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Technetium-99m-Tetrofosmin Scintigraphy in Pulmonary Tuberculosis

Departments of Nuclear Medicine and Chest Disease, Dokuz Eylul University, Izmir; Izmir Chest Disease and Surgery Hospital, Izmir, Turkey

Correspondence: Correspondence and reprint address: Berna Degirmenci, MD, Dokuz Eylul University, Medical Faculty, Department of Nuclear Medicine, 35340, Inciralti, Izmir, Turkey.

ABSTRACT

Technetium-99m-tetrofosmin, an agent that is widely used in myocardial imaging, has been reported to accumulate in several types of malignancies, including lung tumors. Yet, there is limited knowledge about its role in imaging infection or inflammatory lesions. The aim of this study was to investigate the role of ^99mTc-tetrofosmin scintigraphy in pulmonary tuberculosis in cases with active and inactive tuberculosis in comparison with radiological and microbiological findings. Methods: Twenty-seven patients with active pulmonary tuberculosis (APTB) and 6 patients with inactive pulmonary tuberculosis (IPTB), proven by sputum smears and cultures, were included in this study. Mean age of the group was 42.6 ± 13 yr. Nine months after therapy, ^99mTc-tetrofosmin scintigraphy was repeated in 6 patients with APTB to evaluate response to therapy. Ten-minute anterior and posterior chest images were acquired 20 and 60 min after the injection of 370 MBq (10 mCi) ^99mTc-tetrofosmin. The images were evaluated both visually and semiquantitatively by two blinded nuclear medicine physicians. For semiquantitative evaluation, regions of interest (ROIs) were drawn over the lesion (L) and nonlesion areas (NL). The mean count values of ROIs were obtained and L/NL ratios were calculated. Results: According to the visual evaluations, ^99mTc-tetrofosmin uptake was Grade (+) in 4 (15%) and Grade (++) in 23 (85%) patients with APTB. Technetium-99m-tetrofosmin uptake was negative in 5 patients with IPTB. Grade (+) ^99mTc-tetrofosmin uptake was observed in only one inactive case. After therapy, there was no ^99mTc-tetrofosmin uptake in 3 patients, which correlated well with chest radiography and clinical findings. In the other 2 patients, ^99mTc-tetrofosmin uptake was slightly decreased when compared with a previous scan that correlated with radiological and clinical findings. In 1 patient with bilateral lung disease, ^99mTc-tetrofosmin uptake decreased on the right lung lesions, whereas the left lung lesions persisted with no change. The mean early and delayed L/NL ratios of APTB were 1.53 ± 0.22 and 1.45 ± 0.21, respectively. Although ^99mTc-tetrofosmin uptake in APTB lesions was more visually marked in early images than that in delayed images, there was no statistically significant difference between these two sets of images. Conclusion: Technetium-99m-tetrofosmin scintigraphy showed increased uptake in APTB lesions related to disease activity. After treatment, ^99mTc-tetrofosmin uptake disappeared or decreased, correlating well with radiological and clinical findings. Technetium-99m-tetrofosmin scintigraphy may have a complementary role in the assessment of APTB as well as in follow-up treatment.

Key Words: technetium-99m-tetrofosmin • pulmonary tuberculosis • infection imaging