18F-FDG-PET/CT Imaging of Thoracic and Extrathoracic Tuberculosis in Children

Tuberculosis (TB) remains a major health problem, affecting approximately one-third of the world׳s population. The tubercle bacillus can affect virtually any organ of the human body and if left untreated can lead to severe morbidity and death. Diagnosis of active TB is challenging, especially in children. As a “great imitator,” the disease can mimic numerous other pathologies, both clinically and at imaging. Although recognition of active TB is crucial to initiate adequate treatment in a timely fashion, thereby preventing transmission of disease, differentiation of active and quiescent disease is not always straightforward. Since the first reports more than 20 years ago, FDG-PET/CT imaging has been shown to detect active disease with accuracy equal or superior to other conventional imaging modalities. The role of FDG-PET in evaluating patients with TB is rapidly expanding. FDG-PET/CT can effectively identify foci of intrathoracic and extrathoracic TB, assess disease activity, differentiate between active and latent disease, monitor response to therapy, identify potential biopsy targets, and serve as a surrogate end point for new drug trials. Efficacy of FDG-PET/CT in the especially challenging pediatric population will be the focus of this review.