From the Departments of Nuclear Medicine.
Neurology.
Clin Nucl Med. 2020 Apr;45(4):276-282. doi: 10.1097/RLU.0000000000002968.
Tuberculosis (TB) is a major health problem. Activated macrophages in TB lesions show high metabolic activity and can be assessed using F-FDG PET/CT. This retroprospective study was done to evaluate the utility of F-FDG PET/CT in initial assessment and therapeutic response in patients with TB.
Eighty-seven patients (male-to-female ratio, 46:41) diagnosed with pulmonary TB and extrapulmonary TB underwent whole-body F-FDG PET/CT for initial assessment and a follow-up scan 3 to 4 months after initiation of antitubercular therapy (ATT). Visual and semiquantitative (SUVmax) analyses were used for scan assessment. Treatment responses on interim scans were categorized as complete metabolic response (CMR), favorable response to therapy (FRT), stable disease (SD), and disease progression (DP). CMR, FRT, and SD cases were considered as responders and DP cases as nonresponders. Treatment response was correlated with clinical outcome (mortality) and ATT duration.
Baseline F-FDG PET/CT scans were positive in all the patients and detected additional disease sites than suspected clinically in 72% patients. On interim PET/CT, 13 patients showed CMR, 43 showed FRT, 8 showed SD, and 23 showed DP. A longer duration of ATT was seen in nonresponders (P ≤ 0.001) than responders. During follow-up, 9/87 patients died, out of which 8 patients were of DP group and 1 patient belonged to SD. Nonresponders showed 35% mortality compared with 1.6% in the responder group (P ≤ 0.001).
F-FDG PET/CT is a valuable imaging modality for disease mapping and assessing therapeutic response. Treatment response in the interim PET/CT done at 3 to 4 months predicted the duration of ATT and clinical outcome of the patients.
结核病（TB）是一个主要的健康问题。结核病变中的活化巨噬细胞显示出高代谢活性，可以使用 F-FDG PET/CT 进行评估。这项回顾性研究旨在评估 F-FDG PET/CT 在初诊和治疗反应中的作用，以评估其在 TB 患者中的应用。
87 例（男/女比例为 46:41）经临床诊断为肺结核和肺外结核的患者接受了全身 F-FDG PET/CT 扫描，用于初诊和抗结核治疗（ATT）开始后 3-4 个月的随访扫描。使用视觉和半定量（SUVmax）分析进行扫描评估。根据中间扫描的治疗反应将其分为完全代谢反应（CMR）、治疗效果良好（FRT）、疾病稳定（SD）和疾病进展（DP）。CMR、FRT 和 SD 病例被认为是有反应者，DP 病例被认为是无反应者。治疗反应与临床结局（死亡率）和 ATT 持续时间相关。
所有患者的基线 F-FDG PET/CT 扫描均为阳性，并在 72%的患者中发现了比临床怀疑的更多的疾病部位。在中间 PET/CT 扫描中，13 例患者表现为 CMR，43 例患者表现为 FRT，8 例患者表现为 SD，23 例患者表现为 DP。无反应者的 ATT 持续时间较长（P≤0.001）。在随访期间，87 例患者中有 9 例死亡，其中 8 例来自 DP 组，1 例来自 SD 组。无反应者的死亡率为 35%，而有反应者的死亡率为 1.6%（P≤0.001）。
F-FDG PET/CT 是一种用于疾病定位和评估治疗反应的有价值的成像方式。在 3-4 个月时进行的中间 PET/CT 治疗反应预测了 ATT 的持续时间和患者的临床结局。
