (18 men) with pulmonary or extrapulmonary TB were included. Diagnosis of TB was based either on histology or microbiological assessment in 32 patients and was based on typical morphological features of TB in CT and improvement on antimycobacterial medication in 3 patients. Eighty-eight 18F-FDG PET/CT scans were performed at initial assessment and during treatment, on a Siemens Biograph PET/CT. Diagnostic contrast-enhanced CT scans were performed on the 40-slice multidetector CT of the PET/CT scanner. Mean (SD) anti-TB treatment duration was 16.1 (8.9) months. RESULTS The initial 18F-FDG PET identified 64 affected regions in 34 among 35 patients, whereas CT identified 34 affected organs in 23 patients. Matching image results between PET and CT were observed at first visit in 11 patients (31.4%), with relevant differences in 23 (65.7%). In 1 patient, both modalities remained negative. During follow-up 18F-FDG PET scans, we recorded 15 cases with remission of disease, 16 with residual disease (2 patients with multidrug-resistant infection), and 4 cases with progressive disease or delayed onset of adequate immunological response. In only 3 patients, both modalities, PET and CT, showed completely equivalent results. CONCLUSIONS Both components of 18F-FDG PET/CT provide complementary information at initial evaluation and during follow-up; however, 18F-FDG showed more abnormal findings than CT. 18F-FDG PET/CT might be useful for the establishment of individualized treatment regimes, but this requires further prospective studies.
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Role of 18 F-FDG PET in demonstrating disease burden in patients with tuberculous meningitis. J Neurol Sci 2016; 370:196-200. [DOI: 10.1016/j.jns.2016.09.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/05/2016] [Accepted: 09/25/2016] [Indexed: 12/17/2022]
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Cengiz A, Şavk E, Tataroğlu C, Yürekli Y. 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in a Patient with HIV (-) Kaposi Sarcoma. Mol Imaging Radionucl Ther 2016; 25:140-142. [PMID: 27751977 PMCID: PMC5100086 DOI: 10.4274/mirt.07078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Kaposi sarcoma (KS) is a vascular neoplasm that often manifests with multiple vascular nodules on the skin and other organs. Various imaging modalities can be used to display disease extent. Herein we present a 65-year-old female patient with human immunodeficiency virus negative KS along with her whole-body positron emission tomography/computed tomography imaging findings.
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Affiliation(s)
- Arzu Cengiz
- Adnan Menderes University Faculty of Medicine, Department of Nuclear Medicine, Aydın, Turkey, Phone: +90 256 444 12 56 E-mail:
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Febrile syndrome of unknown origin: Indications for 18F-FDG PET/CT in inflammatory and infectious processes. RADIOLOGIA 2016; 59:253-263. [PMID: 27671947 DOI: 10.1016/j.rx.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 05/09/2016] [Accepted: 07/19/2016] [Indexed: 12/17/2022]
Abstract
Fever of unknown origin is defined as a body temperature greater than 38.3°C lasting more than three weeks for which the cause could not be found within one week of hospital admission. More than 200 causes have been reported, and these can be classified into four categories: infections, inflammatory diseases, oncologic processes, and miscellaneous conditions. Noninvasive diagnostic techniques are used in 69.2% of cases and invasive techniques in 30.8%. Structural imaging techniques show the morphological changes from infectious, inflammatory, and tumor-related processes, but they do not allow the detection of the early changes brought about by these processes. The metabolic information provided by 18F-FDG PET/CT has a promising role in these patients. 18F-FDG uptake is based on the cells' use of glucose as a source of energy, so it can be observed in infectious, inflammatory, and tumor-related processes. The established non-oncologic indications for 18F-FDG PET/CT are sarcoidosis, osteomyelitis, spondylodiscitis, fever of unknown origin, and vasculitis, which together account for more than 85% of studies.
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The Role of Nuclear Medicine in the Staging and Management of Human Immune Deficiency Virus Infection and Associated Diseases. Nucl Med Mol Imaging 2016; 51:127-139. [PMID: 28559937 DOI: 10.1007/s13139-016-0422-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 02/07/2023] Open
Abstract
Human immune deficiency virus (HIV) is a leading cause of death. It attacks the immune system, thereby rendering the infected host susceptible to many HIV-associated infections, malignancies and neurocognitive disorders. The altered immune system affects the way the human host responds to disease, resulting in atypical presentation of these disorders. This presents a diagnostic challenge and the clinician must use all diagnostic avenues available to diagnose and manage these conditions. The advent of highly active antiretroviral therapy (HAART) has markedly reduced the mortality associated with HIV infection but has also brought in its wake problems associated with adverse effects or drug interaction and may even modulate some of the HIV-associated disorders to the detriment of the infected human host. Nuclear medicine techniques allow non-invasive visualisation of tissues in the body. By using this principle, pathophysiology in the body can be targeted and the treatment of diseases can be monitored. Being a functional imaging modality, it is able to detect diseases at the molecular level, and thus it has increased our understanding of the immunological changes in the infected host at different stages of the HIV infection. It also detects pathological changes much earlier than conventional imaging based on anatomical changes. This is important in the immunocompromised host as in some of the associated disorders a delay in diagnosis may have dire consequences. Nuclear medicine has played a huge role in the management of many HIV-associated disorders in the past and continues to help in the diagnosis, prognosis, staging, monitoring and assessing the response to treatment of many HIV-associated disorders. As our understanding of the molecular basis of disease increases nuclear medicine is poised to play an even greater role. In this review we highlight the functional basis of the clinicopathological correlation of HIV from a metabolic view and discuss how the use of nuclear medicine techniques, with particular emphasis of F-18 fluorodeoxyglucose, may have impact in the setting of HIV. We also provide an overview of the role of nuclear medicine techniques in the management of HIV-associated disorders.
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Hess S, Alavi A, Basu S. PET-Based Personalized Management of Infectious and Inflammatory Disorders. PET Clin 2016; 11:351-61. [PMID: 27321037 DOI: 10.1016/j.cpet.2016.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
It is challenging to diagnose and manage infectious and inflammatory diseases; symptoms are relatively nonspecific, the disease patterns are often systemic. Imaging is pivotal and fluorodeoxyglucose (FDG)-PET/computed tomography (CT) is increasingly used due to its high sensitivity whole-body approach. At present, the literature is still relatively sparse, but evidence for FDG-PET/CT is mounting in several domains, for example, detecting culprit lesions in systemic infections and inflammations, evaluation of disease extent and therapy monitoring, and many other domains have shown considerable potential, for example, atherosclerosis in systemic inflammation. We believe FDG-PET/CT is becoming a first-line modality for infections and inflammation.
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Affiliation(s)
- Søren Hess
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, Odense 5000, Denmark; Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, Finsensgade 10, Esbjerg 6700, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Winsløwparken 19, 3, Odense 5000, Denmark.
| | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Building 421, Philadelphia, PA 19104, USA
| | - Sandip Basu
- Radiation Medicine Center (BARC), Tata Memorial Hospital Annexe, E. Borges Marg, Parel, Mumbai-400012, India
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Murphy SN, Herrick C, Wang Y, Wang TD, Sack D, Andriole KP, Wei J, Reynolds N, Plesniak W, Rosen BR, Pieper S, Gollub RL. High throughput tools to access images from clinical archives for research. J Digit Imaging 2016; 28:194-204. [PMID: 25316195 PMCID: PMC4359193 DOI: 10.1007/s10278-014-9733-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Historically, medical images collected in the course of clinical care have been difficult to access for secondary research studies. While there is a tremendous potential value in the large volume of studies contained in clinical image archives, Picture Archiving and Communication Systems (PACS) are designed to optimize clinical operations and workflow. Search capabilities in PACS are basic, limiting their use for population studies, and duplication of archives for research is costly. To address this need, we augment the Informatics for Integrating Biology and the Bedside (i2b2) open source software, providing investigators with the tools necessary to query and integrate medical record and clinical research data. Over 100 healthcare institutions have installed this suite of software tools that allows investigators to search medical record metadata including images for specific types of patients. In this report, we describe a new Medical Imaging Informatics Bench to Bedside (mi2b2) module (www.mi2b2.org), available now as an open source addition to the i2b2 software platform that allows medical imaging examinations collected during routine clinical care to be made available to translational investigators directly from their institution’s clinical PACS for research and educational use in compliance with the Health Insurance Portability and Accountability Act (HIPAA) Omnibus Rule. Access governance within the mi2b2 module is customizable per institution and PACS minimizing impact on clinical systems. Currently in active use at our institutions, this new technology has already been used to facilitate access to thousands of clinical MRI brain studies representing specific patient phenotypes for use in research.
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Affiliation(s)
- Shawn N Murphy
- Research IS and Computing, Partners HealthCare, Charlestown, MA, 02129, USA,
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Ankrah AO, van der Werf TS, de Vries EFJ, Dierckx RAJO, Sathekge MM, Glaudemans AWJM. PET/CT imaging of Mycobacterium tuberculosis infection. Clin Transl Imaging 2016; 4:131-144. [PMID: 27077068 PMCID: PMC4820496 DOI: 10.1007/s40336-016-0164-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/09/2016] [Indexed: 12/17/2022]
Abstract
Tuberculosis has a high morbidity and mortality worldwide. Mycobacterium tuberculosis (Mtb) has a complex pathophysiology; it is an aerobic bacillus capable of surviving in anaerobic conditions in a latent state for a very long time before reactivation to active disease. In the latent tuberculosis infection, the individual has no clinical evidence of active disease, but exhibits a hypersensitive response to proteins of Mtb. Only some 5–10 % of latently infected individuals appear to have reactivation of tuberculosis at any one time point after infection, and neither imaging nor immune tests have been shown to predict tuberculosis reactivation reliably. The complex pathology of the organism provides multiple molecular targets for imaging the infection and targeting therapy. Positron emission tomography (PET) integrated with computer tomography (CT) provides a unique opportunity to noninvasively image the whole body for diagnosing, staging and assessing therapy response in many infectious and inflammatory diseases. PET/CT is a powerful noninvasive tool that can rapidly provide three-dimensional views of disease deep within the body and conduct longitudinal assessment over time in one particular patient. Some PET tracers, such as 18F-fluorodeoxyglucose (18F-FDG), have been found to be useful in various infectious diseases for detection, assessing disease activity, staging and monitoring response to therapy. This tracer has also been used for imaging tuberculosis. 18F-FDG PET relies on the glucose uptake of inflammatory cells as a result of the respiratory burst that occurs with infection. Other PET tracers have also been used to image different aspects of the pathology or microbiology of Mtb. The synthesis of the complex cell membrane of the bacilli for example can be imaged with 11C-choline or 18F-fluoroethylcholine PET/CT while the uptake of amino acids during cell growth can be imaged by 3′-deoxy-3′-[18F]fluoro-l-thymidine. PET/CT provides a noninvasive and sensitive method of assessing histopathological information on different aspects of tuberculosis and is already playing a role in the management of tuberculosis. As our understanding of the pathophysiology of tuberculosis increases, the role of PET/CT in the management of this disease would become more important. In this review, we highlight the various tracers that have been used in tuberculosis and explain the underlying mechanisms for their use.
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Affiliation(s)
- Alfred O Ankrah
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands ; Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
| | - Tjip S van der Werf
- Department of Internal Medicine, Infectious Diseases, and Pulmonary Diseases and Tuberculosis, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik F J de Vries
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Gronigen, The Netherlands
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