Skip to main content

Advertisement

SpringerLink
Log in

Tuberculous lymphadenitis: FDG PET and CT findings in responsive and nonresponsive disease

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

No data is available on the different FDG PET and CT findings in the lymph nodes (LN) of patients with HIV and tuberculosis (TB) who respond compared with those who do not respond to anti-TB treatment by 4 months after initiation of TB treatment. These findings were the focus of our study.

Methods

PET/CT scans performed at 4 months after initiation of TB treatment in 20 consecutive HIV patients were analysed. SUVmax values were obtained for all regions of LN involvement. The diameter of the LNs was measured and the CT enhancement (LNs showing peripheral rim enhancement with central low attenuation, PRECLO, in comparison with homogeneously involved LNs) and the calcification patterns of involved LNs assessed. The relationship between the PET and CT findings and the clinical outcome, response or nonresponse, was evaluated.

Results

FDG PET identified 91 sites of LN involvement, 20 of which were not identified by CT. SUVmax values were significantly higher in nonresponders (8 patients, SUVmax 11.2 ± 4.0, mean ± SD) when compared to responders (12 patients, SUVmax 2.6 ± 2.3; p = 0.0001). In ROC analysis (AUC 0.952) a cut-off value of 4.5 for SUVmax yielded a sensitivity and specificity of 95 % and 85 % for discriminating nonresponding from responding LNs. LNs were significantly larger in nonresponders (1.9 ± 0.4 cm) than in responders (1.4 ± 0.4 cm; p = 0.0001); the AUC in the ROC analysis was 0.76. PRECLO LNs were significantly larger (2.2 ± 0.3 cm) than homogeneous involved LN basins (1.5 ± 0.4 cm) and LN basins with calcification (1.4 ± 0.5 cm; p = 0.001). Using the presence of at least one LN basin with PRECLO as a criterion for nonresponse, responders could be separated from nonresponders with a sensitivity of 88 % and a specificity of 66 %.

Conclusion

LNs responding to TB treatment could be differentiated from nonresponding LNs with a sensitivity and specificity of 95 % and 85 % using a SUVmax cut-off value of 4.5 and a sensitivity and specificity of 88 % and 66 % using the presence of at least one LN basin with PRECLO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Arciniegas W, Orjuela D. Extrapulmonary tuberculosis: a review of 102 cases in Pereira, Colombia. Biomedica. 2006;26:71–80.

    PubMed  Google Scholar 

  2. Golden M, Vikram H. Extrapulmonary tuberculosis: an overview. Am Fam Physician. 2005;72:1761–8.

    PubMed  Google Scholar 

  3. Sharma S, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res. 2004;120:316–53.

    PubMed  CAS  Google Scholar 

  4. De Backer A, Mortele K, Deeren D, Vanschoubroeck J, De Keulenaer B. Abdominal tuberculous lymphadenopathy: MRI features. Eur Radiol. 2005;15:2104–9.

    Article  PubMed  Google Scholar 

  5. Pombo F, Rodriguez E, Mato J, Perez-Fontan J, Rivera E, Valvuena L. Patterns of contrast enhancement of tuberculous lymph nodes demonstrated by computed tomography. Clin Radiol. 1992;46:13–7.

    Article  PubMed  CAS  Google Scholar 

  6. Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol. 2002;12:312–23.

    Article  PubMed  Google Scholar 

  7. Golden M, Holenarasipur V. Extrapulmonary tuberculosis: an overview. Am Fam Physician. 2005;72:1761–8.

    PubMed  Google Scholar 

  8. Andrea J, Caceres J, Pallisa E, Martinez-Rodriguez M. Radiological manifestations of pulmonary tuberculosis. Eur J Radiol. 2004;51:139–49.

    Article  Google Scholar 

  9. Itoh H, Shim Y, Lee J, Ahn J, Han M, Noma S. Pulmonary tuberculosis: CT findings – early active disease and sequential changes with antituberculous therapy. Radiology. 1993;186:653–60.

    PubMed  Google Scholar 

  10. Sathekge M, Maes A, Kgomo M, Stoltz A, Pottel H, Van de Wiele C. Impact of FDG PET imaging on the management of tuberculosis treatment: a pilot study. Nuklearmedizin. 2010;49:35–40.

    Article  PubMed  CAS  Google Scholar 

  11. Matsui T, Nakata N, Nagai A, Takahashi M, Momose T, Ohtomo K, Koyasu S. Inflammatory cytokines and hypoxia contribute to 18F-FDG uptake by cells involved in pannus formation in rheumatoid arthritis. J Nucl Med. 2009;50:920–6.

    Article  PubMed  CAS  Google Scholar 

  12. Alavi A, Gupta J, Alberini M, Hickeson L, Adam E, Bhargava P, Zhuang H. Positron emission tomography in non-malignant thoracic disorders. Semin Nucl Med. 2002;32:293–321.

    Article  PubMed  Google Scholar 

  13. Paik J, Lee K, Choe S, Choi Y, Kim B. Augmented 18F-FDG uptake in activated monocytes occurs during the priming process and involves tyrosine kinases and protein-kinase C. J Nucl Med. 2004;45:124–8.

    PubMed  CAS  Google Scholar 

  14. Davis S, Nuermberger E, Um P, Vidal C, Jedynak B, Pomper M, Bishai W, Jain S. Noninvasive pulmonary [18F]-2-fluoro-deoxy-D-glucose positron emission tomography correlates with bactericidal activity of tuberculosis drug treatment. Antimicrob Agents Chemother. 2009;11:4879–84.

    Article  Google Scholar 

  15. American Thoracic Society; CDC; Infectious Diseases Society of America. Treatment of tuberculosis. MMWR Recomm Rep. 2003;52(RR-11):1–77.

    Google Scholar 

  16. Schluger N. Keystone Symposia on Tuberculosis: from lab research to field trials (C6), abstract 041. Vancouver, British Columbia, Canada, 20–25 March 2007.

  17. Van Deun A, Martin A, Palomino JC. Diagnosis of drug-resistant tuberculosis: reliability and rapidity of detection. Int J Tuberc Lung Dis. 2010;14:131–40.

    PubMed  Google Scholar 

  18. Ahmad S, Mokaddas E. Recent advances in the diagnosis and treatment of multidrug-resistant tuberculosis. Respir Med. 2009;103:1777–90.

    Article  PubMed  Google Scholar 

  19. Long R. Smear-negative pulmonary tuberculosis in industrialized countries. Chest 2001;120:330–4.

    Article  PubMed  CAS  Google Scholar 

  20. Mendelson M. Diagnosing tuberculosis in HIV-infected patients: challenges and future prospects. Br Med Bull. 2007;81–82:149–65.

    Article  PubMed  Google Scholar 

  21. Sathekge M, Maes A, Kgomo M, Pottel H, Stolz A, Van de Wiele C. FDG uptake in lymph nodes of HIV+ and tuberculosis patients: implications for cancer staging. Q J Nucl Med. 2010;6:698–703.

    Google Scholar 

  22. Moon WK, Im JG, Yeon KM, Han MC. Mediastinal tuberculous lymphadenitis: CT findings of active and inactive disease. AJR Am J Roentgenol. 1998;170:715–8.

    PubMed  CAS  Google Scholar 

  23. Je B, Kim M, Kim S, Park D, Kim T, Lee N. Detailed nodal features of cervical tuberculous lymphadenitis on serial neck computed tomography before and after chemotherapy. J Comput Assist Tomogr. 2005;29:889–94.

    Article  PubMed  Google Scholar 

  24. Prasoon D. Acid-fast bacilli in fine needle aspiration smears from tuberculous lymph nodes. Acta Cytol. 2000;44:297–300.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of Interest

None.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, University of Pretoria, Pretoria, South Africa

    Mike Sathekge, Alex Maes, Mariza Vorster & Christophe Van de Wiele

  2. Department of Radiology, University of Pretoria, Pretoria, South Africa

    Harlem Gongxeka

  3. Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium

    Alex Maes

  4. Department of Morphology and Medical Imaging, University Hospital Leuven, Leuven, Belgium

    Alex Maes

  5. Department of Nuclear Medicine, University Hospital Ghent, Ghent, Belgium

    Yves D’Asseler & Christophe Van de Wiele

  6. Steve Biko Academic Hospital, University of Pretoria, Private Bag X169, Pretoria, 0001, South Africa

    Mike Sathekge

Authors
  1. Mike Sathekge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alex Maes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yves D’Asseler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mariza Vorster
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harlem Gongxeka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christophe Van de Wiele
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mike Sathekge.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sathekge, M., Maes, A., D’Asseler, Y. et al. Tuberculous lymphadenitis: FDG PET and CT findings in responsive and nonresponsive disease. Eur J Nucl Med Mol Imaging 39, 1184–1190 (2012). https://doi.org/10.1007/s00259-012-2115-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-012-2115-y

Keywords

Search

Navigation