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

Öz

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

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

• Akciğer dışı tüberküloz, PET, SUV, yanlış pozitif, malignite

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