Quantitative 18F-FDG PET-CT scan characteristics correlate with tuberculosis treatment response

Area of Science:

• Nuclear Medicine
• Radiomics
• Infectious Disease Imaging

Background:

• F-18 FDG PET-CT is increasingly used for monitoring tuberculosis (TB) treatment response.
• Assessing TB lung lesions is challenging due to complexity, diffuse nature, dynamic changes, and persistent metabolic activity.
• Quantifying scan-based markers of disease burden and activity is crucial but difficult.

Purpose of the Study:

• To analyze serial F-18 FDG PET-CT scans using semi-automated whole lung quantification.
• To identify scan characteristics that best correlate with clinical and microbiological TB treatment outcomes.
• To evaluate the utility of quantitative PET-CT metrics in assessing treatment response.

Main Methods:

• Semi-automated, whole lung quantification of lung lesions on serial F-18 FDG PET-CT scans.
• Analysis of data from the Catalysis TB Treatment Response Cohort.
• Correlation of quantified scan metrics with clinical and microbiological outcomes.

Main Results:

• Quantified scan metrics correlated with clinical outcomes at diagnosis and 1 month post-treatment.
• Improved accuracy in differentiating clinical outcomes was observed at 6 months.
• High cavity volume predicted treatment failure (AUC 0.81); suboptimal reduction in glycolytic activity predicted recurrence (AUC 0.8).
• Lesion burden reduced post-treatment, but dynamic changes persisted in individual lesions.

Conclusions:

• Quantitative F-18 FDG PET-CT imaging provides a robust measure of TB disease burden and better characterizes treatment outcomes than qualitative assessment.
• Validated quantitative metrics hold potential for patient stratification and evaluating TB treatment efficacy.