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Annals of Nuclear Medicine
Published in: Annals of Nuclear Medicine 1/2018

Open Access 01-01-2018 | Original Article

Diagnostic value of 99mTc-ethambutol scintigraphy in tuberculosis: compared to microbiological and histopathological tests

Authors: A. H. S. Kartamihardja, Y. Kurniawati, R. Gunawan

Published in: Annals of Nuclear Medicine | Issue 1/2018

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Abstract

Objective

Tuberculosis (TB) still remains the world’s endemic infection. TB affects the lungs and any part of the body other than the lung. The diagnosis of TB has not changed much over the decades. Ethambutol is one of the first line treatments for TB. It can be labeled using 99mTc. 99mTc-ethambutol will be accumulated in the site of TB lesion and can be imaged using gamma camera. The aim of this study was to evaluate the diagnostic value of 99mTc-ethambutol scintigraphy in detecting and localizing of TB.

Methods

Retrospective cross-sectional study was done. Subjects were patients suspected of having TB infection. Whole body and SPECT-CT imaging at the suspected area was done 1 and 4 h after injection of 370–555 MBq 99mTc-ethambutol. 99mTc-ethambutol scintigraphy was analyzed visually. The results were compared with that of histopathological or microbiological tests. Statistical analysis was done to determine the sensitivity, specificity, PPV, NPV and accuracy.

Results

One hundred and sixty-eight subjects were involved in this study. There were 110 men and 58 women with mean age of 34.52 ± 11.94 years. There were concordance results in 156 (92.86%) and discordant in 12 (7.14%) subjects between 99mTc-ethambutol scintigraphy and histopathological or microbiological result. The sensitivity, specificity, PPV, NPV and accuracy of 99mTc-ethambutol scintigraphy in the diagnosis of pulmonary TB were 93.9, 85.7, 93.9, 85.7 and 91.4%, respectively, for extra-pulmonary TB 95.5, 77.8, 97.9, 63.6, and 85.1%, respectively, and for total tuberculosis 94.9, 83.3, 96.3, 78.1 and 92.8%, respectively. There was no side effect observed in this study.

Conclusion

99mTc-ethambutol scintigraphy is a useful diagnostic imaging technique to detect and localize intra- and extra-pulmonary TB. It is safe to be performed even in pediatric patient. Consuming ethambutol less than 2 weeks did not influence the result.
Literature
1.
2.
Fanning A. Tuberculosis extra-pulmonary disease. CMAJ 1999; 160: 1597–603.
3.
Iseman MD. Tuberculosis in relation to human immunodeficiency virus and acquired immunodeficiency syndrome. In: Iseman MD, editor. A clinician’s guide to tuberculosis. Philadelphia: Lippincott Williams and Wilkins; 2000. pp. 199–252.
4.
Dutt AK, Stead WW. Epidemiology. In: Schlossberg D ed. Tuberculosis and non-tuberculous mycobacterial infection. Philadelphia: W.B. Saunders Company; 1999. pp. 3–16.
5.
6.
World Health Organization. Expert Group Meeting Report. Using the Xpert MTB/RIF assay to detect pulmonary and extra-pulmonary tuberculosis and rifampicin resistance in adults and children. World Health Organization, Geneva 2013.
7.
World Health Organization. Systemic screening for active tuberculosis, principles and recommendation. World Health Organization, Geneva 2013.
8.
World Health Organization. Improving the diagnosis and treatment of smear negative pulmonary and extra-pulmonary tuberculosis among adults and adolescent. Stop TB Department of HIV/AIDS. World Health Organization, Geneva 2007.
9.
World Health Organization. Global tuberculosis control. World Health Organization Report, Geneva 2009.
10.
Daniel TM, De Banne SM. The serodiagnosis of tuberculosis and other mycobacterial diseases by enzyme-linked immunosorbent assay. Am Rev Respir Dis. 1987;135:1137–51.PubMed
11.
Bhan S, Nag V. Skeletal tuberculosis. In: Sharma SK, Mohan A, edit Tuberculosis. New Delhi: Jaypee Brothers Medical Publisers; 2001:pp. 237 – 60.
12.
Sharrard WInfections of bones and joints. In Paediatric Orthopaedics and Fractures, edited by WJW Sharrard. 3rd Ed,. Oxford: Blackwell Scientific, 1993: pp. 1247–84.
13.
Seabold JE, Palestreo CJ, Brown ML, et al. Procedure guideline for gallium scintigraphy in inflammation. J Nucl Med. 1997;38(6):994–7.PubMed
14.
Ergun P, Turay UY, Ortapamuk H, Biber C, et al. The role of gallium-67 scintigraphy and high resolution computed tomography as predictors of disease activity in sputum smear negative pulmonary tuberculosis. Turk Respir J. 2003;4(3):123–6.
15.
Degirmenci B, Kilinc O, Cirak KA, et al. 99mTc-tetrofosmin scintigraphy in pulmonary tuberculosis. J Nucl Med. 1998;39(12):2116–20.PubMed
16.
Raziel G, Masjedi MR, Fotouhi F, et al. The role of Tc-99m MIBI scintigraphy in the management of patients with pulmonary tuberculosis. Eur Rev Med Pharmacol Sci 2012; 16: 622–62.
17.
Sathekge M, Maes A, Kgomo M, Stoltz A, Van de Wiele C. Use of 18F-FDG PET to predict response to first-line tuberculostatics in HIV-associated tuberculosis. J Nucl Med. 2011;52:880–5.CrossRefPubMed
18.
Bakheet SMB, Powe J, Kandil A, Ezzat A, Rostom A, Amartey J. F-18 FDG uptake in breast infection and inflammation. Clin Nucl Med. 2000;25(2):100–3.CrossRefPubMed
19.
Mora Ríos FG, Isunza Ramírez A, López Marmolejo A, Palma Rosillo RM, Guízar Cuevas S, et al. Sensitivity and specificity of the Tc-99m ciprofloxacin scan in pediatric osteomyelitis. Acta Ortop Mex. 2010;24(4):248 – 51.PubMed
20.
Britton KE, Wareham DW, Das SS, Solanki KK, Amaral H, Bhatnagar A, Kartamihardja AHS, et al. Imaging bacterial infection with Tc-99m–ciprofloxacin (infecton). J Clin Pathol. 2002;55:817–23.CrossRefPubMedPubMedCentral
21.
Kartamihardja AHS. Pencitraan 99mTc-cyprofloxacine dibandingkan dengan 99mTc-HMPAO-WBC pada Penderita Infeksi Tulang dan Sendi. MKB 2006; 38 (2): 59–65.
22.
Hidayat B, Anwar IB, Kartamihardja AHS, Masjhur JS. Peranan pencitraan 99mTc-infecton dalam mendeteksi spondilitis tuberkulosa. MKB 2000; 32 (2): 123–9.
23.
Hall AV, Solanki KK, Vijanmuri S, et al. Evaluation of efficacy of 99mTc-infecton, a novel agent for detecting site of infection. J Clin Pathol. 1998;51:215–9.CrossRefPubMedPubMedCentral
24.
Kartini N, Nurlaila Z. Microbiological characterization of 99mTc-cyprofloxacin and 99mTc-ethambutol labeled compounds as the infection imaging radiopharmaceuticals. Regional seminar on pharmaceuticals and biomedical analysis, School of Pharmacy. Institut Teknologi Bandung, 2005.
25.
Namrata S, Bathnagar A. Clinical evaluation of Tc-99m 2IT-INH in normal subjects and patients with tubercular lesions. Afr J Pharm Pharmacol. 2009;3(4):110–9.
26.
Hugh G, Watts, Lifeso RM. Current concepts review-tuberculosis of bones and joints. J Bone Jt Surg Am. 1996; 78: 288–99.
27.
World Health Organization. Treatment of tuberculosis. Guideline for National Programmers. 3rd ed. World Health Organization Report, Geneva: 2003.
28.
Forbes M, Peets EA, Kuck NA. Effect of ethambutol on Mycobacterium. Ann NY Acad Sci. 1966;135:726–31.CrossRefPubMed
29.
Takayama K, Amstrong EL, Kunugi KA, Kilburn JQ. Inhibition by ethambutol of mycolic acid transfer into the cell wall of Mycobacterium smegmatis. Antimicrob Agents Chemother. 1979;16:240–2.CrossRefPubMedPubMedCentral
30.
Verma J, Bathnagar A, Sen S, Singh AK, Bose M. Radio-labeling ethambutol with technetium-99m and its evaluation for detection tuberculosis. World J Nucl Med. 2005;4(1):35–46.
31.
32.
Oekar NK, Kartamihardja AHS. Pencitraan dengan Radionuklida 99mTc-ethambutol untuk diagnosis tuberkulosis extra pulmonal (penelitian pada hewan percobaan). MKB 2006.; 38 (3): 116–21.
33.
34.
Oekar NK. Kit Diagnostik Berbasis Teknik Nuklir dalam Penatalaksanaan Tuberkulosis. Maj Kedokt Indon. 2008;58(10):388–94.
35.
Wangsaatmadja H, dan Kartini N. Profil Farmakokinetika Radiofarmaka Etambutol Bertanda Teknesium-99m sebagai sediaan sidik tuberkulosis. J Farm Indones. 2011;5(4):188–94.
36.
Kartamihardja AHS. 99m Tc-ethambutol imaging in detecting and localizing of tuberculosis. 9th World Congress of Nuclear Medicine and Biology. Seoul, 2006.
37.
38.
Juwita R, Sumpena Y, Eka M, Sriyani, Kartini K. Biological evaluation of 99mTc-ethambutol for early detection of tuberculosis infection in animal model. Maj Farm Indones. 2009;20(2):55–61.
39.
40.
Lenaerts A, Barry CE, Dartos V. Heterogenity in tuberculosis pathology, microenvironments and therapeutic responses. Immunol Rev. 2015;264(1):200–308.CrossRef
41.
de Souza NMV, de Lima Ferreira M, Pinheiro AC, Saraiva MF, de Almeida MV and Valle MS. Synthesis and biological aspects of mycolic acid: an important target againts Mycobacterium tuberculosis. Sci World J. 2008;8:720–51.CrossRef
42.
Glassroth J. Diagnosis of tuberculosis. Tuberculosis. A comprehensive international approach, Reichman LB, Hershfield ES, editors. New York, Marcel Dekker, 1993: pp. 149–65.
43.
Rooney JJ, Crocco JA, Kramer S, Lyons HA. Further observations on tuberculin reactions in active tuberculosis. Am J Med. 1976;60:517–22.CrossRefPubMed
44.
de Anthony H. Management of an HIV-positive patients with smear negative pulmonary tuberculosis. Tuberc Compr Clin Ref 2009;98.
Metadata
Title
Diagnostic value of 99mTc-ethambutol scintigraphy in tuberculosis: compared to microbiological and histopathological tests
Authors
A. H. S. Kartamihardja
Y. Kurniawati
R. Gunawan
Publication date
01-01-2018
Publisher
Springer Japan
Published in
Annals of Nuclear Medicine / Issue 1/2018
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI
https://doi.org/10.1007/s12149-017-1220-1

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