Institute of Nuclear Medicine, University College Hospitals NHS Trust, London NW1 2BU, UK.
Division of Infection and Immunity, Centre for Clinical Microbiology, University College London, and NIHR Biomedical Research Centre, University College London Hospitals, London, UK.
Int J Infect Dis. 2015 Mar;32:87-93. doi: 10.1016/j.ijid.2014.12.007.
Early diagnosis of tuberculosis (TB) is necessary for effective treatment. In primary pulmonary TB, chest radiography remains the mainstay for the diagnosis of parenchymal disease, while computed tomography (CT) is more sensitive in detecting lymphadenopathy. In post-primary pulmonary TB, CT is the method of choice to reveal early bronchogenic spread. Concerning characterization of the infection as active or not, CT is more sensitive than radiography, and (18)F-fluorodeoxyglucose positron emission tomography/CT ((18)F-FDG PET/CT) has yielded promising results that need further confirmation. The diagnosis of extrapulmonary TB sometimes remains difficult. Magnetic resonance imaging (MRI) is the preferred modality in the diagnosis and assessment of tuberculous spondylitis, while (18)F-FDG PET shows superior image resolution compared with single-photon-emitting tracers. MRI is considered superior to CT for the detection and assessment of central nervous system TB. Concerning abdominal TB, lymph nodes are best evaluated on CT, and there is no evidence that MRI offers added advantages in diagnosing hepatobiliary disease. As metabolic changes precede morphological ones, the application of (18)F-FDG PET/CT will likely play a major role in the assessment of the response to anti-TB treatment.
早期诊断结核病（TB）对于有效治疗至关重要。在原发性肺结核中，胸部 X 线摄影仍然是诊断实质疾病的主要手段，而计算机断层扫描（CT）在检测淋巴结病方面更敏感。在继发型肺结核中，CT 是揭示早期支气管播散的首选方法。在判断感染是否为活动性方面，CT 比 X 线摄影更敏感，（18）氟代脱氧葡萄糖正电子发射断层扫描/CT（（18）F-FDG PET/CT）的结果令人鼓舞，但需要进一步证实。肺外结核病的诊断有时仍然很困难。磁共振成像（MRI）是诊断和评估结核性脊柱炎的首选方法，而（18）氟代脱氧葡萄糖正电子发射断层扫描（FDG PET）显示出比单光子发射示踪剂更高的图像分辨率。MRI 在检测和评估中枢神经系统结核病方面优于 CT。在腹部结核病中，淋巴结在 CT 上最佳评估，没有证据表明 MRI 在诊断肝胆疾病方面具有优势。由于代谢变化先于形态变化，（18）F-FDG PET/CT 的应用可能在评估抗结核治疗反应方面发挥重要作用。
