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PET and CT Scans Could Shorten TB Treatment

By MedImaging International staff writers
Posted on 05 Mar 2020

Image: Dynamic 11C-rifampin PET/CT imaging can aid tuberculosis treatment (Photo courtesy of Johns Hopkins Medicine)

A new imaging tool combines positron emission tomography (PET) and computed tomography (CT) to noninvasively measure the effectiveness of rifampin, a key tuberculosis (TB) drug.

Developed by researchers at Johns Hopkins Medicine (Baltimore, MD, USA), Fred Hutchinson Cancer Research Center (Seattle, WA, USA), and other institutions, the noninvasive imaging technique, called dynamic ¹¹C-rifampin PET/CT, can open a clearer window on the previously hidden battle taking place between microbe and rifampin in the lungs by more precisely tracking, over time, the pharmacokinetics of rifampin at infection sites in order to optimize antimicrobial dosing and shorten TB treatments.

For the study, 12 newly identified patients with rifampin-susceptible pulmonary TB were studied to explore the dynamic ¹¹C-rifampin PET/CT tool. Participants were first given an injected microdose of ¹¹C-rifampin that was tracked by PET to determine the drug's concentration over time in TB-infected lesions in the lungs and other body areas. Patients were then given untagged rifampin at the recommended treatment dosage level, and blood was drawn at various times and the levels of rifampin were measured by mass spectrometry. This showed that the microdose amount of ¹¹C-rifampin accurately represented the behavior of the traditional clinical dosage.

The results of the PET scan data revealed that the amount of ¹¹C-rifampin uptake was lowest in the walls of the TB-caused lung lesions and cavities, less than half what was seen in uninfected lung tissues. The findings were recapitulated by PET-CT in experimentally infected rabbits with cavitary TB and confirmed using postmortem mass spectrometry. The PET concentration-time profiles were also used to provide estimates on the rifampin dosing required to achieve cure in four months. The study was published on February 17, 2020, in Nature Medicine.

“While most TB patients are successfully treated with drug regimens which include rifampin, it still takes at least a six-month course to cure the disease,” said senior author Professor Sanjay Jain, MD, of Johns Hopkins Medicine. "We now have evidence that imaging the lungs with PET and CT scans may help researchers and physicians better determine how much rifampin is reaching the bacteria over time, and then use the data to steer decisions for speedier and more effective TB-fighting measures such as higher doses of the drug.”

A serious treatment issue for TB is that the infectious agent, Mycobacterium tuberculosis, protects itself by acting like a microbial mole, burrowing safe-haven cavities in the lungs. The cavities are carved by the same activity that the TB bacteria use to produce pneumonia. As the process also destroys blood vessels and builds up scar tissue in the area surrounding a cavity, it can be difficult for anti-TB drugs travelling through the bloodstream to reach the microbes nested inside. The characteristic pulmonary lesions can be seen as spots on CT scans.

Related Links:
Johns Hopkins Medicine
Fred Hutchinson Cancer Research Center

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68 (37.908554077148): SELECT fid FROM jos_deeppockets WHERE id=294781046 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294781046 AND published='1' LIMIT 1

69 (31.948089599609): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

70 (299.93057250977): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294781046 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (639.20021057129): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294781046 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (45.7763671875): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (70.095062255859): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294781046 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (41.961669921875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294781046 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (45.061111450195): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

105 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

106 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294781046 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (48.160552978516): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294781046 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

109 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

110 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294781046 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (370.02563476562): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294781046 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (652.07481384277): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (382.1849822998): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

115 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

116 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

117 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

118 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

119 (37.193298339844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

120 (185.01281738281): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 18856.048583984): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

123 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

124 (!!!!! 5177.9747009277): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294781046 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294781046 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 535742.99812317): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (152.1110534668): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (41.961669921875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (51.021575927734): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (578.88031005859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (499.01008605957): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (267.98248291016): SELECT name FROM jos_deeppockets WHERE id=215

136 (46.014785766602): SELECT name FROM jos_deeppockets WHERE id=215

137 (553.84635925293): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (416.99409484863): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

140 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

141 (!!!!! 9772.0623016357): TRUNCATE TABLE jos_trademed_module

142 (109.91096496582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294781046 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (84.161758422852): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294781046 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (881.19506835938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

147 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

148 (!!!!! 1103.1627655029): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

150 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

151 (37.908554077148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294781046 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294781046 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

153 (26.941299438477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=215 or channel_id is null)

154 (66.041946411133): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

156 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294781046 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294781046 AND published='1' LIMIT 1

157 (41.007995605469): select jos_twitters.link from jos_twitters where cat=10

158 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

159 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

160 (33.140182495117): select jos_linkedin.link from jos_linkedin where cat=10

161 (316.85829162598): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1405.9543609619): insert into jos_banners_delta values (14615,'2025-06-19 02:06:49','216.73.216.120','view'),(14202,'2025-06-19 02:06:49','216.73.216.120','view'),(14203,'2025-06-19 02:06:49','216.73.216.120','view')

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