TY - JOUR
T1 - 18F-FDG PET/CT as a Noninvasive Biomarker for Assessing Adequacy of Treatment and Predicting Relapse in Patients Treated for Pulmonary Tuberculosis
AU - Lawal, Ismaheel O.
AU - Fourie, Bernard P.
AU - Mathebula, Matsontso
AU - Moagi, Ingrid
AU - Lengana, Thabo
AU - Moeketsi, Nontando
AU - Nchabeleng, Maphoshane
AU - Hatherill, Mark
AU - Sathekge, Mike M.
N1 - Funding Information:
This work was funded with grants received from RePORT Africa (OISE-16-62054) and the South African Medical Research Council (TB HIV Collaborating Centre). Ismaheel Lawal is a PhD student at the Department of Nuclear Medicine, University of Pretoria. He receives a monthly stipend from the Nuclear Medicine Research Infrastructure (NuMeRI) hosted at the Department of Nuclear Medicine, University of Pretoria. No other potential conflict of interest relevant to this article was reported.
Publisher Copyright:
© 2020 Society of Nuclear Medicine Inc.. All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Microbial culture is the gold standard for determining the effectiveness of tuberculosis treatment. End-of-Treatment (EOT) 18F-FDG PET/CT findings are variable among patients with negative microbial culture results after completing a standard regimen of antituberculous treatment (ATT), with some patients having a complete metabolic response to treatment whereas others have residual metabolic activity (RMA). We herein determine the impact of findings on EOT 18F-FDG PET/CT on tuberculosis relapse in patients treated with a standard regimen of ATT for drug-sensitive pulmonary tuberculosis (DS-PTB). Methods: Patients who completed a standard regimen of ATT for DS-PTB and were declared cured based on a negative clinical and bacteriologic examination were prospectively recruited to undergo EOT 18F-FDG PET/CT. Images were assessed for the presence of RMA. Patients were subsequently followed up for 6 mo looking for symptoms of tuberculosis relapse. When new symptoms developed, relapse was confirmed with bacteriologic testing. Repeat 18F-FDG PET/CT was done in patients who relapsed. Results: Fifty-Three patients were included (mean age, 37.81 ± 11.29 y), with 62% being male and 75% HIV-infected. RMA was demonstrated in 33 patients (RMA group), whereas 20 patients had a complete metabolic response to ATT (non-RMA group). There was a higher prevalence of lung cavitation in the RMA group (P 5 0.035). The groups did not significantly differ in age, sex, presence of HIV infection, body mass index, or hemoglobin level (P . 0.05). On follow-up, no patients in the non-RMA group developed tuberculosis relapse. Three patients in the RMA group developed relapse. All patients who developed tuberculosis relapse had bilateral disease with lung cavitation. Conclusion: A negative EOT 18F-FDG PET/CT result is protective against tuberculosis relapse. Nine percent of patients with RMA after ATT may experience tuberculosis relapse within 6 mo of completing ATT. Bilateral disease with lung cavitation is prevalent among patients with tuberculosis relapse.
AB - Microbial culture is the gold standard for determining the effectiveness of tuberculosis treatment. End-of-Treatment (EOT) 18F-FDG PET/CT findings are variable among patients with negative microbial culture results after completing a standard regimen of antituberculous treatment (ATT), with some patients having a complete metabolic response to treatment whereas others have residual metabolic activity (RMA). We herein determine the impact of findings on EOT 18F-FDG PET/CT on tuberculosis relapse in patients treated with a standard regimen of ATT for drug-sensitive pulmonary tuberculosis (DS-PTB). Methods: Patients who completed a standard regimen of ATT for DS-PTB and were declared cured based on a negative clinical and bacteriologic examination were prospectively recruited to undergo EOT 18F-FDG PET/CT. Images were assessed for the presence of RMA. Patients were subsequently followed up for 6 mo looking for symptoms of tuberculosis relapse. When new symptoms developed, relapse was confirmed with bacteriologic testing. Repeat 18F-FDG PET/CT was done in patients who relapsed. Results: Fifty-Three patients were included (mean age, 37.81 ± 11.29 y), with 62% being male and 75% HIV-infected. RMA was demonstrated in 33 patients (RMA group), whereas 20 patients had a complete metabolic response to ATT (non-RMA group). There was a higher prevalence of lung cavitation in the RMA group (P 5 0.035). The groups did not significantly differ in age, sex, presence of HIV infection, body mass index, or hemoglobin level (P . 0.05). On follow-up, no patients in the non-RMA group developed tuberculosis relapse. Three patients in the RMA group developed relapse. All patients who developed tuberculosis relapse had bilateral disease with lung cavitation. Conclusion: A negative EOT 18F-FDG PET/CT result is protective against tuberculosis relapse. Nine percent of patients with RMA after ATT may experience tuberculosis relapse within 6 mo of completing ATT. Bilateral disease with lung cavitation is prevalent among patients with tuberculosis relapse.
KW - 18F-FDG PET/CT
KW - end-of-Treatment
KW - relapse
KW - residual metabolic activity
KW - tuberculosis
UR - http://www.scopus.com/inward/record.url?scp=85079692134&partnerID=8YFLogxK
U2 - 10.2967/JNUMED.119.233783
DO - 10.2967/JNUMED.119.233783
M3 - Article
C2 - 31451489
AN - SCOPUS:85079692134
SN - 0161-5505
VL - 61
SP - 412
EP - 417
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 3
ER -