Positron Emission Tomography/Computed Tomography Imaging in Abdominal Tuberculosis

Amongst, extrapulmonary tuberculosis, the abdominal involvement is an important type that may present with nonspecific clinical features. It is considered a mimicker of many other gastrointestinal pathologies; hence it poses a significant diagnostic challenge leading to delayed diagnosis and consequently increased incidence of complications. Abdominal tuberculosis may involve lymph nodes, peritoneum, gastrointestinal tract, pancreas, and hepatobiliary system. The early diagnosis, followed by the initiation of anti-tubercular treatment is the key to decreasing morbidity and mortality. Anatomical imaging modalities play a vital role in diagnosing abdominal involvement. 18F-FDG PET/CT is a non-invasive biomarker and well-established imaging modality in clinical oncology at different stages the malignancies. Recently, there has been a growing interest in 18F-FDG PET/CT imaging in patients with pyrexia of unknown origin, infection, and inflammatory diseases, including tubercular infection. PET/CT plays an essential role in early diagnosis, disease mapping, and extent of disease, to guide the biopsy from the metabolically active site, monitoring the response to anti-tubercular drugs, prognostication, and identifying the non-responder or multidrug-resistant cases. It may help to determine the treatment duration and individualize therapy instead of empirical treatment. The new radiotracers for understanding disease processes and anti-tubercular drug kinetics may play a significant role in managing the TB and require for further research.