正电子发射计算机体层摄影-CT在肺结核临床研究中的应用进展与展望

doi:10.3969/j.issn.1000-6621.2020.06.015

摘要/Abstract

摘要：

正电子发射计算机体层摄影-CT(PET-CT)扫描可对潜伏性结核感染/亚临床结核病进行早期评估,确定潜在的感染病变部位;有助于不明原因发热患者寻找病因;通过观察病变处 ¹⁸F标记的氟代脱氧葡萄糖( ¹⁸F-FDG)摄取情况了解病变的炎症反应,可对结核活动性做出客观评价。在抗结核治疗过程中,通过观察病变的 ¹⁸F-FDG摄取的系列变化可对治疗是否成功做出预测。但由于其价格昂贵等问题,目前该技术尚不具备临床广泛应用的条件;不过基于其技术优势,有望在结核病临床与基础研究中发挥作用。

关键词: 潜伏性结核病, 结核, 正电子发射断层显像术, 体层摄影术, X线计算机, 诊断显像, 评论

Abstract:

Positron emission computed tomography-CT (PET-CT) scan can be used for evaluating the latent tuberculosis (TB) infection/subclinical TB infection in early stage, identifying the potential infectious lesions, finding the etiological factors in patients with unexplained fever, comprehending the inflammatory reaction of lesions by observing the uptake of fluorodeoxyglucose ( ¹⁸F-FDG), and making an objective evaluation of TB activity. During the course of anti-TB treatment, the success of the treatment can be predicted by observing the series of changes of ¹⁸-FDG uptake of the lesion. However, due to the high price and other issues, the widespread clinical application of PET-CT is limited. Nevertheless, based on the technical advantages of PET-CT, it is still expected to play an important role in clinical and scientific research of TB.

Key words: Latent tuberculosis, Tuberculosis, Positron-emission tomography, Tomography, X-ray computed, Diagnostic imaging, Comment

宋其生, 路希维. 正电子发射计算机体层摄影-CT在肺结核临床研究中的应用进展与展望[J]. 中国防痨杂志, 2020, 42(6): 621-625. doi: 10.3969/j.issn.1000-6621.2020.06.015

SONG Qi-sheng, LU Xi-wei. Progress and prospect of positron emission computed tomography applied in clinical research of pulmonary tuberculosis[J]. Chinese Journal of Antituberculosis, 2020, 42(6): 621-625. doi: 10.3969/j.issn.1000-6621.2020.06.015

参考文献 50

[1]	周新华 . 肺结核的影像学诊断——从形态分析到分子影像诊断. 中国防痨杂志, 2014,36(8):638-642.
[2]	王欣璐, 尹吉林, 张金赫 , 等. 60例活动性结核正电子发射体层摄影-CT误诊为恶性肿瘤的分析. 中华放射学杂志, 2013,47(1):34-38.
[3]	李妍, 张慧玲, 欧阳玲 . 女性盆腔结核与卵巢上皮癌的诊断与鉴别诊断. 结核病与肺部健康杂志, 2019,8(1):60-64.
[4]	侯代伦 . 重视影像学新技术在肺外结核诊断中的应用价值. 中国防痨杂志, 2020,42(1):4-7.
[5]	汪涛, 初向阳, 孙玉鹗 , 等. ¹⁸F-脱氧葡萄糖正电子发射体层显像检查在肺结核患者中的应用 . 中国胸心血管外科临床杂志, 2006,13(2):73-76.
[6]	伍建林, 王帅 . 现代医学影像技术在肺结核诊断中的应用价值与现状. 结核病与肺部健康杂志, 2012,1(1):60-62.
[7]	Lin PL, Ford CB, Coleman MT , et al. Sterilization of granulomas is common in active and latent tuberculosis despite within-host variability in bacterial killing. Nat Med, 2014,20(1):75-79.
[8]	Via LE, Schimel D, Weiner DM , et al. Infection dynamics and response to chemotherapy in a rabbit model of tuberculosis using [ ¹⁸F]2-fluoro-deoxy-D-glucose positron emission tomography and computed tomography . Antimicrob Agents Chemother, 2012,56(8):4391-4402.
[9]	Coleman MT, Maiello P, Tomko J , et al. Early Changes by ¹⁸Fluorodeoxyglucose positron emission tomography coregistered with computed tomography predict outcome after Mycobacterium tuberculosis infection in cynomolgus macaques . Infect Immun, 2014,82(6):2400-2404.
[10]	Drain PK, Bajema KL, Dowdy D , et al. Incipient and subclinical tuberculosis: a clinical review of early stages and progression of infection. Clin Microbiol Rev, 2018, 31(4). pii:e00021-18.
[11]	Ghesani N, Patrawalla A, Lardizabal A , et al. Increased cellular activity in thoracic lymph nodes in early human latent tuberculosis infection. Am J Respir Crit Care Med, 2014,189(6):748-750.
[12]	Tramontana JM, Utaipat U, Molloy A , et al. Thalidomide treatment reduces tumor necrosis factor alpha production and enhances weight gain in patients with pulmonary tuberculosis. Mol Med, 1995,1(4):384-397.
[13]	Barry CE 3rd, Boshoff HI, Dartois V , et al. The spectrum of latent tuberculosis: rethinking the biology and intervention strategies. Nat Rev Microbiol, 2009,7(12):845-855.
[14]	Dowdy DW, Basu S, Andrews JR . Is passive diagnosis enough? The impact of subclinical disease on diagnostic strategies for tuberculosis. Am J Respir Crit Care Med, 2013,187(5):543-551.
[15]	Medlar EM . The pathogenesis of minimal pulmonary tuberculosis; a study of 1,225 necropsies in cases of sudden and unexpected death. Am Rev Tuberc, 1948,58(6):583-611.
[16]	Ghesani N, Patrawalla A, Lardizabal A , et al. Increased cellular activity in thoracic lymph nodes in early human latent tuberculosis infection. Am J Respir Crit Care Med, 2014,189(6):748-750.
[17]	Esmail H, Lai RP, Lesosky M , et al. Characterization of progressive HIV-associated tuberculosis using 2-deoxy-2-[ ¹⁸F]fluoro-D-glucose positron emission and computed tomography . Nat Med, 2016,22(10):1090-1093.
[18]	Sánchez-Montalvá A, Barios M, Salvador F , et al. Usefulness of FDG PET/CT in the management of tuberculosis. PLoS One, 2019,14(8):e0221516.
[19]	Hara T, Kosaka N, Suzuki T , et al. Uptake rates of ¹⁸F-fluorodeoxyglucose and 11C-cholinein lung cancer and pulmonary tuberculosis: a positron emission tomography study . Chest, 2003,124(3):893-901.
[20]	Paik JY, Lee KH, Choe YS , et al. Augmented ¹⁸F-FDG uptake in activated monocytes occurs during the priming process and involves tyrosine kinases and protein kinase C . J Nucl Med, 2004,45(1):124-128.
[21]	Deol P, Vohra R, Saini AK , et al. Role of Mycobacterium tuberculosis Ser/Thr kinase PknF: implications in glucose transport and cell division. J Bacteriol, 2005,187(10):3415-3420.
[22]	Nordin AJ, Rossetti C, Rahim NA . Disseminated tuberculosis infection: a ‘super’ ¹⁸F-FDG PET/CT appearance . Eur J Nucl Med Mol Imaging, 2009,36(5):882. doi: 10.1007/s00259-009-1107-z URL
[23]	Kim IJ, Lee JS, Kim SJ , et al. Double-phase ¹⁸F-FDG PET-CT for determination of pulmonary tuberculoma activity . Eur J Nucl Med Mol Imaging, 2008,35(4):808-814.
[24]	Jeong YJ, Paeng JC, Nam HY , et al. ¹⁸F-FDG positron-emission tomography/computed tomography findings of radiographic lesions suggesting old healed tuberculosis . J Korean Med Sci, 2014,29(3):386-391. doi: 10.3346/jkms.2014.29.3.386 URL
[25]	Steinbrück P, D$\check{a}$nkovã D, Edwards LB , et al. Tuberculosis risk in persons with “fibrotic” x-ray lesions. Bull Int Union Tuberc, 1972,47:135-159.
[26]	Diel R, Loddenkemper R, Nienhaus A . Predictive value of interferon-γ release assays and tuberculin skin testing for progression from latent TB infection to disease state: a meta-analysis. Chest, 2012,142(1):63-75.
[27]	Ji Y, Shao C, Cui Y , et al. ¹⁸F-FDG Positron-Emission Tomography/Computed Tomography Findings of Radiographic Lesions Suggesting Old Healed Pulmonary Tuberculosis and High-risk Signs of Predicting Recurrence: A Retrospective Study . Sci Rep, 2019,9(1):12582. doi: 10.1038/s41598-019-49057-5 URL
[28]	Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP , et al. Fever of Unknown Origin: the Value of FDG-PET/CT. Semin Nucl Med, 2018,48(2):100-107.
[29]	Seon HJ, Kim YI, Lim SC , et al. Clinical significance of residual lesions in chest computed tomography after anti-tuberculosis treatment. Int J Tuberc Lung Dis, 2014,18(3):341-346.
[30]	Ralph AP, Ardian M, Wiguna A , et al. A simple, valid, numerical score for grading chest x-ray severity in adult smear-positive pulmonary tuberculosis. Thorax, 2010,65(10):863-869.
[31]	Malherbe ST, Shenai S, Ronacher K , et al. Persisting positron emission tomography lesion activity and Mycobacterium tuberculosis mRNA after tuberculosis cure. Nat Med, 2016,22(10):1094-1100.
[32]	Pasipanodya JG, McNabb SJ, Hilsenrath P , et al. Pulmonary impairment after tuberculosis and its contribution to TB burden. BMC Public Health, 2010,10:259.
[33]	Helsen N, Van den Wyngaert T, Carp L , et al. FDG-PET/CT for treatment response assessment in head and neck squamous cell carcinoma: a systematic review and meta-analysis of diagnostic performance. Eur J Nucl Med Mol Imaging, 2018,45(6):1063-1071. doi: 10.1007/s00259-018-3978-3 URL
[34]	Martinez V, Castilla-Lievre MA, Guillet-Caruba C , et al. ¹⁸F-FDG PET/CT in tuberculosis: an early non-invasive marker of therapeutic response . Int J Tuberc Lung Dis, 2012,16(9):1180-1185. doi: 10.5588/ijtld.12.0010 URL
[35]	Dureja S, Sen IB, Acharya S . Potential role of F18 FDG PET-CT as an imaging biomarker for the noninvasive evaluation in uncomplicated skeletal tuberculosis: a prospective clinical observational study. Eur Spine J, 2014,23(11):2449-2454.
[36]	Chen RY, Dodd LE, Lee M , et al. PET/CT imaging correlates with treatment outcome in patients with multidrug-resis-tant tuberculosis. Sci Transl Med, 2014, 6(265): 265ra166.
[37]	Stelzmueller I, Huber H, Wunn R , et al. ¹⁸F-FDG PET/CT in the initial assessment and for follow-up in patients with tuberculosis . Clin Nucl Med, 2016,41(4):187-194.
[38]	Tian G, Xiao Y, Chen B , et al. FDG PET/CT for therapeutic response monitoring in multi-site non-respiratory tuberculosis. Acta Radiol, 2010,51(9):1002-1006.
[39]	Park IN, Ryu JS, Shim TS . Evaluation of therapeutic response of tuberculoma using F-18 FDG positron emission tomography. Clin Nucl Med, 2008,33(1):1-3.
[40]	Hofmeyr A, Lau WF, Slavin MA . Mycobacterium tuberculosis infection in patients with cancer, the role of 18-fluorodeoxy-glucose positron emission tomography for diagnosis and monitoring treatment response. Tuberculosis (Edinb), 2007,87(5):459-463.
[41]	Dooley KE, Lahlou O, Ghali I , et al. Risk factors for tuberculosis treatment failure, default, or relapse and outcomes of retreatment in Morocco. BMC Public Health, 2011,11:140.
[42]	Panjabi R, Comstock GW, Golub JE . Recurrent tuberculosis and its risk factors: adequately treated patients are still at high risk. Int J Tuberc Lung Dis, 2007,11(8):828-837.
[43]	Hesseling AC, Walzl G, Enarson DA , et al. Baseline sputum time to detection predicts month two culture conversion and relapse in non-HIV-infected patients. Int J Tuberc Lung Dis, 2010,14(5):560-570.
[44]	Demura Y, Tsuchida T, Uesaka D , et al. Usefulness of ¹⁸F-fluorodeoxyglucose positron emission tomography for diagnosing disease activity and monitoring therapeutic response in patients with pulmonary mycobacteriosis . Eur J Nucl Med Mol Imaging, 2009,36(4):632-639. doi: 10.1007/s00259-008-1009-5 URL
[45]	Sathekge M, Maes A, Kgomo M , et al. Use of ¹⁸F-FDG PET to predict response to first-line tuberculostatics in HIV-associa-ted tuberculosis . J Nucl Med, 2011,52(6):880-885. doi: 10.2967/jnumed.110.083709 URL
[46]	Sathekge M, Maes A, D’Asseler Y , et al. Tuberculous lymphadenitis: FDG PET and CT findings in responsive and nonresponsive disease. Eur J Nucl Med Mol Imaging, 2012,39(7):1184-1190.
[47]	Coleman MT, Chen RY, Lee M , et al. PET-CT imaging reveals a therapeutic response to oxazolidinones in macaques and humans with tuberculosis. Sci Transl Med, 2014, 6(265): 265ra167.
[48]	World Health Organization. Treatment of tuberculosis guidelines. Geneva: World Health Organization, 2010: 84-85.
[49]	Flick H, Rumetshofer R, Wurzinger G . Tuberkulose. Wien Klin Wochenschr Educ, 2012,7(1):234-241.
[50]	Mittal S, Jain AK, Chakraborti KL , et al. Evaluation of healed status in tuberculosis of spine by fluorodeoxyglucose-positron emission tomography/computed tomography and contrast magnetic resonance imaging. Indian J Orthop, 2019,53(1):160-168.