Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases

Abstract

Purpose: To describe findings of pulmonary tuberculoma at 2-[fluorine 18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET).

Materials and methods: Ten consecutive patients who underwent PET and subsequently were proved to have pulmonary tuberculoma were analyzed. Tuberculosis was proved histopathologically in eight by means of wedge resection or lobectomy (n = 7) or needle biopsy (n = 1) and in two by means of clinical follow-up for more than 2 years. PET scans were evaluated by using peak standardized uptake values. Computed tomographic (CT) and histopathologic findings also were reviewed.

Results: Nine of 10 tuberculomas showed FDG uptake at PET, and the mean peak standardized uptake value was 4.2 +/- 2.2 (SD). FDG uptake (range, 1. 9-3.7) in lesions adjacent to main abnormalities was demonstrated in four patients. On CT scans, the mean of the longest nodule diameters was 21 mm +/- 8, and there were some areas of branching linear opacities or satellite nodules that suggested pulmonary tuberculosis in seven patients. Histopathologic findings were chronic granulomatous inflammation with caseation necrosis (n = 7) and healed tuberculosis with aspergilloma (n = 1).

Conclusion: Pulmonary tuberculoma commonly causes an increase in FDG uptake. These results suggest that in geographic regions with a high prevalence of granulomatous lesions, positive FDG PET results should be interpreted with caution in differentiating benign from malignant pulmonary abnormalities.