Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, South Africa; Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands.
Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium.
Semin Nucl Med. 2018 Mar;48(2):108-130. doi: 10.1053/j.semnuclmed.2017.10.005. Epub 2017 Nov 16.
Tuberculosis (TB) is currently the world's leading cause of infectious mortality. Imaging plays an important role in the management of this disease. The complex immune response of the human body to Mycobacterium tuberculosis results in a wide array of clinical manifestations, making clinical and radiological diagnosis challenging. F-FDG-PET/CT is very sensitive in the early detection of TB in most parts of the body; however, the lack of specificity is a major limitation. F-FDG-PET/CT images the whole body and provides a pre-therapeutic metabolic map of the infection, enabling clinicians to accurately assess the burden of disease. It enables the most appropriate site of biopsy to be selected, stages the infection, and detects disease in previously unknown sites. F-FDG-PET/CT has recently been shown to be able to identify a subset of patients with latent TB infection who have subclinical disease. Lung inflammation as detected by F-FDG-PET/CT has shown promising signs that it may be a useful predictor of progression from latent to active infection. A number of studies have identified imaging features that might improve the specificity of F-FDG-PET/CT at some sites of extrapulmonary TB. Other PET tracers have also been investigated for their use in TB, with some promising results. The potential role and future perspectives of PET/CT in imaging TB is considered. Literature abounds on the very important role of F-FDG-PET/CT in assessing therapy response in TB. The use of F-FDG for monitoring response to treatment is addressed in a separate review.
结核病(TB)是目前全球导致传染性死亡的首要病因。影像学在这种疾病的管理中起着重要作用。人体对结核分枝杆菌的复杂免疫反应导致了广泛的临床表现,使得临床和影像学诊断具有挑战性。18F-FDG-PET/CT 在检测全身大多数部位的 TB 方面非常敏感;然而,其特异性不足是一个主要的局限性。18F-FDG-PET/CT 可对全身进行成像,并提供感染的治疗前代谢图谱,使临床医生能够准确评估疾病负担。它能够选择最合适的活检部位,对感染进行分期,并在以前未知的部位发现疾病。最近的研究表明,18F-FDG-PET/CT 能够识别出潜伏性 TB 感染患者中的亚临床疾病亚群。18F-FDG-PET/CT 检测到的肺部炎症显示出有希望的迹象,它可能是从潜伏性感染向活动性感染进展的有用预测指标。一些研究已经确定了一些影像学特征,这些特征可能会提高 18F-FDG-PET/CT 在一些肺外 TB 部位的特异性。其他 PET 示踪剂也被用于研究 TB,取得了一些有希望的结果。考虑了 PET/CT 在 TB 成像中的潜在作用和未来前景。文献中大量涉及 18F-FDG-PET/CT 在评估 TB 治疗反应方面的非常重要作用。另一份综述探讨了使用 18F-FDG 监测治疗反应的问题。