Skip to main content

Usefulness of 18F-fluorodeoxyglucose positron emission tomography for diagnosing disease activity and monitoring therapeutic response in patients with pulmonary mycobacteriosis



To evaluate the usefulness of 18F-FDG PET in the imaging of pulmonary lesions related to disease activity and in monitoring responses to treatment in patients with pulmonary mycobacteriosis (PM).

Materials and methods

We used high-resolution computed tomography (HRCT) and 18F-FDG PET to evaluate 47 consecutive untreated patients with PM, 25 with tuberculosis (TB) and 22 with Mycobacterium avium-intracellulare complex (MAC), who presented with small peripheral pulmonary nodules ≤3 cm, and compared the findings. The diagnosis of mycobacteriosis was confirmed by bacteriological examinations of bronchoscopic or surgically resected specimens. PET scans were visually and quantitatively analysed using SUVmax. In addition, 14 patients with PM underwent repeat PET scanning during antimycobacterial therapy, and changes in 18F-FDG uptake were clinically evaluated (6 during treatment and 12 after treatment).


Of all the lesions, 87.2% had SUVmax levels ranging from 3 to 7 (5.05 ± 1.56, range 2.5–7.6, n = 47). Further, SUV levels in patients with PM reflected disease activity as estimated by HRCT, but did not differ significantly between those with TB (4.96 ± 1.61, n = 25) and MAC (5.15 ± 1.53, n = 22). 18F-FDG uptake was significantly decreased in all 14 patients who received chemotherapy, indicating a positive response to treatment.


18F-FDG PET is considered to be useful for the diagnosis and evaluation of disease activity along with HRCT findings, and in monitoring response to chemotherapy in patients with PM.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5


  1. Lillington GA, Caskey CI. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med 1993;14:111–9.

    PubMed  CAS  Google Scholar 

  2. Swensen SJ, Jett JR, Payne WS, Viggiano RW, Pairolero PC, Trastek VF. An integrated approach to evaluation of the solitary pulmonary nodule. Mayo Clin Proc 1990;65:173–86.

    PubMed  CAS  Google Scholar 

  3. Nomori H, Horio H, Fuyuo G, Kobayashi R, Morinaga S, Suemasu K. Lung adenocarcinomas diagnosed by open lung or thoracoscopic vs. bronchoscopic biopsy. Chest 1998;114:40–4.

    PubMed  Article  CAS  Google Scholar 

  4. Winer-Muram HT. The solitary pulmonary nodule. Radiology 2006;239:34–49.

    PubMed  Article  Google Scholar 

  5. Liu SF, Liu JW, Lin MC, Lee CH, Huang HH, Lai YF. Monitoring treatment responses in patients with pulmonary TB using serial lung gallium-67 scintigraphy. AJR Am J Roentgenol 2007;188:W403–8.

    PubMed  Article  Google Scholar 

  6. Goo JM, Im JG, Do KH, Yeo JS, Seo JB, Kim HY, et al. Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases. Radiology 2000;216:117–21.

    PubMed  CAS  Google Scholar 

  7. Patz EF, Lowe VJ, Hoffman JM, Paine SS, Burrowes P, Coleman RE, et al. Focal pulmonary abnormalities: evaluation with F-18-fluorodeoxyglucose PET scanning. Radiology 1993;188:487–90.

    PubMed  Google Scholar 

  8. Hara T, Kosaka N, Suzuki T, Suzuki T, Kudo K, Niino H. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study. Chest 2003;124:893–901.

    PubMed  Article  CAS  Google Scholar 

  9. Demura Y, Tsuchida T, Ishizaki T, Mizuno S, Totani Y, Ameshima S, et al. 18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax. J Nucl Med 2003;44:540–8.

    PubMed  CAS  Google Scholar 

  10. Kim IJ, Lee JS, Kim SJ, Kim YK, Jeong YJ, Jun S, et al. Double-phase 18F-FDG PET-CT for determination of pulmonary tuberculoma activity. Eur J Nucl Med Mol Imaging 2008;35:808–14.

    PubMed  Article  Google Scholar 

  11. Lowe VJ, Hoffman JM, DeLong DM, Patz EF, Coleman RE. Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities. J Nucl Med 1994;35:1771–6.

    PubMed  CAS  Google Scholar 

  12. Higashi K, Ito K, Hiramatsu Y, Ishikawa T, Sakuma T, Matsunari I, et al. 18F-FDG uptake by primary tumor as a predictor of intratumoral lymphatic vessel invasion and lymph node involvement in non-small cell lung cancer: analysis of a multicenter study. J Nucl Med 2005;46:267–73.

    PubMed  Google Scholar 

  13. Im JG, Itoh H, Shim YS, Lee JH, Ahn J, Han MC, et al. Pulmonary tuberculosis: CT findings – early active disease and sequential change with antituberculous therapy. Radiology 1993;186:653–60.

    PubMed  CAS  Google Scholar 

  14. Primack SL, Logan PM, Hartman TE, Lee KS, Müller NL. Pulmonary tuberculosis and Mycobacterium avium-intracellulare: a comparison of CT findings. Radiology 1995;194:413–7.

    PubMed  CAS  Google Scholar 

  15. Elizabeth H, Moore MD. Atypical mycobacterial infection in the lung: CT appearance. Radiology 1993;187:777–82.

    Google Scholar 

  16. Chan W, Chia M, Lee LK, Macfadyen DM. Bacteriological measures for the detection of cases of pulmonary tuberculosis. Bull WHO 1971;45:551–8.

    PubMed  CAS  Google Scholar 

  17. Bandoh S, Fujita J, Ueda Y, Tojo Y, Ishii T, Kubo A, et al. Uptake of fluorine-18-fluorodeoxyglucose in pulmonary Mycobacterium avium complex infection. Intern Med 2003;42:726–9.

    PubMed  Article  Google Scholar 

  18. Pratt PC. Pathology of tuberculosis. Semin Roentgenol 1970;14:196–203.

    Article  Google Scholar 

  19. Sumartojo E. When tuberculosis treatment fails. A social behavioral account of patient adherence. Am Rev Respir Dis 1993;147:1311–20.

    PubMed  CAS  Google Scholar 

  20. Lee HS, Oh JY, Lee JH, Yoo CG, Lee CT, Kim YW, et al. Response of pulmonary tuberculosis to anti-tuberculous treatment. Eur Respir J 2004;23:452–5.

    PubMed  Article  CAS  Google Scholar 

  21. Hofmeyr A, Lau WF, Slavin MA. Mycobacterium tuberculosis infection in patients with cancer, the role of 18-fluorodeoxyglucose positron emission tomography for diagnosis and monitoring treatment response. Tuberculosis 2007;87:459–63.

    PubMed  Article  Google Scholar 

  22. Park IN, Ryu JS, Shim TS. Evaluation of therapeutic response of tuberculoma using F-18 FDG positron emission tomography. Clin Nucl Med 2008;33:1–3.

    PubMed  Article  CAS  Google Scholar 

  23. Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992;33:1972–80.

    PubMed  CAS  Google Scholar 

  24. Kubota R, Kubota K, Yamada S, Tada M, Ido T, Tamahashi N. Microautoradiographic study for the differentiation of intratumoral macrophages, granulation tissues and cancer cells by the dynamics of fluorine-18-fluorodeoxyglucose uptake. J Nucl Med 1994;35:104–12.

    PubMed  CAS  Google Scholar 

  25. Miller WT. Spectrum of pulmonary nontuberculous mycobacterial infection. Radiology 1994;191:343–50.

    PubMed  Google Scholar 

  26. Kuhlman JE, Deutsch JH, Fishman EK, Siegelman SS. CT features of thoracic mycobacterial disease. Radiographics 1990;10:413–31.

    PubMed  CAS  Google Scholar 

Download references


This work was supported by the 21st Century COE Program “Biomedical Imaging Technology Integration Program” funded by the Japan Society for the Promotion of Science (JSPS).

Author information

Authors and Affiliations


Corresponding author

Correspondence to Yoshiki Demura.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Demura, Y., Tsuchida, T., Uesaka, D. et al. Usefulness of 18F-fluorodeoxyglucose positron emission tomography for diagnosing disease activity and monitoring therapeutic response in patients with pulmonary mycobacteriosis. Eur J Nucl Med Mol Imaging 36, 632–639 (2009).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Nontuberculous mycobacterial infection
  • Tuberculoma
  • Solitary pulmonary nodule
  • 18F-FDG PET
  • Therapeutic response