Project Type
Coordinated Research Project
Project Code
E15021
CRP
2055
Approved Date
13 February 2014
Expected End Date
4 December 2018
Completed Date
6 November 2018
Description
Over 95% of TB deaths occur in low- and middle-income Member States, where TB is among the top three causes of death for women in reproductive age. This disease has become or is becoming a medical emergency not only in developing Member States but also in some high-income countries, because of migration of people from low-income to higher-income areas, because of frequent co-infection with HIV/AIDS, and because of the development of drug-resistant strains of TB (3). Aim of this study is to engage Member States in a coordinated research project to develop a comprehensive TB imaging strategy through the use 18F-FDG PET/CT for imaging TB patients with special focus on: (a) extrapulmonary TB (b) multi drug resistant TB (MDR-TB) and (c) monitor response to therapy (Baseline 18F-FDG PET scan and repeat scan at 2 months and 6months post therapy) in order to reduce rates and deaths from TB especially drug resistant TB. Radionuclide imaging of infection has for long time relied almost exclusively on single-photon-emitting agents, evolving from early applications of 67Ga-citrate scintigraphy to scintigraphy with autologous leukocytes, labelled either directly (by in vitro incubation with agents such as 111In-Oxine or 99mTc-HMPAO before reinfusion) or indirectly (e.g., administering radiolabeled antibodies binding to surface antigens expressed by granulocytes)(1-2). The latest entry for radionuclide imaging of infection in the clinical setting is represented by PET with 18F-FDG, based on nonspecific enhanced glucose consumption of inflammatory cells and/or growing bacteria at the site(s) of infection(1-2). Nearly 11% of all deaths from infectious diseases are caused by tuberculosis (TB). This will contribute to the overall improvement of health care by accurate and early diagnosis of intractable TB infections in high risk patients through a multicentre imaging trial using 18F-FDG by increasing the detection rate of respiratory, abdominal, CNS, and postoperative infections related to TB. Overall, infectious disease constitutes a big burden to healthcare systems not only because of the direct costs related to treatments, but also in terms of parameters describing the overall economic and social burden deriving from associated disabilities and chronic debilitating illnesses, such as the disability-adjusted life years and the health-adjusted life expectancy. The top infectious diseases causing deaths worldwide are lower respiratory infections (including pneumonia and influenza), chronic obstructive pulmonary disease, diarrheal diseases, HIV/AIDS, and tuberculosis (TB). While the impact of radionuclide imaging in the first four such infectious conditions is rather limited, special attention should be paid to the potential role of nuclear medicine imaging in certain stages of TB infection. Such role is not to be seen in the diagnostic approach to TB, but rather in subsequent stages, for characterization of the disease and for assessing its response to therapy.
Objectives
A comprehensive TB imaging strategy using F-18 FDG PET/CT will be developed and introduced especially with developing Member States in order to reduce rates and deaths from MDR and extrapulmonary TB.
Specific objectives
To assess the adequacy of 18F-FDG PET/CT for post-therapy surveillance
To monitor therapy response, with emphasis on the possibility of an interim scan (2 months after starting therapy) to predict response with respect to the final scan at 6 months, or 9 to 12 months
Use 18F-FDG PET/CT for imaging TB patients for: (a) the diagnosis of extrapulmonary TB (c) Use of 18F-FDG PET/CT as biomarker to monitor response to TB therapy, cure and relapse (Baseline 18F-FDG PET scan and repeat scan at 2 months and 6months post therapy)
Impact
Before the initiation of this project, PET imaging in EPTB was not considered by the treating physicians. From the data of patients included in this project, PET imaging has been found to be very useful and is now routinely performed especillay Pott's spine and TBM cases. Further emphasis can be given on MDRTB based on PET scan finding
This multi-centre trial shows that 18F-FDG PET-CT imaging can be used as a biomarker to evaluate the full extent of disease which is superior to current practice of conventional CT imaging.
The utility of PET/CT as an efficient health technology tool further validated.
Relevance
PET/CT imaging technology using short-lived radiotracers produced by cyclotron allow for the timely identification of functional and metabolic changes in the patient’s whole body, which precede morphological and structural changes with the application of the appropriate PET radiotracers. 18F-FDG used for PET/CT Imaging is known to accumulate at sites of infection, inflammation and in autoimmune and granulomatous diseases. This CRP provided participants from member Sates to be bale to participate in a multicentre trial and be able to validate the clinical utility of nuclear technique such PET/CT in the management of tuberculosis.
CRP Publications
Type
Peer reviewed research journal
Year
2016
Description
Imaging in Extrapulmonary Tuberculosis for rapid diagnosis, treatment monitoring, and pathogenesis studies. Today TB remains a major global public health problem with 1.5 million deaths annually. 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, monitoring of TB treatments, and acquisition of newer insights into pathogenesis. We review the typical and atypical imaging features of extrapulmonary TB and discuss the roles of several imaging modalities for the diagnosis and management of EPTB. Radiological investigations continue to play an important role in the evaluation of various manifestations, sites of infection and disease burden in patients with TB, especially extrapulmonary TB keeping in mind that TB can mimic a number of other disease entities. FDG PET-CT provides a visual metabolic map, complementary to conventional imaging techniques. It is likely that this technique will play an important role in decision making regarding duration of therapy in extrapulmonary TB, MDR TB, XDR TB and patients with a past history of TB
Country/Organization
International Journal of Infectious Diseases
Type
12th World Congress of WFNMB 2018 at Melbourne
Year
2018
Description
PET-CT in Evaluation of Extra-Pulmonary Tuberculosis and Treatment Monitoring in Multidrug Resistance Tuberculosis. / Shamim Momtaz Ferdousi Begum, Mohammad Abdus Shakur Khan, Fatima Begum,Khokon Kumar Nath, Fatema Tuz Zohra, Nurun Nahar. Presented at WFNM82018 Abstract
Country/Organization
Bangladesh
Type
Peer reviewed research journal/ Journal of the neurological sciences, 370, pp.196-200.
Year
2016. Gambhir, S., Kumar, M., Ravina, M., Bhoi, S.K., Kalita, J. and Misra, U.K., 2016. Role of 18F-FDG PET in demonstrating disease burden in patients with tuberculous meningitis. Journal of the neurological sciences, 370, pp.196-200.
Publication URL
https://www.sciencedirect.com/science/article/pii/S0022510X16306165
Description
Objective: To study the role of 18fluoro-deoxy glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan in documenting the disease burden in patients with tuberculous meningitis (TBM), and compare these findings with conventional imaging and magnetic resonance imaging (MRI).Subjects and methods: Ten patients with definite TBM were prospectively recruited. The severity of TBM was graded into stage I to III. The patients were subjected to whole body 18F-FDG PET/CT imaging and MRI brain. 18F-FDG PET/CT results were compared with the findings of brain MRI and other convectional imaging modalities (ultrasonography of abdomen and chest radiograph).Results: There were ten patients with TBM whose median age was 27 (14–55) years, and the median duration of illness was 4 (0.5–8.0) months. Two patients were in stage I, six in stage II, and two in stage III meningitis. 18F-FDG PET/CT confirmed the cranial MRI findings in six patients, revealed additional brain lesion in one and did not detect the existing MRI lesions in three patients. 18F-FDG PET/CT however detected additional lesions in vertebrae, spinal cord and lymph nodes which were not seen on the conventional imaging.Conclusion18F-FDG PET/CT has a complementary role to MRI for detection of cranial lesions and is more sensitive in detecting the extra cranial tuberculosis burden in the patients with TBM.
Country/Organization
India
Type
Peer reviewed research journal/ International Journal of Infectious Diseases, Volume 56, March 2017
Year
2017/ Gambhir, S., Ravina, M., Rangan, K., Dixit, M., Barai, S. and Bomanji, J., 2017. Imaging in extrapulmonary tuberculosis. International Journal of Infectious Diseases, 56, pp.237-247.
Publication URL
https://reader.elsevier.com/reader/sd/E4D1696F65FCBF64E11E8953D16F938D1210FCF71D…
Description
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.
Country/Organization
India
Type
Peer reviewed research journal/ Clinical nuclear medicine, 42(6), pp.e304-e305.
Year
2017. Rangan, K., Ravina, M., Yadav, N., Suraj, A.S. and Gambhir, S., 2017. 18F-FDG PET/CT of Tuberculosis Meningitis and Carotid Pseudoaneurysm. Clinical nuclear medicine, 42(6), pp.e304-e305.
Publication URL
https://journals.lww.com/nuclearmed/Abstract/2017/06000/18F_FDG_PET_CT_of_Tuberc…
Description
A 26-year-old woman presented with a headache, left-sided weakness of the body, and pulsatile swelling above the sternal notch. She was treated for abdominal tuberculosis in the past, two years later she developed miliary tuberculosis and was put on modified regimen of antitubercular drugs in view of drug induced hepatitis. Ultrasound neck revealed saccular aneurysm measuring 4 x 3 cm, located in between common carotid arteries with an eccentric thrombus. MRI brain revealed multiple tuberculoma with thick basal meningeal enhancement. Cerebrospinal fluid was positive for Mycobacterium tuberculosis. F-FDG PET/CT was done to delineate the extent of the disease.
Country/Organization
India
Type
12th World Congress of WFNMB 2018 at Melbourne
Year
2018
Description
Treatment monitoring in Multidrug Resistance Tuberculosis Using 18F FDG PET-CT' / Shamim M F Begum, Fatima Begum, MD Abdus Shakur Khan, Subhashis Dey, Kokon Kumar Nath, Nahid Hossain, Nasreen Sultana, Raihan Hussain and Jamshed Bomanji. Bangladesh J. Nucl. Med. 2017; 20(1):78.
Country/Organization
Bangladesh
