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2016 ; 4
(ä): 131-144
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PET/CT imaging of Mycobacterium tuberculosis infection
#MMPMID27077068
Ankrah AO
; van der Werf TS
; de Vries EF
; Dierckx RA
; Sathekge MM
; Glaudemans AW
Clin Transl Imaging
2016[]; 4
(ä): 131-144
PMID27077068
show ga
Tuberculosis has a high morbidity and mortality worldwide. Mycobacterium
tuberculosis (Mtb) has a complex pathophysiology; it is an aerobic bacillus
capable of surviving in anaerobic conditions in a latent state for a very long
time before reactivation to active disease. In the latent tuberculosis infection,
the individual has no clinical evidence of active disease, but exhibits a
hypersensitive response to proteins of Mtb. Only some 5-10 % of latently infected
individuals appear to have reactivation of tuberculosis at any one time point
after infection, and neither imaging nor immune tests have been shown to predict
tuberculosis reactivation reliably. The complex pathology of the organism
provides multiple molecular targets for imaging the infection and targeting
therapy. Positron emission tomography (PET) integrated with computer tomography
(CT) provides a unique opportunity to noninvasively image the whole body for
diagnosing, staging and assessing therapy response in many infectious and
inflammatory diseases. PET/CT is a powerful noninvasive tool that can rapidly
provide three-dimensional views of disease deep within the body and conduct
longitudinal assessment over time in one particular patient. Some PET tracers,
such as (18)F-fluorodeoxyglucose ((18)F-FDG), have been found to be useful in
various infectious diseases for detection, assessing disease activity, staging
and monitoring response to therapy. This tracer has also been used for imaging
tuberculosis. (18)F-FDG PET relies on the glucose uptake of inflammatory cells as
a result of the respiratory burst that occurs with infection. Other PET tracers
have also been used to image different aspects of the pathology or microbiology
of Mtb. The synthesis of the complex cell membrane of the bacilli for example can
be imaged with (11)C-choline or (18)F-fluoroethylcholine PET/CT while the uptake
of amino acids during cell growth can be imaged by
3'-deoxy-3'-[(18)F]fluoro-l-thymidine. PET/CT provides a noninvasive and
sensitive method of assessing histopathological information on different aspects
of tuberculosis and is already playing a role in the management of tuberculosis.
As our understanding of the pathophysiology of tuberculosis increases, the role
of PET/CT in the management of this disease would become more important. In this
review, we highlight the various tracers that have been used in tuberculosis and
explain the underlying mechanisms for their use.