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18F-FDG-PET/CT Imaging of Thoracic and Extrathoracic Tuberculosis in Children
Matthieu Pelletier-Galarneau1, Patrick Martineau2, Lionel S Zuckier3
1Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Radiology and Nuclear Medicine, Montreal Heart Institute, Montréal, Québec, Canada; Division of Nuclear Medicine, CHU Sainte-Justine, Montréal, Québec, Canada.
Insights
Tuberculosis (TB) diagnosis is challenging, especially in children. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) effectively detects active TB, assesses disease, and monitors treatment response, offering superior accuracy to conventional methods.
Area of Science:
- Nuclear Medicine
- Radiology
- Infectious Diseases
Background:
- Tuberculosis (TB) affects one-third of the global population, posing significant morbidity and mortality risks.
- Diagnosing active TB is complex due to its mimicry of other conditions and challenges in differentiating active from latent disease.
- Timely diagnosis and treatment are crucial for preventing TB transmission.
Purpose of the Study:
- To review the expanding role of Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in evaluating patients with TB.
- To focus on the efficacy of FDG-PET/CT in the pediatric population, where TB diagnosis is particularly challenging.
Main Methods:
- Review of literature on FDG-PET/CT applications in TB diagnosis and management.
- Comparison of FDG-PET/CT accuracy with conventional imaging modalities for TB detection.
- Emphasis on FDG-PET/CT's utility in pediatric TB cases.
Main Results:
- FDG-PET/CT demonstrates accuracy equal to or superior to conventional imaging for detecting active TB.
- The modality effectively identifies intrathoracic and extrathoracic TB foci.
- FDG-PET/CT assesses disease activity, differentiates active from latent TB, monitors treatment response, and identifies biopsy targets.
Conclusions:
- FDG-PET/CT is a valuable tool for TB evaluation, offering comprehensive insights into disease status.
- Its application is expanding, including its use as a surrogate endpoint in new drug trials.
- The review highlights the specific benefits of FDG-PET/CT in diagnosing and managing TB in children.
Abstract:
Tuberculosis (TB) remains a major health problem, affecting approximately one-third of the world׳s population. The tubercle bacillus can affect virtually any organ of the human body and if left untreated can lead to severe morbidity and death. Diagnosis of active TB is challenging, especially in children. As a "great imitator," the disease can mimic numerous other pathologies, both clinically and at imaging. Although recognition of active TB is crucial to initiate adequate treatment in a timely fashion, thereby preventing transmission of disease, differentiation of active and quiescent disease is not always straightforward. Since the first reports more than 20 years ago, FDG-PET/CT imaging has been shown to detect active disease with accuracy equal or superior to other conventional imaging modalities. The role of FDG-PET in evaluating patients with TB is rapidly expanding. FDG-PET/CT can effectively identify foci of intrathoracic and extrathoracic TB, assess disease activity, differentiate between active and latent disease, monitor response to therapy, identify potential biopsy targets, and serve as a surrogate end point for new drug trials. Efficacy of FDG-PET/CT in the especially challenging pediatric population will be the focus of this review.