Imaging of Pulmonary Tuberculosis with 18F-Fluoro-Deoxy-Glucose and 18F-Ethylcholine

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 18 F-FDG and followed by imaging with 18 F-fluoroethyl- choline 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 18 F-fluoroethyl-choline PET/CT demonstrated some improvement, which correlated with clinical improvement. Conclusion: Tuberculous lesions demonstrate increased accumulation of 18 F-fluoroethyl-choline on PET/CT, which may be useful in the evaluation of treatment response. When used in combination with 18 F-FDG, it could be of value in