Imaging of Pulmonary Tuberculosis with F-Fluoro-Deoxy-Glucose and F-Ethylcholine

ABSTRACT

Introduction:

A 37-year-old man was referred for PET/CT with the following diagnostic challenge: a longstanding smoking history, histologically confirmed TB and sarcoidosis with worsening chest-related symptoms and a non-responsive right upper lobe lung lesion (as detected on CT).

Materials and Methods:

PET/CT imaging was performed with ¹⁸F-FDG and followed by imaging with ¹⁸F-fluoroethylcholine in an attempt to better characterize the lung lesion. This was followed by biopsies of the right upper lobe nodule, the pleura and a brain lesion.

Results:

Both tracers demonstrated increased uptake in the lung lesion and in multiple lymph node groups. Histology revealed the presence of a granulomatous disease in the lung lesion, the pleura and in the brain. Follow-up evaluation with ¹⁸F-fluoroethyl-choline PET/CT demonstrated some improvement, which correlated with clinical improvement.

Conclusion:

Tuberculous lesions demonstrate increased accumulation of ¹⁸F-fluoroethyl-choline on PET/CT, which may be useful in the evaluation of treatment response. When used in combination with ¹⁸F-FDG, it could be of value in distinguishing malignant lesions from tuberculosis.

Keywords:

F-fluoroethyl-choline, F-FDG, functional imaging, lung lesions, PET/CT, sarcoidosis, tuberculosis.