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. 2019 Jan 24;19(1):83.
doi: 10.1186/s12879-019-3705-0.

Sub-clinical abnormalities detected by PET/MRI in household tuberculosis contacts

James S Molton  1   2 , Benjamin A Thomas  3 , Yan Pang  1 , Lih Kin Khor  4 , James Hallinan  4 , Claire M Naftalin  2 , John J Totman  3 , David W Townsend  3 , Tow Keang Lim  1   2 , Cynthia Bin Eng Chee  5 , Yee Tang Wang  5 , Nicholas I Paton  6   7
Affiliations

Sub-clinical abnormalities detected by PET/MRI in household tuberculosis contacts

James S Molton et al. BMC Infect Dis. .

Abstract

Background: The understanding of early events following TB exposure is limited by traditional tests that rely on detection of an immune response to infection, which is delayed, or on imaging tests with low sensitivity for early disease. We investigated for evidence of lung abnormalities in heavily exposed TB contacts using PET/MRI.

Methods: 30 household contacts of 20 index patients underwent clinical assessment, IGRA testing, chest x-ray and PET/MRI scan using 18-F-FDG. MRI images were examined by a radiology/nuclear medicine dual-qualified physician using a standardised report form, while PET/MRI images were examined independently by another radiology/nuclear medicine dual-qualified physician using a similar form. Standardised uptake value (SUV) was quantified for each abnormal lesion.

Results: IGRA was positive in 40%. PET/MRI scan was abnormal in 30%, predominantly FDG uptake in hilar or mediastinal lymph nodes and lung apices. We did not identify any relationship between PET/MRI findings and degree of exposure or IGRA status.

Conclusion: PET-based imaging may provide important insights into the natural history following exposure to TB that may not be available from traditional tests of TB immune response or imaging. The clinical significance of the abnormalities is uncertain and merits further investigation in longitudinal studies.

Keywords: Exposure; MRI; PET-scan; Tuberculosis.

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Conflict of interest statement

Ethics approval and consent to participate

The National Healthcare Group Domain Specific Review Board approved the study (2013/00116) including waiver of consent to collect de-identified information about the corresponding index patients from the national TB database. All participants gave written informed consent.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Abnormal imaging findings in TB contacts. a. Participant 2. 61y female, asymptomatic, (i) CXR: normal (ii) PET/MRI: FDG-avid right mediastinal lymph node (SUVmax 3.2); b. Participant 3. 35y female, asymptomatic, (i) CXR: normal (ii) PET/MRI: Spherical FDG-avid lesion in the apex of the right lung (SUVmax 3.9) (iii) Increased signal observed on MRI (HASTE); c. Participant 8. 54y male, asymptomatic, (i) CXR: normal (ii) PET/MRI: FDG-avid right hilar lymph node (SUVmax 2.4) and mediastinal lymph node (SUVmax 2.5); d. Participant 9. [914] 46y male, asymptomatic, (i) CXR: normal (ii) PET/MRI: Diffuse left upper lobe parenchymal uptake (SUVmax 2.2) (iii) No underlying MRI changes; e. Participant 12. 30y male, 1 week of mild non-productive cough, (i) CXR: normal (ii) PET/MRI: Right hilar lymph node (SUVmax 2.6); f. Participant 14. [922] 25y male, asymptomatic, (i) CXR: normal (ii) PET/MRI: RUL parenchymal uptake (1.3) (iii) Small underlying lesion identified on MRI images; g. Participant 16. [924] 22y male, 1 week of mild non-productive cough, (i) CXR: normal (ii) PET/MRI: Patchy right middle lobe parenchymal uptake (2.8), (iii) Bilateral underlying patchy changes identified on MRI. The area of right middle lobe uptake overlies an area of MRI abnormality; h. Participant 18. 46y female, asymptomatic, (i) CXR: normal (ii) PET/MRI: Right hilar lymph node (SUVmax 2.2); i. Participant 30. 66y male, asymptomatic, (i) CXR: normal, (ii) PET/MRI: several FDG-avid hilar lymph nodes (SUVmax = 2.8). (Note that all PET images are SUV images scaled between 0 (white) and 3 (black))
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References

    1. Barry CE, 3rd, Boshoff HI, Dartois V, Dick T, Ehrt S, Flynn J, Schnappinger D, Wilkinson RJ, Young D. The spectrum of latent tuberculosis: rethinking the biology and intervention strategies. Nat Rev Microbiol. 2009;7(12):845–855. doi: 10.1038/nrmicro2236. - DOI - PMC - PubMed
    1. Drain PK, Bajema KL, Dowdy D, Dheda K, Naidoo K, Schumacher SG, Ma S, Meermeier E, Lewinsohn DM, Sherman DR. Incipient and subclinical tuberculosis: a clinical review of early stages and progression of infection. Clin Microbiol Rev. 2018;31(4). - PMC - PubMed
    1. Chen TC, Lu PL, Yang CJ, Lin WR, Lin CY, Jou R, Feng MC, Wang TH, Ho CK, Hwang JJ, et al. Management of a nosocomial outbreak of Mycobacterium tuberculosis Beijing/W genotype in Taiwan: an emphasis on case tracing with high-resolution computed tomography. Jpn J Infect Dis. 2010;63(3):199–203. - PubMed
    1. Hirama T, Hagiwara K, Kanazawa M. Tuberculosis screening programme using the QuantiFERON-TB gold test and chest computed tomography for healthcare workers accidentally exposed to patients with tuberculosis. J Hosp Infect. 2011;77(3):257–262. doi: 10.1016/j.jhin.2010.11.012. - DOI - PubMed
    1. Lee SW, Jang YS, Park CM, Kang HY, Koh WJ, Yim JJ, Jeon K. The role of chest CT scanning in TB outbreak investigation. Chest. 2010;137(5):1057–1064. doi: 10.1378/chest.09-1513. - DOI - PubMed

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