Positron emission tomography in the diagnosis and treatment management of tuberculosis.

Early diagnosis of TB is essential for community health and infection control, as well as for starting appropriate therapy for patients. Early detection of MDR is essential for the same reasons, plus the fact that currently a very high percentage of MDR patients die, especially in developing countries. Both genotypic and phenotypic methods allowing assessment of MDR tuberculosis on the bacilli isolated from fluids of infected patients are available, but these tests are lengthy (6-16 weeks) and require infected body fluids, which are not always easily assessable. Patients presenting pulmonary TB can also be culture-negative. Diagnosis of active disease in a pulmonary tuberculoma has long been problematic because the non-specific character of the disease, its changing manifestations and the slow growth of the organisms make its isolation a long and time-consuming process. Determination of pulmonary tuberculoma activity may be mandatory for optimal treatment strategy, therefore imaging techniques may be helpful in early detection. The aim of this review is to assess the role of Positron Emission Tomography (PET) imaging in the diagnosis and therapy management of TB. Although studies and data on the potential role of FDG PET in the diagnosis of tuberculosis are limited, a literature search revealed some interesting studies on this subject. Most of the studies described indicate that PET imaging, especially FDG PET as diagnostic tool, could be a noninvasive method that gives additional information about the disease status, enabling improved therapeutic management of pulmonary mycobacterial infection. Furthermore, several studies provide evidence that PET imaging could be useful in tuberculostatic therapy evaluation.