PURPOSE OF REVIEW : To review the main applications, advantages and limitations of 18F-FDG PET and PET/computed
tomography (CT), and some other tracers in imaging of tuberculosis (TB).
RECENT FINDINGS : In pulmonary TB, granulomas typically demonstrate increased 18F-FDG uptake, and areas of active TB can
be differentiated from old or inactive disease by dual time point imaging. However, standardized uptake
value measurements are high in both TB and malignant lesions, with significant overlap that limits their
usefulness. In extrapulmonary TB, 18F-FDG PET detects more tuberculous lesions than CT, is of value in
assessing response to tuberculostatic treatment, and helps in diagnosing spinal infection and identifying
TB-related spondylitis; however, again, differentiation of malignant versus TB lymph node involvement is
problematic. 18F-FDG PET can also be considered a marker of disease status in patients with HIV and TB
co-infection. Overall, evaluation of treatment response is potentially the most important clinical application
of 18F-FDG PET in TB, owing to its ability to distinguish active from inactive disease.
SUMMARY : 18F-FDG PET and PET/CT may assist early diagnosis and facilitate differentiation between malignancies
and TB, identification of extrapulmonary TB, staging of TB, and assessment of treatment response.