Neuromelioidosis is a rare but severe manifestation of melioidosis with central nervous system (CNS) involvement, caused by gram negative saprophytic bacteria named Burkholderia pseudo-mallei and is associated with high morbidity and mortality. Early and accurate detection of active disease is crucial for appropriate management. We report a series of three cases of neuromelioidosis evaluated using Gallium-68–labelled fibroblast activation protein inhibitor (⁶⁸GaGa-FAPI) positron emission tomography/computed tomography (PET/CT). ⁶⁸GaGa-FAPI, a novel molecular imaging tracer targeting activated fibroblasts, has demonstrated utility in imaging infection and inflammation in addition to malignancies. Unlike ¹⁸FFDG (F-18 Fluorodeoxyglucose), ⁶⁸GaGa-FAPI shows negligible physiological uptake in normal brain parenchyma, allowing superior lesion conspicuity. In the three cases reported, ⁶⁸GaGa-FAPI PET/CT clearly demonstrated active CNS inflammatory lesions better than ¹⁸FFDG PET-CT, facilitating accurate disease assessment and aiding clinical decision-making. The findings on ⁶⁸GaGa-FAPI PET/CT correlated with the MRI findings and further it was found to be better than MRI for response evaluation in one case. This highlights the potential role of ⁶⁸GaGa-FAPI PET/CT as a promising functional imaging modality in the evaluation of neuromelioidosis and other CNS infections.
Mayur et al. (Thu,) studied this question.