(18)F-FDG PET/CT in tuberculosis: an early non-invasive marker of therapeutic response.
OBJECTIVE
To evaluate the potential of (18)F-fluoro-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) for early therapeutic intervention in patients with probable or confirmed tuberculosis (TB).


METHODS
Twenty-one consecutive human  immunodeficiency virus negative patients were prospectively included. All patients underwent (18)F-FDG PET/CT before and after 1 month of anti-tuberculosis treatment. The maximum standardised uptake value (SUV(max)) of the most (18)F-FDG avid lesions was recorded.


RESULTS
The median age of patients was 36 years (range 18-84); 33.3% were male, 80.9% were born in endemic countries, and 23.8% had a past history of TB. TB was confirmed on culture in 8, on histology in 9 and on the basis of clinical symptoms in 4 patients. (18)F-FDG PET/CT detected  active pulmonary TB (n = 1), extra-pulmonary (n = 10) or both (n = 10). The second (18)F-FDG PET/CT showed reduced radiotracer uptake intensity in 19 of 21 patients, with a median percentage decrease of SUV(max) of 31% (range 2-84). Two patients  showed no improvement. TB was ruled out in one patient during follow-up; the final diagnosis was a non-Hodgkin's lymphoma. The other patient was smear-positive for 3 months.


CONCLUSIONS
(18)F-FDG PET/CT allows an easy evaluation of early therapeutic response in patients with TB,  particularly extra-pulmonary TB.
Service de Médecine Interne et Immunologie Clinique, Unité Mixte de Recherche en Santé 996, Institut National de la Santé et de la Recherche Médicale, Paris, France. valerie.martinez@abc.aphp.fr
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Martinez
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Castilla-Lievre
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Guillet-Caruba
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Grenier
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Fior
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Desarnaud
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Doucet-Populaire
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Boué
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014376:Tuberculosis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000208:ethnology; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy; D051598:Whole Body Imaging; D055815:Young Adult
D000995:Antitubercular Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18