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Potential false positive active extra pulmonary tuberculosis lesions on FDG PET/CT imaging in malignancy

Year 2010, Volume: 37 Issue: 1, 42 - 47, 01.03.2010

Abstract

Objectives: Integrated fusion imaging modality Positron Emission Tomography Computed Tomography (PET/CT) using 18Fluorine-Fluoro Deoxy Glucose (18F-FDG) is commonly utilized in imaging oncology. We expand the role of this imaging modality in our study to demonstrate the appearance of active extra pulmonary tuberculosis (TB) lesions. Materials and methods: This study involved prospective evaluation of 8 patients using 18F-FDG PET/CT with confirmed diagnosis of extra pulmonary TB infection. Visually high intensity lesions in abnormal areas were studied where the mean and maximum standardized uptake value (SUVmean and SUVmax) were tabulated. The diagnosis of TB infection was confirmed by isolation of TB bacillus from these lesions or evidence of responding to anti TB treatment during post treatment evaluation using FDG PET/ CT at follow up. Results: The genders are equally affected. Majority of the group falls within young age below 50 years. Number of PET/CT studies demonstrating lesions either singly or multiple were equal in distribution. Nodal involvement is commonest in our study including mediastinum, paraaortic and inguinal groups. Other sites of infection include spine and bowel. The average SUVmax and SUVmean for all lesions were 7.7 and 5.2 respectively. Conclusion: Active TB lesions are FDG avid. Thus, FDG avid lesions should be interpreted with extra careful when FDG PET / CT is utilized in managing malignancy. Keywords: extra pulmonary tuberculosis, 18F-FDG PET/CT, SUVmax, false positive, malignancy

References

  • Global tuberculosis control - surveillance, planning, financ- ing. WHO Report 2008 WHO/HTM/TB/2008.393.
  • Address TB/HIV, MDR/XDR-TB and other challenges. WHO Report 2008 WHO/HTM/TB/2008.393.
  • Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Morbidity and Mortality Weekly Report. Recom- mendations and Reports 2005;54:15
  • Diagnostic Standards and Classification of Tuberculosis in Adults and Children. Official Statement of the American Thorax Society and the Centers for Disease Control and Pprevention. Crit Care Med 2000:161:1376-l 395.
  • Yamada S, Kubota K, Kubota R, Ido T, Tamahashi N. High accumulation of fluorine-18-fluorodeoxyglucose in tur- pentine- induced inflammatory tissue. J Nucl Med 1995; 36:1301–1306.
  • Bakheet SM, Powe J, Ezzat A, Rostom A. F-18-FDG uptake in tuberculosis. Clin Nucl Med 1998; 23: 739–742.
  • Park CH, Lee MH, Oh CG. F-18FDG positron emission to- mographic imaging in bilateral iliopsoas abscesses. Clin Nucl Med 2002;27:680-681.
  • Zhuang H, Duarte PS, Pourdehand M, Shnier D, Alavi A. Exclusion of chronic osteomyelitis with F-18 fluorodeoxy- glucose positron emission tomographic imaging. Clin Nucl Med 2000;25:281-284.
  • Kalicke T, Schmitz A, Risse JH, et al. Fluorine-18 fluorode- oxyglucose PET in infectious bone diseases: results of his- tologically confirmed cases. Eur J Nucl Med 2000;27:524- 528.
  • Zhuang H, Duarte PS, Pourdehnad M, Maes et al. The prom- ising role of F-18-FDG-PET in detecting infected lower limb prosthesis implants. J Nucl Med 2001;42:44-48.
  • Kisielinski K, Cremerius U, Reinartz P, Niethard FU. Fluo- rodeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty. J Arthroplast 2003;18:528-532.
  • Hsu CH, Lee CM, Wang FC, Lin YH. F-18 fluorodeoxyg- lucose positron emission tomography in pulmonary crypto- coccoma. Clin Nucl Med 2003;28:791-793.
  • Bakheet SMB, Powe J, Kandil A, Ezzat A, Rostom A, Ama- rtey J. F-18FDG uptake in breast infection and inflamma- tion. Clin Nucl Med 2000;25:100-103.
  • Izquierdo-Garcia D, Davies JR, Graves MJ, et al.Comparison of methods for magnetic resonance-guided [18-F] fluorode- oxyglucose positron emission tomography in human carot- id arteries: reproducibility, partial volume correction, and correlation between methods. Stroke 2009;40:86-93.
  • Arauz A, Hoyos L, Zenteno M, Mendoza R, Alexanderson E. Carotid plaque inflammation detected by 18F-fluoro- deoxyglucose-positron emission tomography. Pilot study. Clin Neurol Neurosurg 2007;109:409-412.
  • Tawakol A, Migrino RQ, Bashian GG, et al. In vivo 18F- fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflam- mation in patients. J Am Coll Cardiol 2006;48:1818-1824
  • Rudd JH, Myers KS, Bansilal S, et al. Atherosclerosis in- flammation imaging with 18F-FDG PET: carotid, iliac, and femoral uptake reproducibility, quantification methods, and recommendations. J Nucl Med 2008;49:871-878.
  • Alexánderson Rosas E, Lamothe Molina PA, Iñarra Talboy F, Calleja Torres R, Martínez García A, Ochoa López JM, Meave González AValue of the assessment of myocardial viability: evaluation with positron emission tomography 18F-FDG. Arch Cardiol Mex 2008;78:431-437
  • Masud MM, Fujimoto T, Miyake M, Watanuki S, Itoh M, Tashiro M. Redistribution of whole-body energy metabo- lism by exercise: a positron emission tomography study. Ann Nucl Med 2009;23:81-88.
  • Mittra E, Quon A. Positron emission tomography/computed tomography: the current technology and applications. Ra- diol Clin North Am 2009;47:147-160.
  • Alexander GE, Chen K, Pietrini P, Rapoport SI, Reiman EM. Longitudinal PET Evaluation of Cerebral Metabolic Decline in Dementia: A Potential Outcome Measure in Alzheimer’s Disease Treatment Studies. Am J Psychiatry 2002 ;159:738-745.
  • Jeffry L, Kerrou K, Camatte S, et al. Peritoneal tuberculosis revealed by carcinomatosis on CT scan and uptake at FDG- PET. BJOG 2003;110:1129-1131.
  • Yang CM, Hsu CH, Lee CM, Wang FC. Intense uptake of F-18 -fluoro-2 deoxy-D-glucose in active pulmonary tuber- culosis. Ann Nucl Med 2003;17:407-410.
  • Goo JM, Im JG, Do KH, et al. Pulmonary tuberculoma eval- uated by means of FDG-PET: findings in 10 cases. Radiol- ogy 2000; 216:117-121.
  • Concia E, Prandini N, Massari L, Ghisellini F, Consoli V, Menichetti F, Lazzeri E. Osteomyelitis: clinical update for practical guidelines. Nucl Med Commun 2006;27:645- 660.
  • El-Maghraby TA, Moustafa HM, Pauwels EK. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. Q J Nucl Med Mol Im- aging 2006;50:167-192.
  • Vercellino L, Bousquet G, Baillet G, et al. 18F-FDG PET/ CT imaging for an early assessment of response to sunitinib in metastatic renal carcinoma: preliminary study. Cancer Biother Radiopharm 2009;24:137-144.
  • Dose Schwarz J, Bader M, Jenicke L, Hemminger G, Jän- icke F, Avril N. Early prediction of response to chemother- apy in metastatic breast cancer using sequential 18F-FDG PET. J Nucl Med 2005;46:1144-1150.
  • Vees H, Buchegger F, Albrecht S, et al.18F-choline and/ or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low prostate-specific antigen values (<1 ng/mL) after radical prostatectomy. BJU Int 2007;99:1415-1420.

Kanser FDG PET/CT görüntülemesinde olası yanlış pozitif aktif akciğer-dışı tüberküloz lezyonları

Year 2010, Volume: 37 Issue: 1, 42 - 47, 01.03.2010

Abstract

Amaç: 18Florin-Floro-Deoksi-glukoz (18F-FDG) kullanılarak yapılan, Pozitron emisyon tomografi bilgisayarlı tomografisi (PET/CT) birleşik füzyon görüntülemesi onkolojik görüntüleme için sıklıkla kullanılır. Biz çalışmamızda, bu görüntüleme yönteminin rolünü genişleterek, aktif akciğer dışı tüberküloz (TB) lezyonlarını göstermek amacıyla kullandık. Gereç ve yöntem: Bu çalışam doğrulanmış akciğer dışı TB enfeksiyonlu 8 hastada 18F-FDG PET/CT kullanılarak prospektif bir değerlendirme şeklinde gerçekleştirildi. Anormal bölgelerdekki görsel yüksek yoğunlukklu lezyonlar ortlama ve maksimum standardize tutlum değerleri (SUVort ve SUVmaks) elde edildi ve tabloalştırıldı. Tüberküloz tanısı, lezyonlardan TB basili izolasyonu veya tedavi sonrası takipte FDG PET/CT lezyonlarının tedavi cevabının görülmesiyle doğrulandı. Bulgular: Her iki cinse eşit oranda etkilenmişti. Her iki gruptakilerin çoğu 50 yaş altında idi. Lezyonları gösteren PET/CT çalışma sayısı hem tek hem de çoğul olarak eşit dağılım gösterdi. Çalışmada nodal tutulum en sık mediastinal, paraaortik ve inguinal bölge lenf bezlerinde görüldü. Diğer enfeksiyon bölgeleri, omurga ve barsaklar idi. Ortalama SUVmaks ve SUVort değerleri tüm lezyonlar için sırasıyla 7.7 ve 5.2 idi. Sonuç: Aktif TB lezyonları FDG\'yi tutma eğilimindedir. Bu nedenle FDG PET/CT görüntülemesi kanser tedavisinde yol gösterici olarak kullanılıyorsa, elde edilene FDG tutullum görüntüleri çok dikkatle yorumlanmalıdır.

References

  • Global tuberculosis control - surveillance, planning, financ- ing. WHO Report 2008 WHO/HTM/TB/2008.393.
  • Address TB/HIV, MDR/XDR-TB and other challenges. WHO Report 2008 WHO/HTM/TB/2008.393.
  • Guidelines for the Investigation of Contacts of Persons with Infectious Tuberculosis. Recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Morbidity and Mortality Weekly Report. Recom- mendations and Reports 2005;54:15
  • Diagnostic Standards and Classification of Tuberculosis in Adults and Children. Official Statement of the American Thorax Society and the Centers for Disease Control and Pprevention. Crit Care Med 2000:161:1376-l 395.
  • Yamada S, Kubota K, Kubota R, Ido T, Tamahashi N. High accumulation of fluorine-18-fluorodeoxyglucose in tur- pentine- induced inflammatory tissue. J Nucl Med 1995; 36:1301–1306.
  • Bakheet SM, Powe J, Ezzat A, Rostom A. F-18-FDG uptake in tuberculosis. Clin Nucl Med 1998; 23: 739–742.
  • Park CH, Lee MH, Oh CG. F-18FDG positron emission to- mographic imaging in bilateral iliopsoas abscesses. Clin Nucl Med 2002;27:680-681.
  • Zhuang H, Duarte PS, Pourdehand M, Shnier D, Alavi A. Exclusion of chronic osteomyelitis with F-18 fluorodeoxy- glucose positron emission tomographic imaging. Clin Nucl Med 2000;25:281-284.
  • Kalicke T, Schmitz A, Risse JH, et al. Fluorine-18 fluorode- oxyglucose PET in infectious bone diseases: results of his- tologically confirmed cases. Eur J Nucl Med 2000;27:524- 528.
  • Zhuang H, Duarte PS, Pourdehnad M, Maes et al. The prom- ising role of F-18-FDG-PET in detecting infected lower limb prosthesis implants. J Nucl Med 2001;42:44-48.
  • Kisielinski K, Cremerius U, Reinartz P, Niethard FU. Fluo- rodeoxyglucose positron emission tomography detection of inflammatory reactions due to polyethylene wear in total hip arthroplasty. J Arthroplast 2003;18:528-532.
  • Hsu CH, Lee CM, Wang FC, Lin YH. F-18 fluorodeoxyg- lucose positron emission tomography in pulmonary crypto- coccoma. Clin Nucl Med 2003;28:791-793.
  • Bakheet SMB, Powe J, Kandil A, Ezzat A, Rostom A, Ama- rtey J. F-18FDG uptake in breast infection and inflamma- tion. Clin Nucl Med 2000;25:100-103.
  • Izquierdo-Garcia D, Davies JR, Graves MJ, et al.Comparison of methods for magnetic resonance-guided [18-F] fluorode- oxyglucose positron emission tomography in human carot- id arteries: reproducibility, partial volume correction, and correlation between methods. Stroke 2009;40:86-93.
  • Arauz A, Hoyos L, Zenteno M, Mendoza R, Alexanderson E. Carotid plaque inflammation detected by 18F-fluoro- deoxyglucose-positron emission tomography. Pilot study. Clin Neurol Neurosurg 2007;109:409-412.
  • Tawakol A, Migrino RQ, Bashian GG, et al. In vivo 18F- fluorodeoxyglucose positron emission tomography imaging provides a noninvasive measure of carotid plaque inflam- mation in patients. J Am Coll Cardiol 2006;48:1818-1824
  • Rudd JH, Myers KS, Bansilal S, et al. Atherosclerosis in- flammation imaging with 18F-FDG PET: carotid, iliac, and femoral uptake reproducibility, quantification methods, and recommendations. J Nucl Med 2008;49:871-878.
  • Alexánderson Rosas E, Lamothe Molina PA, Iñarra Talboy F, Calleja Torres R, Martínez García A, Ochoa López JM, Meave González AValue of the assessment of myocardial viability: evaluation with positron emission tomography 18F-FDG. Arch Cardiol Mex 2008;78:431-437
  • Masud MM, Fujimoto T, Miyake M, Watanuki S, Itoh M, Tashiro M. Redistribution of whole-body energy metabo- lism by exercise: a positron emission tomography study. Ann Nucl Med 2009;23:81-88.
  • Mittra E, Quon A. Positron emission tomography/computed tomography: the current technology and applications. Ra- diol Clin North Am 2009;47:147-160.
  • Alexander GE, Chen K, Pietrini P, Rapoport SI, Reiman EM. Longitudinal PET Evaluation of Cerebral Metabolic Decline in Dementia: A Potential Outcome Measure in Alzheimer’s Disease Treatment Studies. Am J Psychiatry 2002 ;159:738-745.
  • Jeffry L, Kerrou K, Camatte S, et al. Peritoneal tuberculosis revealed by carcinomatosis on CT scan and uptake at FDG- PET. BJOG 2003;110:1129-1131.
  • Yang CM, Hsu CH, Lee CM, Wang FC. Intense uptake of F-18 -fluoro-2 deoxy-D-glucose in active pulmonary tuber- culosis. Ann Nucl Med 2003;17:407-410.
  • Goo JM, Im JG, Do KH, et al. Pulmonary tuberculoma eval- uated by means of FDG-PET: findings in 10 cases. Radiol- ogy 2000; 216:117-121.
  • Concia E, Prandini N, Massari L, Ghisellini F, Consoli V, Menichetti F, Lazzeri E. Osteomyelitis: clinical update for practical guidelines. Nucl Med Commun 2006;27:645- 660.
  • El-Maghraby TA, Moustafa HM, Pauwels EK. Nuclear medicine methods for evaluation of skeletal infection among other diagnostic modalities. Q J Nucl Med Mol Im- aging 2006;50:167-192.
  • Vercellino L, Bousquet G, Baillet G, et al. 18F-FDG PET/ CT imaging for an early assessment of response to sunitinib in metastatic renal carcinoma: preliminary study. Cancer Biother Radiopharm 2009;24:137-144.
  • Dose Schwarz J, Bader M, Jenicke L, Hemminger G, Jän- icke F, Avril N. Early prediction of response to chemother- apy in metastatic breast cancer using sequential 18F-FDG PET. J Nucl Med 2005;46:1144-1150.
  • Vees H, Buchegger F, Albrecht S, et al.18F-choline and/ or 11C-acetate positron emission tomography: detection of residual or progressive subclinical disease at very low prostate-specific antigen values (<1 ng/mL) after radical prostatectomy. BJU Int 2007;99:1415-1420.
There are 29 citations in total.

Details

Primary Language Turkish
Journal Section Research Articles
Authors

Abdul Jalil Nordin This is me

Hairil Rashmizal This is me

Noraini Abdul Rahim This is me

Claudio Rossetti This is me

Publication Date March 1, 2010
Submission Date March 2, 2015
Published in Issue Year 2010 Volume: 37 Issue: 1

Cite

APA Nordin, A. J., Rashmizal, H., Rahim, N. A., Rossetti, C. (2010). Kanser FDG PET/CT görüntülemesinde olası yanlış pozitif aktif akciğer-dışı tüberküloz lezyonları. Dicle Tıp Dergisi, 37(1), 42-47.
AMA Nordin AJ, Rashmizal H, Rahim NA, Rossetti C. Kanser FDG PET/CT görüntülemesinde olası yanlış pozitif aktif akciğer-dışı tüberküloz lezyonları. diclemedj. March 2010;37(1):42-47.
Chicago Nordin, Abdul Jalil, Hairil Rashmizal, Noraini Abdul Rahim, and Claudio Rossetti. “Kanser FDG PET/CT görüntülemesinde Olası yanlış Pozitif Aktif akciğer-dışı tüberküloz Lezyonları”. Dicle Tıp Dergisi 37, no. 1 (March 2010): 42-47.
EndNote Nordin AJ, Rashmizal H, Rahim NA, Rossetti C (March 1, 2010) Kanser FDG PET/CT görüntülemesinde olası yanlış pozitif aktif akciğer-dışı tüberküloz lezyonları. Dicle Tıp Dergisi 37 1 42–47.
IEEE A. J. Nordin, H. Rashmizal, N. A. Rahim, and C. Rossetti, “Kanser FDG PET/CT görüntülemesinde olası yanlış pozitif aktif akciğer-dışı tüberküloz lezyonları”, diclemedj, vol. 37, no. 1, pp. 42–47, 2010.
ISNAD Nordin, Abdul Jalil et al. “Kanser FDG PET/CT görüntülemesinde Olası yanlış Pozitif Aktif akciğer-dışı tüberküloz Lezyonları”. Dicle Tıp Dergisi 37/1 (March 2010), 42-47.
JAMA Nordin AJ, Rashmizal H, Rahim NA, Rossetti C. Kanser FDG PET/CT görüntülemesinde olası yanlış pozitif aktif akciğer-dışı tüberküloz lezyonları. diclemedj. 2010;37:42–47.
MLA Nordin, Abdul Jalil et al. “Kanser FDG PET/CT görüntülemesinde Olası yanlış Pozitif Aktif akciğer-dışı tüberküloz Lezyonları”. Dicle Tıp Dergisi, vol. 37, no. 1, 2010, pp. 42-47.
Vancouver Nordin AJ, Rashmizal H, Rahim NA, Rossetti C. Kanser FDG PET/CT görüntülemesinde olası yanlış pozitif aktif akciğer-dışı tüberküloz lezyonları. diclemedj. 2010;37(1):42-7.