Annals of nuclear medicine · 2026
Prospective feasibility study of [68Ga]Gallium citrate PET/CT for treatment response assessment in spinal tuberculosis: exploratory comparison with follow-up [18 F]FDG PET/CT.
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Varghese Justin K, Sunny Saumya Sara, Arockiaraj Justin, Venkatesh K, Manesh S Abi, Gowri S Mahasampath, Hephzibah Julie
Аннотация
OBJECTIVE: Spinal tuberculosis (STB) remains a major clinical challenge in high-burden countries. Infection imaging agents such as [18 F]FDG and [67Ga]Gallium citrate have limitations in specificity and interpretation. [68Ga]Gallium citrate, produced via a [68Ge/68Ga] generator, offers logistical and economic advantages. This prospective feasibility study evaluated the potential utility of [68Ga]Gallium citrate PET/CT in patients with spinal tuberculosis and descriptively explored follow-up [18 F]FDG PET/CT findings in a subset of patients.
METHODS: Thirty-two patients with suspected or confirmed spinal TB underwent early treatment baseline [68Ga]Gallium citrate PET/CT within one month of ATT initiation. Spinal lesions demonstrating [68Ga]Gallium citrate uptake equal to or greater than abdominal aortic blood-pool activity were visually classified as positive. Follow-up [68Ga]Gallium citrate PET/CT was performed after 9-12 months in 21 patients, all of whom demonstrated favourable clinical response. Seventeen of these patients also underwent follow-up [18 F]FDG PET/CT. Imaging findings were descriptively correlated with available clinical, radiological, biochemical, microbiological, and histopathological findings.
RESULTS: At early treatment baseline imaging, 22/32 patients (68.8%) demonstrated increased spinal [68Ga]Gallium citrate uptake, whereas 10/32 (31.2%) showed no abnormal spinal uptake. Among the 21 patients who underwent follow-up [68Ga]Gallium citrate PET/CT, 12 had demonstrated positive spinal uptake at baseline and 9 had been negative. All 12 baseline-positive patients demonstrated resolution of spinal [68Ga]Gallium citrate uptake at follow-up, while the 9 baseline-negative patients remained negative. All 21 patients demonstrated favourable clinical response. Among the 17 patients who also underwent follow-up [18 F]FDG PET/CT, residual spinal [18 F]FDG uptake was observed in 13, whereas 4 showed no abnormal uptake.
CONCLUSION: In this prospective feasibility study, all patients with baseline [68Ga]Gallium citrate avidity who underwent follow-up imaging demonstrated complete resolution of tracer uptake, accompanied by a favourable clinical response. Because no treatment failures or non-responders were encountered, the ability of [68Ga]Gallium citrate PET/CT to identify persistent active disease or predict treatment outcome could not be assessed. However, persistent [18 F]FDG uptake was observed in several patients at follow-up. These findings should be interpreted as exploratory, given the absence of baseline [18 F]FDG PET/CT for comparison. Larger prospective studies including patients with heterogeneous treatment outcomes are required to determine the role of [68Ga]Gallium citrate PET/CT in treatment response assessment.
METHODS: Thirty-two patients with suspected or confirmed spinal TB underwent early treatment baseline [68Ga]Gallium citrate PET/CT within one month of ATT initiation. Spinal lesions demonstrating [68Ga]Gallium citrate uptake equal to or greater than abdominal aortic blood-pool activity were visually classified as positive. Follow-up [68Ga]Gallium citrate PET/CT was performed after 9-12 months in 21 patients, all of whom demonstrated favourable clinical response. Seventeen of these patients also underwent follow-up [18 F]FDG PET/CT. Imaging findings were descriptively correlated with available clinical, radiological, biochemical, microbiological, and histopathological findings.
RESULTS: At early treatment baseline imaging, 22/32 patients (68.8%) demonstrated increased spinal [68Ga]Gallium citrate uptake, whereas 10/32 (31.2%) showed no abnormal spinal uptake. Among the 21 patients who underwent follow-up [68Ga]Gallium citrate PET/CT, 12 had demonstrated positive spinal uptake at baseline and 9 had been negative. All 12 baseline-positive patients demonstrated resolution of spinal [68Ga]Gallium citrate uptake at follow-up, while the 9 baseline-negative patients remained negative. All 21 patients demonstrated favourable clinical response. Among the 17 patients who also underwent follow-up [18 F]FDG PET/CT, residual spinal [18 F]FDG uptake was observed in 13, whereas 4 showed no abnormal uptake.
CONCLUSION: In this prospective feasibility study, all patients with baseline [68Ga]Gallium citrate avidity who underwent follow-up imaging demonstrated complete resolution of tracer uptake, accompanied by a favourable clinical response. Because no treatment failures or non-responders were encountered, the ability of [68Ga]Gallium citrate PET/CT to identify persistent active disease or predict treatment outcome could not be assessed. However, persistent [18 F]FDG uptake was observed in several patients at follow-up. These findings should be interpreted as exploratory, given the absence of baseline [18 F]FDG PET/CT for comparison. Larger prospective studies including patients with heterogeneous treatment outcomes are required to determine the role of [68Ga]Gallium citrate PET/CT in treatment response assessment.