Imaging in extrapulmonary tuberculosis Gambhir, Sanjay; Ravina, Mudalsha; Rangan, Kasturi ...
International journal of infectious diseases,
03/2017, Volume:
56, Issue:
C
Journal Article
Peer reviewed
Open access
Highlights • The diagnosis of extrapulmonary tuberculosis (EPTB) remains challenging due to protean clinical manifestations and difficulties in making an accurate diagnosis. • Advances in imaging ...technologies now allow for accurate localization of diseased sites and access to obtain biological samples for microbiological, histopathological, and molecular testing. • Evidence is building for the use of newer imaging modalities for monitoring the response to treatment and relapse.
Background
Sentinel lymph node biopsy (SLNB) using radio-pharmaceutical (RP) and a blue dye is gold standard for axillary staging in clinically node-negative early breast cancer. High costs and ...limited availability of RP and/or gamma probe are major deterrents in performing SLNB in developing countries. Fluorescence-guided SLNB can obviate the need for RP and gamma probe. Fluorescein is an inexpensive fluorescent lymphatic tracer. In this study, we compared SLN identification rate (SLN-IR) and false negative rates (FNR) of fluorescein-guided SLNB and radio-guided SLNB using
99m
Tc-Sulfur-colloid, in isolation, or in combination with methylene blue dye (MBD).
Methods
Sixty-five cN0 early and large operable breast cancer patients underwent validation SLNB using fluorescein (and blue LED light),
99m
Tc-Sulfur-colloid (and gamma probe) and MBD. Inj Fluorescein 4% was injected, 1 ml each peri-tumoral and sub-areolar five minutes before axillary incision. Axillary dissection was performed irrespective of SLNB histology. The SLN-IR and FNR with various tracers and their combinations were compared.
Results
The mean number of SLNs identified was 3.5 ± 1.8 (range 1–6). The SLN-IR using RP alone was 94%, fluorescein alone was 92%, and MBD alone was 82%. The SLN-IR using fluorescein plus MBD combination was 95.4%, compared to 97% using MBD plus RP combination. FNR was 6.3% using fluorescein plus MBD, as well as RP plus MBD combinations.
Conclusions
SLN-IR of > 90% and SLN-FNR of < 10% using fluorescein plus MBD combination are in acceptable range, and are comparable to that of RP plus MBD combination. Fluorescein can replace RP for performing SLNB, in combination with MBD.
Over the last several decades, myocardial perfusion imaging with single photon emission tomography and positron emission tomography has been a mainstay for the evaluation of patients with known or ...suspected coronary artery disease non-invasively. Technical advances in imaging modalities and radiopharmaceutical have revolutionaries the understanding of pathogenesis and management of various diseases. In this article, we shall discuss the various available imaging nuclear medicine techniques, radiopharmaceutical, and common indications. In the era of "precision medicine," imaging has to be patient centered. We will briefly review the upcoming areas of nuclear medicine imaging apart from perfusion imaging, such as advances in myocardial blood flow quantitation and molecular imaging.
As a part of our programme to develop nanobioconjugates for the treatment of cancer, we first synthesized extracellular, protein-capped, highly stable and well-dispersed gadolinium oxide (Gd2O3) ...nanoparticles by using thermophilic fungus Humicola sp. The biodistribution of the nanoparticles in rats was checked by radiolabelling with Tc-99m. Finally, these nanoparticles were bioconjugated with the chemically modified anticancer drug taxol with the aim of characterizing the role of this bioconjugate in the treatment of cancer. The biosynthesized Gd2O3 nanoparticles were characterized by UV-vis spectroscopy, transmission electron microscopy (TEM), X-ray diffraction (XRD) and X-ray photoemission spectroscopy (XPS). The Gd2O3-taxol bioconjugate was confirmed by UV-vis spectroscopy and fluorescence microscopy and was purified by using high performance liquid chromatography (HPLC).
Abstract
Background and Purpose 18FFluoro-2-deoxy-2-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) has a promising role in the workup and management of carcinoma of unknown ...primary (CUP). We have evaluated the effect of whole-body FDG PET/CT in assessing the patients presented with suspected brain metastasis (CUP-BM) on brain magnetic resonance imaging (MRI) or computed tomography (CT).
Materials and Methods This retrospective study included FDG PET/CT of 50 patients (24 males, mean: 58 ± 12.2 years old) with a CUP-BM diagnosis based on MRI and CT imaging. The final diagnosis of primary brain neoplasm (BP) or brain metastases (BM) was based on FDG PET/CT findings and/or histopathology (HPE).
Results On FDG PET/CT, 52% (26/50) of patients did not have any systemic lesion apart from a brain lesion. Out of these, 50% (13/26) had HPE confirmation of primary brain neoplasm (BP). FDG PET/CT identified multiple systemic lesions apart from brain lesions in the remaining 48% (24/50) of patients. They were categorized as the brain metastases (BM) group. The primary lesions were located in the lungs (n = 20), kidneys (n = 1), prostate (n = 1), esophagus (n = 1), and tongue (n = 1).
Conclusion FDG PET/CT could suggest a diagnosis of BM based on the presence of systemic lesions. It also provides an easily accessible peripheral site for biopsy and systemic disease burden in a single scan. FDG PET/CT's up-front use in suspected CUP-BM on CT and/or MRI could differentiate the BM from BP in most cases and avoid brain biopsy in the BM group.
Takayasu arteritis (TAK) could cause a stroke or transient ischemic attack (TIA) in young individuals due to inflammatory vascular occlusion or intracerebral hemorrhage. We compared the clinical ...presentation, angiographic features, longitudinal patterns of disease activity, medical treatments, and survival in 34 TAK patients with stroke/TIA and 157 without stroke/TIA from a single-center retrospective cohort. TAK patients with stroke/TIA were older (
= 0.044) with a greater proportion of males (
= 0.022), more frequent vision loss (odds ratio (OR) for stroke/TIA vs. without stroke TIA 5.21, 95% CI 1.42-19.14), and less frequent pulse or blood pressure inequality (OR 0.43, 95% CI 0.19-0.96) than TAK patients without stroke/TIA. Hata's angiographic type IIa was more common in TAK patients with stroke/TIA (OR 11.00, 95%CI 2.60-46.58) and type V in TAK patients without stroke/TIA (OR 0.27, 95% CI 0.12-0.58). Cyclophosphamide was used more often in TAK patients with stroke/TIA (
= 0.018). Disease activity at baseline, 6, 12, and 24 months of follow-up was mostly similar for both groups. Risk of mortality was similar in TAK patients with or without stroke/TIA (hazard ratio unadjusted 0.76, 95% CI 0.15-3.99; adjusted for gender, age of disease onset, delay to diagnosis, baseline disease activity, and the number of conventional or biologic/targeted synthetic immunosuppressants used 1.38, 95% CI 0.19-10.20) even after propensity score-matched analyses. Stroke or TIA does not appear to affect survival in TAK patients adversely.
Background
Initial studies of tuberculosis (TB) in macaques and humans using
18
F-FDG positron emission tomography (PET) imaging as a research tool suggest its usefulness in localising disease sites ...and as a clinical biomarker. Sequential serial scans in patients with extrapulmonary TB (EPTB) could inform on the value of PET-CT for monitoring response to treatment and defining cure.
Patients and methods
HIV-negative adults with EPTB from eight sites across six countries had three
18
F-FDG PET/CT scans: (i) within 2 weeks of enrolment, (ii) at 2 months into TB treatment and (iii) at end of ATT treatment. Scanning was performed according to the EANM guidelines.
18
F-FDG PET/CT scans were performed 60 ± 10 min after intravenous injection of 2.5–5.0 MBq/kg of
18
F-FDG.
Findings
One hundred and forty-seven patients with EPTB underwent 3 sequential scans. A progressive reduction over time of both the number of active sites and the uptake level (SUVmax) at these sites was seen. At the end of WHO recommended treatment, 53/147 (36.0%) patients had negative PET/CT scans, and 94/147 (63.9%) patients remained PET/CT positive, of which 12 patients had developed MDR TB. One died of brain tuberculoma.
Interpretation
Current
18
F-FDG PET/CT imaging technology cannot be used clinically as a biomarker of treatment response, cure or for decision-making on when to stop EPTB treatment. PET/CT remains a research tool for TB and further development of PET/CT is required using new
Mycobacterium tuberculosis
-specific radiopharmaceuticals targeting high-density surface epitopes, gene targets or metabolic pathways.
Aims: The production of nitrogen-13 (13N)-NH3 by ethanol method using automated synthesizer and accessing the production yield, quality control for clinical application. Context: 13N, together with ...18F, 15O, and 11C, is one of the positron emitters that can be produced on the multi-gigabecquerel scale in biomedical cyclotrons. (13N)-ammonia is frequently used for cardiac PET studies. It is widely applied for the evaluation of myocardial perfusion in the clinical assessment of cardiac disorders. Simple, fast, and reliable preparation methods have contributed to the routine application of this tracer. Although only two methods are available, a challenge remains to adopt a more efficient and consistent approach to its production. For clinical application, routine production of this tracer is mandatory in compliance with regulatory guidelines. Being at hospital radiopharmacy it is our responsibility to support the clinical service with uninterrupted production and supply of (13N)-NH3. Materials and Methods: The chemicals were used commercially available from Sigma Aldrich, India, Ltd., and Fisher Scientific, India, Ltd. (Mumbai, India), Sep-Pak CM cartridges (Waters India, Pvt., Ltd.,). Radio-thin layer chromatography was carried out using aluminum sheets precoated with silica gel 60 F254 (E. Merck, India). Results: The protocol developed with MPS-100 synthesizer yield (13N)-NH3 95-97% (EOB) with a synthesis time of around 7 min. Conclusions: With the installation of HM-18 cyclotron at our hospital, center is capable to produce (13N)-NH3 of good yield and purity through the ethanol method, for mycocardial perfusion studies. Our protocol is simple, reproducible, and robust.
In the past few years, photo-luminescent inorganic materials have been studied extensively as fluorescent sensors, and diagnostic and bioimaging tools. The assessment of photoluminescence (PL) ...properties of selenium nanoparticles (Se NPs), especially mycosynthesized Se NPs, is still in its infancy. Herein, we have biosynthesized highly dispersed fluorescent Se NPs (42 nm) using endophytic fungus
Fusarium oxysporum
, and fully characterized them using sophisticated instruments like TEM, XRD, UV–Vis spectrophotometer, FTIR, and PL spectrometer. To determine the therapeutic efficacy and side effect profiles, these crystalline Se NPs were radiolabeled with technetium-99m (
99m
Tc) and their biodistribution and renal clearance times were investigated in the normal Wister rat. The results showed that these Se NPs may be useful for targeting the lungs and liver dysfunction as significant accumulation of these NPs was observed in the liver (approx. 19.47 ± 4%) and lungs (at 6 ± 1%) after 10 min of post-injection. Quick circulation and the presence of Se NPs in kidney (3.8 ± 2%) also suggested the easy excretion of these NPs from the body through urinary tract. Furthermore, the antioxidant activity of Se NPs (IC
50
, 159.5 μg/mL) has been investigated using DPPH free radical scavenging assay with scavenging efficacy of 80.4% where ascorbic acid (IC
50
, 5.6 μg/mL) was used as a positive control. Additionally, the microscopic study of the inhibition zone encircled around Se NPs confirmed their strong antifungal and antisporulant activity against the black fungus
Aspergillus niger
.
Non-Hodgkin lymphoma (NHL) is a group of malignant lymphoproliferative disorders arising predominantly in the lymph nodes with various clinical and histological characteristics. At least 25% of NHL ...originates from tissues other than lymph nodes and sometimes even from sites that do not contain lymphoid tissue. These are referred to as primary extranodal lymphomas (pENLs). pENL is a universal diagnostic challenge to the clinicians and pathologists due to their varied clinical presentations, morphological mimicry, and molecular alterations. The GIT is the most common site of pENL followed by nasopharynx/oropharynx, testis, uterus/ovary, thyroid, and central nervous system. Long bones (tibia), maxillary sinus, skin, and paraspinal soft tissues are the other rare anatomic sites of pENL. We reported a case of a 60-year-old female presented with pain and mass in the pelvis region.
F-Fluorodeoxyglucose (
F-FDG) positron emission tomography (PET) and fused PET/CT was done, which revealed extensive extranodal involvement of the lung, bilateral kidneys, uterus, ovaries, bones, and muscles with no involvement of lymph nodes or lymphomatous organs. Extensive extranodal involvement with sparing of lymphomatous organ has not been reported earlier.
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