The role of 99mTc-MIBI scintigraphy in the management of patients with pulmonary tuberculosis

G. Raziei 1,2, M. Reza Masjedi 3, F. Fotouhi 4, I. Neshandar Asli 4, B. Shafiei 4, H. Javadi 5, M. Assadi 6

1 Departemet of Nuclear Medicine, Milad Hospital, Tehran (Iran);
2 Departemet of Nuclear Medicine, Shohada-e Tajrish Hospital, Shaheed Beheshti University of Medical Sciences, Tehran (Iran);
3 National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shaheed Beheshti University of Medical Sciences, Tehran (Iran);
4 Department of Nuclear Medicine, Taleghani Hospital, Shaheed Beheshti University of Medical Science, Tehran (Iran);
5 Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan (Iran);
6 The Persian Gulf Nuclear Medicine Research Center, Bushehr University of Medical Sciences, Bushehr (Iran)

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• Nuclear Medicine

BACKGROUND: This study aimed to determine whether 99mTc-methoxyisobutylisonitrile (MIBI) scanning could improve diagnostic accuracy of pulmonary tuberculosis (PTB) and help clinical decision making for an accurate management.

MATERIALS AND METHODS: 99mTc-MIBI scintigraphy was performed in 62 cases of PTB 34 cases had active pulmonary tuberculosis (APTB) and were at the beginning of antituberculosis medication (group 1) as well as 28 cases had inactive pulmonary tuberculosis (IPTB) and were post antituberculosis medication (group 2). The qualitative and semiquantitative findings of both scanning methods were assessed. For semiquantitative evaluation, regions of interest (ROIs) were drawn over the lesion (L), non-lesion (NL) and neck soft tissue (NST). The mean count values of ROIs were obtained and L/NL and L/NST were calculated.

RESULTS: Thirty-four patients with APTB (15 males and 19 females; mean age of 47.85 ± 1.91 yrs) and 28 cases with IPTB (9 male and 19 females; mean age of 53.96 ± 2.33 yrs) were included in this study. The sensitivity, specificity, accuracy, positive and negative predictive (PPV and NPV) values of 99mTc-MIBI were 88.2%, 75%, 82.2%, 81.1% and 84% respectively. The mean value of L/NL in the APTB for 99mTc-MIBI was 1.45 ± 0.18 and L/NST was 1.57 ± 0.26 which was significant statistically (p  < 0.00).

CONCLUSIONS: The study demonstrated that 99mTc-MIBI scanning can be complementary to other diagnostic techniques especially in patients with indeterminate APTB and those in whom recurrent disease is suspected. In addition, because of its availability, rather low costs, easy performance, and objective semiquantitative information supplied, 99mTc-MIBI scanning might be establish in routine imaging center to assess the pulmonary tuberculosis. However, further exploration is needed to validate its clinical role.

Corresponding Author: Majid Assadi, MD; e-mail: assadipoya@yahoo.com, asadi@bpums.ac.ir