Usefulness of FDG PET/CT in the management of tuberculosis

Abstract

Background The aim of our study is to describe the FDG-PET/CT findings in patients with tuberculosis and to correlate them with the patient’s prognosis. Methods We retrospectively collected data from patients with tuberculosis, who had an FDG-PET/CT performed prior to treatment initiation from 2010 to 2015. Results Forty-seven out of 504 patients with active tuberculosis diagnosis (9.33%) underwent an FDG-PET/CT. The reasons for performing the FDG-PET/CT were: characterization of a pulmonary nodule (24; 51.1%), study of fever of unknown origin (12; 25.5%), study of lymph node enlargement (5; 10.6%) and others (6; 12.8%). Median age was 64 (IQR 50–74) years and 31 (66%) patients were male. Twenty-six (55.3%) patients had an immunosuppressant condition. According to the FDG-PET/CT, 48.6% of the patients had more than 1 organ affected and 46.8% had lymph node involvement. Median SUVmax of the main lesion was 5 (IQR 0.28–11.85). We found an association between the FDG accumulation and the size of the main lesion with a correlation coefficient of 0.54 (p<0.002). Patients with an unsuccessful outcome had a higher ratio SUVmax main lesion / SUVmean liver (1.92 vs 7.67, p<0.02). Conclusions In our cohort, almost half of the patients had more than 1 organ affected and 46.8% of them had lymph node involvement. FDG uptake was associated with the size of the main lesion and seems to be related to the treatment outcome. The extent of its potential to be used as an early predictor of treatment success still needs to be defined.

Tuberculosis diagnosed by thoracic surgeons

“…Active tuberculous lesions are characterized by an increased tracer uptake, but it is difficult to differentiate between active tuberculosis and cancer. Based on PET-CT, one cannot distinguish tuberculous lesions from other infectious inflammatory or granulomatous processes, such as sarcoidosis [7,23,24]. As far as our study group is concerned, PET-CT was not useful for the diagnosis of tuberculosis.…”

<p>¹⁸F-FDG PET–CT Diagnosis of Tuberculosis in Celiac Lymph Nodes</p>

“…At present, the patient is still undergoing antituberculosis treatment. As she refused to have biopsies taken during the whole process, the method described by Sánchez-Montalvá et al 14 was used to observe lesion size and glucose metabolism with 18 F-FDG PET–CT to further confirm the clinical diagnosis and evaluate the efficacy of treatment.…”

18F-FDG PET/CT contribution to tuberculous vertebral osteomyelitis diagnosis: a case report

“…Firstly, 18 F-FDG PET/CT can reveal more extensive disease in comparison to CT alone in cases of active TB, with its incremental diagnosing value based on both revealing hilar involvement but also unexpected sites of extrapulmonary TB [ 2 ]. Furthermore, SUVmax has been shown to be a sensitive and accurate marker for noninvasive evaluation of treatment response, thereby indirectly prompting early diagnosis of resistant Mycobacterium tuberculosis strains [ 2 , 3 ]. Finally, a recent study evaluating asymptomatic patients with high SUVmax lesions provided new insights in the TB latency period [ 4 ].…”