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PET/CT features of extrapulmonary tuberculosis at first clinical presentation: a cross-sectional observational ¹⁸F-FDG imaging study across six countries

Bomanji, J; Sharma, R; Mittal, BR; Gambhir, S; Qureshy, A; Begum, SMF; Paez, D; ... International Atomic Energy Agency Extra-pulmonary TB Consortium; + view all (2020) PET/CT features of extrapulmonary tuberculosis at first clinical presentation: a cross-sectional observational ¹⁸F-FDG imaging study across six countries. European Respiratory Journal , 55 (2) , Article 1901959. 10.1183/13993003.01959-2019. Green open access

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Abstract

BACKGROUND: A large proportion of the huge global burden of Extrapulmonary tuberculosis (EPTB) are treated empirically without accurate definition of disease sites, and extent of multi-organ disease involvement. Positron emission tomography (PET) imaging using 18F-FDG in TB could be a useful imaging technique for localising disease sites and extent of disease. METHODS: We conducted a study of HIV-negative adult patients with a new clinical diagnosis of EPTB across 8 centres located in 6 countries: India, Pakistan, Thailand, South Africa, Serbia, and Bangladesh to assess the extent of disease and common sites involved at first presentation. 18F-FDG PET/CT scans were performed within 2 weeks of presentation. FINDINGS: A total of 358 patients with EPTB (189 females; 169 males) were recruited over 45 months. Age range 18-83 years (females: median 30 years; males: median 38 years). 350/358 (98%) patients (183 female, 167 male) had positive scan. 118/350 (33.7%) had a single extrapulmonary site and 232/350 (66.3%) had more than one site (organ) affected. Lymph nodes, skeletal, pleura and brain were common sites. 100/358 (28%) of EPTB patients had 18F-FDG PET/CT positive sites in the lung. 110 patients were 18F-FDG PET/CT positive in more body sites than were noted clinically at first presentation and 160 patients had the same number of positive body sites. INTERPRETATION: 18F-FDG PET/CT scan has potential for further elucidating the spectrum of disease, pathogenesis of EPTB, and monitoring the effects of treatment on active lesions over time, and requires longitudinal cohort studies, twinned with biopsy and molecular studies.

Type: Article
Title: PET/CT features of extrapulmonary tuberculosis at first clinical presentation: a cross-sectional observational ¹⁸F-FDG imaging study across six countries
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1183/13993003.01959-2019
Publisher version: https://doi.org/10.1183/13993003.01959-2019
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Tuberculosis, Extrapulmonary tuberculosis, Imaging, 18F-FDG PET/CT scan, site localization
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10090212
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