Purpose
Uveitis is a sight-threatening intraocular inflammation and one of the leading causes of visual impairment in young people. Tuberculosis (TB) is one of the underlying systemic diseases in patients with uveitis and one of the few causes of uveitis with a definitive effective treatment (1,2).However, diagnosis of ocular TB is difficult due to the wide spectrum of clinical presentations (Figure 1) and limitations of current diagnostic strategies including, tuberculin skin tests, interferon-gamma release assays such as QuantiFERON® -TB Gold test, radiology and invasive tissue biopsy...
Methods and Materials
Patient characteristics Between January 2007 and Juni 2009 we screened 85 patients with different forms of uveitis by QuantiFERON TB-Gold test. Positive test results were found in 24 patients. The types of intraocular inflammation in the QuantiFERON positive patients were retinal vasculitis, serpiginous choroiditis, multifocal choroiditis, anterior and posterior uveitis and panuveitis.Nine patients were female and 15 patients male. The mean age of the patients was 51 years (range 17-76 years). Details of patient characteristics are summarized in Table 1. PET/CT examination 18F-FDG-PET/CT was performed...
Results
18F-FDG PET/CT In 9 of the QuantiFERON-positive patients (45%) PET/CT detected increased FDG uptake (mean SUVmax 3.3 ±1.6, range,1.6-9.6) in normal-sized or slightly enlarged mediastinal or hilar lymph nodes (Table 1). In two of these patients Mycobact. tuberculosis was detected in culture after PET/CT guided lymph node biopsy.Two patients (no.2 and no.14) with different forms of uveitis and metabolically active lymph nodes of different degree in PET/CT are presented at Figure 3 and Figure 4.Hilar and mediastinal lymph nodes without FDG-uptake, partly calcified, were found...
Conclusion
18F-FDG-PET/CT may contribute to the difficult diagnosis of a tuberculosis-induced intraocular inflammation, especially in the case of latent and asymptomatic infection in areas of low prevalence of the disease. In QuantiFERON positive patients with uveitis 18F-FDG-PET/CT is useful to identify metabolically active lymph nodes, appropriate for biopsy and thereby helps to establish the definitive diagnosis and adequate therapy.
References
Varma D, Anand S, Reddy AR et.al. Tuberculosis: an under-diagnosed aetiological agent in uveitis with an effective treatment. Eye 2006; 20:1068-1073Gupta V, Gupta A, Rao NA. Intraocular tuberculosis – An update. Surv Ophthalmol 2007; 52:561-587El-Haddad G, Zhuang H, Gupta N, Alavi A. Evolving role of positron emission tomography in the management of patients with inflammatory and other benign disorders. Semin Nucl Med 2004; 34:313-329Bakheet S, Powe J, Ezzat A, Rostom A. F-18-FDG uptake in tuberculosis. Clin Nuc Med 1998; 23:739-742Sathekge M, Maes A, Al-Nahhas A...
Personal Information
Christina Pfannenberg, MD. Department of Radiology & Nuclear Medicine and Centre for Ophthalmology, University of Tuebingen, Germany e-mail:
[email protected]