ECR 2010 / C-1766
The additional value of 18F-FDG-PET/CT in the diagnosis of tuberculosis as presumptive cause of sight-threatening intraocular inflammation
Keywords:
Head and neck, Oncology
Authors:
C. Pfannenberg, P. Aschoff, D. Doycheva, J. Hetzel, C. D. Claussen, M. Reimold, M. Zierhut; Tübingen/DE
DOI:
10.1594/ecr2010/C-1766
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 in 7 patients (35%), all suffering from serpiginous choroiditis (Figure 5). 4 patients showed additional calcified granulomas in the lung (Figure 6).
- PET/CT did not reveal any abnormalities in 4 QuantiFERON-positive patients (20%).
- Size of all evaluated lymph nodes, including calcified nodes, varied between 8 and 31 mm, median 14.2 mm. Median size of metabolically active lymph nodes was 17.3 mm in comparison to 10.1 mm of metabolically inactive lymph nodes (p<0.01, r=0.7).
Bronchoscopy
- Bronchoscopy was carried-out in 10 patients, 8 patients with PET positive lymph nodes (4 with retinal vasculitis, 2 with serpiginous choroiditis and 2 with multifocal choroiditis) and two patients with PET negative lymph nodes (Table 1).
- Bronchoscopy included blind transbronchial needle aspiration biopsy (TBNA) in 5 patients, in 5 patients TBNA was technically impossible, because of small size and difficult localization of lymph nodes.
- In two patients with retinal vasculitis (no.2 and no.3), in who bronchoscopy with TBNA was performed, PCR was negative, but the culture disclosed M. tuberculosis. In other three patients with TBNA (no.4, 14 and 16) the microbiological examination was negative.
- Microbiological examination of bronchial lavage for M. tuberculosis was negative in all patients.
Tuberculostatic treatment
- In 11 patients with progressive and sight-threatening course of the uveitis an anti-tuberculosis treatment was instituted. Six of these patients were PET and CT positive, 4 patients were CT positive, but PET negative and 1 patient was PET and CT negative. 3 PET positive patients refused tuberculostatic treatment because of sufficient control of intraocular inflammation and because of potential side effects.
- In 10 of 11 anti-TB treated patients the therapy was carried-out with a combination of three tuberculostatic agents and systemic steroids for at least six months. One patient (no.4) was treated with isoniazid and steroids only.
- In 9 patients (82%), receiving anti-tuberculosis treatment, stabilisation and remission of uveitis was achieved.
- Recurrences of intraocular inflammation were observed in one patient (no.4), who was treated with one tuberculostatic agent and in one patient with serpiginous choroiditis (no.5). Worsening in inflammatory activity with relapses of uveitis occurred in 5 of 9 patients (56%) who did not receive tuberculostatic therapy and were treated with systemic steroids and/or immunosuppressive drugs only. Comparing the influence of anti-TB therapy on inflammatory course of uveitis, a clear beneficial effect in the treated group was observed (Table 1).