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Advanced imaging tools for childhood tuberculosis: potential applications and research needs
Sanjay K Jain1, Savvas Andronikou2, Pierre Goussard3
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Infection and Inflammation Imaging Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Insights
Diagnosing childhood tuberculosis is difficult due to limited pathogen detection. Advanced imaging may improve diagnosis and understanding of pediatric tuberculosis, guiding future research.
Area of Science:
- Pediatric infectious diseases
- Medical imaging
- Tuberculosis research
Background:
- Tuberculosis (TB) is a leading global cause of death, with children under 16 comprising a significant portion of cases in high-incidence regions.
- Diagnosing childhood TB is challenging due to paucibacillary nature and difficulties in obtaining specimens, leading to low sensitivity of current tests.
- Chest radiography aids diagnosis but has limitations; advanced imaging like CT may offer better insights.
Purpose of the Study:
- To highlight the diagnostic challenges of childhood tuberculosis.
- To evaluate the role of advanced imaging in diagnosing pediatric TB.
- To identify knowledge gaps and propose a research roadmap for TB imaging in children.
Main Methods:
- Review of current diagnostic methods for childhood tuberculosis.
- Analysis of the utility of chest radiography and cross-sectional imaging (CT).
- Discussion of advanced imaging techniques for assessing lesional biology non-invasively.
Main Results:
- Current pathogen-based tests for childhood TB have poor sensitivity.
- Chest radiography has limitations in interpreting results for pediatric TB.
- Cross-sectional imaging, when available, is recommended for symptomatic children with suspected TB.
Conclusions:
- Advanced imaging tools offer potential for non-invasive assessment of lesional biology in childhood TB.
- Improved understanding of TB biology can enhance diagnostic sensitivity.
- Further research is needed to address key knowledge gaps in pediatric TB imaging.
Abstract:
Tuberculosis is the leading cause of death globally that is due to a single pathogen, and up to a fifth of patients with tuberculosis in high-incidence countries are children younger than 16 years. Unfortunately, the diagnosis of childhood tuberculosis is challenging because the disease is often paucibacillary and it is difficult to obtain suitable specimens, causing poor sensitivity of currently available pathogen-based tests. Chest radiography is important for diagnostic evaluations because it detects abnormalities consistent with childhood tuberculosis, but several limitations exist in the interpretation of such results. Therefore, other imaging methods need to be systematically evaluated in children with tuberculosis, although current data suggest that when available, cross-sectional imaging, such as CT, should be considered in the diagnostic evaluation for tuberculosis in a symptomatic child. Additionally, much of the understanding of childhood tuberculosis stems from clinical specimens that might not accurately represent the lesional biology at infection sites. By providing non-invasive measures of lesional biology, advanced imaging tools could enhance the understanding of basic biology and improve on the poor sensitivity of current pathogen detection systems. Finally, there are key knowledge gaps regarding the use of imaging tools for childhood tuberculosis that we outlined in this Personal View, in conjunction with a proposed roadmap for future research.
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