¹⁸F-fluorodeoxyglucose PET/CT scans for thoracic tuberculosis: current evidence and future perspectives

The advent of positron emission tomography (PET) combined with computed tomography (CT) in the field of inflammatory/infectious diseases heralds an era of personalised disease management using these noninvasive technologies. This nuclear medicine technique can be a useful tool in tuberculosis (TB) for assessing the extent of extrapulmonary disease, evaluating treatment response and identifying patients at higher risk of disease relapse. The fusion of functional imaging provided by PET with the anatomical and morphological details captured by CT has enabled clinicians to better understand the dynamics of the pathophysiology and natural course of Mycobacterium tuberculosis infection. Using its whole-body field of view, host responses are most commonly visualised using ¹⁸F-fluorodeoxyglucose, which reflects the glycolytic activity of cells. The strict indications for PET/CT in TB are matched by the caution required in interpreting its qualitative, quantitative and volumetric imaging patterns. In this narrative review, we aim to summarise evidence supporting the use of this molecular imaging modality in thoracic presentations of TB, particularly pulmonary and lymph node involvement, together with concepts to aid in the reporting and interpretation of the tests. We will also explore future indications for PET/CT in TB and discuss challenges to its routine use.