Tuberculosis pp 411-430 | Cite as

Radionuclides in Pulmonary and Extra-Pulmonary Tuberculosis

  • David Hamilton
  • Jawda Al-Nabulsi


Radionuclide investigation is a sensitive, but generally non-specific, indicator of the presence and the extent of tuberculosis; proving valuable in differentiating active from inactive disease. It also provides a method of revealing reactivation of the disease, estimating the therapeutic response, and assessing consequential alteration of normal physiology. Experience extends over 40 years but in the last 10 years, with the resurgence of the disease, new radiopharmaceuticals and imaging techniques have been added to the armamentarium. Also in this period, radionuclides have increasingly been focused on detecting the opportunistic infection complications associated with human immunodeficiency virus (HIV)-infected patients.


Bone Scintigraphy Tuberculous Meningitis Spinal Tuberculosis Miliary Tuberculosis Tuberculous Peritonitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Abdel-Dayem HM et al (1994) Sequential thallium and gallium ehest imaging in AIDS patients with non-KS pulmonary complications (abstract). Eur J Nucl Med 21:S77CrossRefGoogle Scholar
  2. Abdel-Dayem H et al (1995) Diffuse Tl-201 uptake in the lungs. Etiologic classification and pattern recognition. Clin Nucl Med 20:164–172PubMedCrossRefGoogle Scholar
  3. Abdel-Dayem HM et al (1996) Evaluation of sequential thallium and gallium scans of the ehest in AIDS patients. J Nucl Med 37:1662–1667PubMedGoogle Scholar
  4. Abdel-Dayem HM et al (1997) Sites of tuberculous involvement in patients with AIDS. Autopsy findings and evaluation of gallium imaging. Clin Nucl Med 22:310–314Google Scholar
  5. Abdelwahab IF et al (1991) Atypical skeletal tuberculosis mimicking neoplasm. Br Radiol 64:551–555Google Scholar
  6. Bakheet SM et al (1998) F-18-FDG uptake in tuberculosis. Clin Nucl Med 23:739–742PubMedCrossRefGoogle Scholar
  7. Bakheet SM et al (1999) Radioiodine uptake in inactive pulmonary tuberculosis. Eur J Nucl Med 26:659–662PubMedCrossRefGoogle Scholar
  8. Bakheet SM et al (2000) F-18 FDG uptake in breast infection and inflammation. Clin Nucl Med 25:100–103PubMedCrossRefGoogle Scholar
  9. Bekerman C, Bitran J (1988) Gallium-67 scanning in the clinical evaluation of human immunodeficiency virus infection: indications and limitations. Semin Nucl Med 8:273–276Google Scholar
  10. Bihl H, Maier H (1987) Unilateral gallium-67 uptake in primary tuberculosis of the major salivary glands. Clin Nucl Med 12:650–653PubMedCrossRefGoogle Scholar
  11. Boumpas DT et al (1987) Skeletal tuberculosis resembling metastatic disease on bone scintigraphy (letter). J Nucl Med 28:1507–1509PubMedGoogle Scholar
  12. Braga FJHN et al (1998) 99mTc-gluco-heptonate scintigraphy in lung tuberculosis patients: initial results (abstract). Eur J Nucl Med 25:1125Google Scholar
  13. Braga FJHN et al (2001) Neural tuberculosis detected by F-18 FDG positron emission tomography. Clin Nucl Med 26: 706PubMedCrossRefGoogle Scholar
  14. Brochner-Mortensen J (1978) Routine methods and their reliability for assessment of glomerular filtration rate in adults. Dan Med Bull 25:181–202PubMedGoogle Scholar
  15. Brophey M et al (1995a) The scintigraphic presentation of Pott’s disease. Clin Nucl Med 20:191–193PubMedCrossRefGoogle Scholar
  16. Brophey M et al (1995b) Prominent small bowel Ga-67 uptake associated with Yersinial and tuberculous enterocolitis. Clin Nucl Med 20:107–110PubMedCrossRefGoogle Scholar
  17. Buchanan N (1981) Radioactive bromide partition test in the diagnosis of tuberculous meningitis (letter). J Pediatr 99:506PubMedGoogle Scholar
  18. Burke T (1995) Tl-201 uptake in pulmonary Mycobacterium avium complex infection. Clin Nucl Med 20:835–836PubMedCrossRefGoogle Scholar
  19. Cook GJ, Fogelman I, Maisey MN (1996) Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation (review). Semin Nucl Med 26: 308–314PubMedCrossRefGoogle Scholar
  20. Daniel TM (1987) New approaches to the rapid diagnosis of tuberculous meningitis. J Infect Dis 155:599–602PubMedCrossRefGoogle Scholar
  21. Degirmenci B et al (1998) Technetium-99m-tetrofosmin scintigraphy in pulmonary tuberculosis. J Nucl Med 39: 2116–2120PubMedGoogle Scholar
  22. Desai SS (1994) Early diagnosis of spinal tuberculosis by MRI. J Bone Joint Surg [Br] 76B:863–869Google Scholar
  23. Dhekne RD et al (1987) Tuberculous pseudotumor of the liver. Clin Nucl Med 12:816–819PubMedCrossRefGoogle Scholar
  24. Dickinson FL, Finlay DB, Beiton IP (1996) Multifocal skeletal tuberculosis: bone scan appearances. Nucl Med Commun 17:957–962PubMedCrossRefGoogle Scholar
  25. Everaert H et al (1997) Ga-67 uptake in a case of tuberculous spondylitis. Clin Nucl Med 22:403–404PubMedCrossRefGoogle Scholar
  26. Fanning A, Dierich H, Lentle B (1974) Bone scanning with technetium 99mTc polyphosphate in tuberculous osteomyelitis. Tuberde 55:227–230CrossRefGoogle Scholar
  27. Fineman DS et al (1989) Detection of abnormalities in febrile AIDS patients with In-111-labeled leukocyte and Ga-67 scintigraphy. Radiology 170:677–680PubMedGoogle Scholar
  28. Fogelman I, Maisey MN, Clarke SEM (1994) An atlas of clinical nuclear medicine, second edition. Dunitz, London Ganz WI, Serafini AN (1989) The diagnostic role of nuclear medicine in the acquired immunodeficiency Syndrome. J NudMed 30:1935–1945Google Scholar
  29. Girgis NI et al (1990) The use of the bromine partition test in the diagnosis and prognosis of tuberculous meningitis. East Afr Med J 67:404–406PubMedGoogle Scholar
  30. Goldfarb CR et al (1995) Ga-67 scintigraphic appearances of tuberculosis in the’ new’ tuberculosis (abstract). J Nucl Med 36:23PGoogle Scholar
  31. Goldfarb CR et al (1997) Gallium scanning in the’ new’ tuberculosis. Clin Nucl Med 22:470–474PubMedCrossRefGoogle Scholar
  32. Gomez MV et al (1995) Abnormal gallium-67 skull uptake: a sign of peripheral marrow activation in HIV-positive patients with disseminated mycobacterioses. J Nucl Med 36:2211–2213Google Scholar
  33. Gomez MV et al (1996) Identification of AIDS-related tuberculosis with concordant gallium-67 and three-hour delayed thallium-201 scintigraphy. Eur J Nucl Med 23:852–854PubMedCrossRefGoogle Scholar
  34. Goo JM et al (2000) Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases. Radiology 216:117–121PubMedGoogle Scholar
  35. Goswami GK et al (2000) Discrepancy between Ga-67 citrate and F-18 fluorodeoxyglucose positron emission tomographic scans in pulmonary infection. Clin Nucl Med 25: 490–491PubMedCrossRefGoogle Scholar
  36. Greenspan A, Stadainik RC (1995) Increased uptake around the hip Joint. Semin Nucl Med 3:283–286Google Scholar
  37. Grieff M, Lisbona R (1991) Detection of miliary tuberculosis by Ga-67 scintigraphy. Clin Nucl Med 16:910–912PubMedCrossRefGoogle Scholar
  38. Groth S (1984) Calculation of 51Cr-EDTA clearance in children from the activity in one plasma sample by transformation of the biexponential plasma time-activity curve into a monoexponential with identical integral area below the time-activity curve. Clin Physiol 4:61–74PubMedCrossRefGoogle Scholar
  39. Gulaldi NC et al (1995) The visualization of pulmonary tuberculosis with Tc-99m (V) DMSA and Tc-99m citrate in comparison to Ga-67 citrate. Clin Nucl Med 20:1012–1014PubMedCrossRefGoogle Scholar
  40. Hardoff R, Efrat M, Gips S (1995) Multifocal osteoarticular tuberculosis resembling skeletal metastatic disease. Evaluation with Tc-99m MDP and Ga-67 citrate. Clin Nucl Med 20:279–281PubMedCrossRefGoogle Scholar
  41. Hashimoto T et al (2000) Peritoneal linear uptake of Ga-67 caused by tuberculous peritonitis. Clin Nucl Med 25:214–215PubMedCrossRefGoogle Scholar
  42. Hovi I et al (1993) Technetium-99m-HMPAO-labeled leukocytes and technetium-99m-labeled human polyclonal immunoglobulin G in diagnosis of focal purulent disease. J Nucl Med 34:1428–1434PubMedGoogle Scholar
  43. Ishino Y, Shiozaki H, Nakata H (1992) Positive Tc-99m pyrophosphate myocardial scintigraphy in a patient with tuberculous pericarditis. Clin Nucl Med 17:515–517PubMedCrossRefGoogle Scholar
  44. Kalicke T et al (2000) Fluorine-18 fluorodeoxyglucose PET in infectious bone diseases: results of histologically confirmed cases. Eur J Nucl Med 27:524–528PubMedCrossRefGoogle Scholar
  45. Kao C-H et al (1993) Usefulness of gallium-67 citrate scans in patients with acute disseminated tuberculosis and comparison with ehest x-rays. I Nucl Med 34:1918–1921Google Scholar
  46. Kao P-F et al (1996) Accumulation of Ga-67 citrate in a tuberculous splenic abscess. Report of a rare case. Clin Nucl Med 21:49–52PubMedCrossRefGoogle Scholar
  47. Kattapuram SV, Lee VW, Shapiro JH (1979) Primary tuberculosis diagnosed by gallium scan. Clin Nucl Med 4:238–239PubMedCrossRefGoogle Scholar
  48. Kim DG et al (1995) 99mTc-HMPAO labeled leukocyte SPECT in intracranial lesions. Surg Neurol 44:338–345PubMedCrossRefGoogle Scholar
  49. Knight SB et al (1996) Evaluation of pulmonary lesions with FDG-PET. Comparison of findings in patients with and without a history of prior malignancy. Chest 109:982–988PubMedCrossRefGoogle Scholar
  50. Kobayashi H et al (1995) Solitary muscular involvement by tuberculosis: CT, MRI and scintigraphic features. Comput Med Imag Graph 19:237–240CrossRefGoogle Scholar
  51. Kramer EL et al (1989) Diagnostic implications of Ga-67 chestscan patterns in human immunodeficiency virus-seropositive patients. Radiology 170:671–676PubMedGoogle Scholar
  52. LaManna MM et al (1984) Gallium localization in peritonitis. Two case reports. Clin Nucl Med 9:25–27PubMedCrossRefGoogle Scholar
  53. Lee JD et al (1992) Immunoscintigraphy in the detection of tuberculosis with radiolabelled antibody fragment against Mycobacterium bovis bacillus Calmette-Guerin: a preliminary study in a rabbit model. Eur J Nucl Med 19:1011–1015PubMedCrossRefGoogle Scholar
  54. Lee VW et al (1994) Pulmonary mycobacterial infections in AIDS: characteristic pattern of thallium and gallium scan mismatch. Radiology 193:389–392PubMedGoogle Scholar
  55. Lee VW et al (1999) Intracranial mass lesions: sequential thallium and gallium scintigraphy in patients with AIDS. Radiology 211:507–512PubMedGoogle Scholar
  56. Leventhal WD, Gordon L, Hotchkiss S (1981) Ga-67-citrate and ultrasonographic visualization of genitourinary tuberculosis. Clin Nucl Med 6:504–505PubMedCrossRefGoogle Scholar
  57. Lin W-Y, Hsieh J-F (1999) Gallium-67 citrate scan in extrapulmonary tuberculosis. Nuklearmedizin 38:199–202PubMedGoogle Scholar
  58. Lin W-Y et al (1998) Diagnostic value of bone and Ga-67 imaging in skeletal tuberculosis. Clin Nud Med 23:743–746CrossRefGoogle Scholar
  59. Lisbona R et al (1993) Gallium-67 scintigraphy in tuberculous and nontuberculous infectious spondylitis. J Nucl Med 34: 853–859PubMedGoogle Scholar
  60. Loken MK (1987) Pulmonary nuclear medicine. Appleton and Lange, CaliforniaGoogle Scholar
  61. Lorberboym M et al (1998) Thallium-201 retention in focal intracranial lesions for differential diagnosis of primary lymphoma and nonmalignant lesions in AIDS patients. J Nucl Med 39:1366–1369PubMedGoogle Scholar
  62. Malhotra CM et al (1985) Ga-67 studies in a patient with acquired immunodeficiency Syndrome and disseminated mycobacterial infection. Clin Nucl Med 10:96–98PubMedCrossRefGoogle Scholar
  63. Mansberg VJ, Murray IP, Rossleigh MA (1997) Complementary scintigraphy in tuberculous osteomyelitis. Clin Nucl Med 22:776–778PubMedCrossRefGoogle Scholar
  64. McAfee JG (1996) Editorial comment on Brophey et al 1995b. The Year Book of Nuclear Medicine. Mosby, St LouisGoogle Scholar
  65. Misra UK, Kaiita J, Das BK (2000) Single photon emission computed tomography in tuberculous meningitis. Postgrad Med J 76:642–645PubMedCrossRefGoogle Scholar
  66. Moody EB, Delbeke D (1992) Nuclear medicine case of the day. Case 1: miliary tuberculosis. Am I Roentgenol 158:1382–1386CrossRefGoogle Scholar
  67. Muradali D et al (1993) Multifocal osteoarticular tuberculosis: report of four cases and review of management. Clin Infect Dis 17:204–209PubMedCrossRefGoogle Scholar
  68. Nocera RM et al (1983) Tc-99m MDP and indium-111 chloride scintigraphy in skeletal tuberculosis. Clin Nucl Med 8:418–420PubMedCrossRefGoogle Scholar
  69. O’Doherty MJ et al (1997) PET scanning and the human immunodeficiency virus-positive patient. J Nucl Med 38: 1575–1583PubMedGoogle Scholar
  70. Ohta H et al (1996) Liver tuberculoma detected by Ga-67 imaging. Clin Nucl Med 21:577PubMedCrossRefGoogle Scholar
  71. Ohta H et al (1998) Tc-99m sestamibi uptake in tuberculosis of the breast. Clin Nucl Med 23:106–108PubMedCrossRefGoogle Scholar
  72. Onsel C et al (1996) Technetium-99m-MIBI scintigraphy in pulmonary tuberculosis. J Nucl Med 37:233–238PubMedGoogle Scholar
  73. Ozturk E et al (1994) The visualization of granulomatous disease with somatostatin receptor scintigraphy. Clin Nucl Med 19:129–132PubMedCrossRefGoogle Scholar
  74. Palestro CJ et al (1991) Relative efficacy of In-111 leukocyte and Ga-67 imaging in HIV (+) patients (abstract). J Nucl Med 32:1003Google Scholar
  75. Parmett SR et al (1995) Utility of Ga-67 scintigraphy in detecting radiologically negative tuberculosis in HIV-positive patients (abstract). J Nucl Med 36:207P–208PGoogle Scholar
  76. Patz EF et al (1993) Focal pulmonary abnormalities: evaluation with F-18-Fluorodeoxyglucose PET scanning. Radiology 188:487–490PubMedGoogle Scholar
  77. Pettengell K et al (1990) Radionuclide scintigraphy in tuberculous enteritis. Gastrointest Radiol 15:148–150PubMedCrossRefGoogle Scholar
  78. Picciotto G et al (1992) Estimation of chromium-51 ethylene diamine tetra-acetic acid plasma clearance: a comparative assessment of simplified techniques. Eur J Nucl Med 19:30–35PubMedCrossRefGoogle Scholar
  79. Piepsz A, Pintelon H, Harn HR (1994) Estimation of normal chromium-51 ethylene diamine tetra-acetic acid clearance in children. Eur J Nucl Med 21:12–16PubMedCrossRefGoogle Scholar
  80. Prat L et al (1991) Ga-67 citrate and Tc-99m HMPAO leukocyte scanning in extrapulmonary tuberculosis. Clin Nucl Med 16:865–866PubMedCrossRefGoogle Scholar
  81. Pui MH, Chin-Sang HR, Rubenstein JD (1986) False-normal bone imaging in spinal tuberculosis. Clin Nucl Med 11: 245–248PubMedCrossRefGoogle Scholar
  82. Rust RJ, Park HM, Robb JA (1981) Skeletal scintigraphy in miliary tuberculosis: photopoenia after treatment. Am J Radiol 137:877–879Google Scholar
  83. Santin M et al (1995) Utility of the gallium-67 citrate scan for the early diagnosis of tuberculosis in patients infected with the human immunodeficiency virus. Clin Infect Dis 20:652–656PubMedCrossRefGoogle Scholar
  84. Sarkar SD, Ravikrishman KP (1978) Gallium-67 citrate scanning in extra-pulmonary tuberculosis (abstract). J Nucl Med 19:734Google Scholar
  85. Sarkar SD et al (1979) Gallium-67 citrate scanning-a new adjunct in the detection and follow-up of extrapulmonary tuberculosis: concise communication. J Nucl Med 20:833–836PubMedGoogle Scholar
  86. Sciuk J et al (1991) Comparison of technetium-99m polyclonal human immunoglobulin and technetium-99m monoclonal antibodies for imaging chronic osteomyelitis. First clinical results. Eur J Nucl Med 18:401–407PubMedCrossRefGoogle Scholar
  87. Schmitz A et al (2000) Use of fluorine-18 fluoro-2-deoxy-Dglucose positron emission tomography in assessing the process of tuberculous spondylitis. J Spinal Disord 13: 541–544PubMedCrossRefGoogle Scholar
  88. Schmidt U, Rebarber IF (1994) Tuberculous pericarditis identified with gallium-67 and indium-111 leukocyte imaging. Clin Nucl Med 19:146–147PubMedCrossRefGoogle Scholar
  89. Sharif HS et al (1989) Brucellar and tuberculous spondylitis: comparative imaging features. Radiology 171:419–425PubMedGoogle Scholar
  90. Shih WJ et al (1986) Progression of mediastinal tuberculosis and superior vena caval obstruction demonstrated by gallium-67 citrate and radiocolloid liver scintigraphy. Clin Nucl Med 11:126–128PubMedCrossRefGoogle Scholar
  91. Siemsen JK et al (1976) Gallium-67 scintigraphy of pulmonary diseases as a complement to radiography. Radiology 118: 371–375PubMedGoogle Scholar
  92. Siemsen JK, Grebe SF, Waxman AD (1978) The use of gallium 67 in pulmonary disorders. Semin Nucl Med 8:235–249PubMedCrossRefGoogle Scholar
  93. Suga K et al (2000) Findings on radionuclide cisternography in a large abdominal cerebrospinal fluid pseudocyst associated with tuberculous peritonitis. Clin Nucl Med 25: 1063–1065PubMedCrossRefGoogle Scholar
  94. Sumi Y et al (1999) Tuberculosis peritonitis: gallium-67 scintigraphic appearance. Ann Nucl Med 13:185–189PubMedCrossRefGoogle Scholar
  95. Sweny P, Farrington K, Moorhead JF (1989) The kidney and its disorders. Blackwell, OxfordGoogle Scholar
  96. Taher MA (1998) Nuclear scan and sonogram in renal tuberculosis (letter). J Assoc Physic India 46:401–402Google Scholar
  97. Tamgac F et al (1995) Extraskeletal accumulation of Tc-99m HMDP in a tuberculous cold abscess. Clin Nucl Med 20:1092PubMedCrossRefGoogle Scholar
  98. Utsunomiya K et al (1997) Clinical significance of thallium 201 and gallium-67 scintigraphy in pulmonary tuberculosis. Eur J Nucl Med 24:252–257PubMedGoogle Scholar
  99. Vanhagen PM et al (1994) Somatostatin analogue scintigraphy in granulomatous diseases. Eur J Nucl Med 21:497–502PubMedCrossRefGoogle Scholar
  100. Villringer K et al (1995) Differential diagnosis of CNS lesions in AIDS patients by FDG-PET. J Comput Assist Tomogr 19: 532–536PubMedCrossRefGoogle Scholar
  101. Von Wenzel KS, Klopper JF, Wasserman HJ (1989) The technetium-99m DTPA partition test in the diagnosis of tuberculous meningitis. South Afr Med J 20:488–489Google Scholar
  102. Vorne M, Sahistrom K, Alanko K (1988) Poor accumulation of technetium-99m glucoheptonate in sarcoidosis and other diffuse infiltrative lung diseases as compared with gallium 67 citrate. Clin Nucl Med 13:107–109PubMedCrossRefGoogle Scholar
  103. Walsh TJ et al (1985) The value of gallium-67 scanning in pulmonary tuberculosis. Am Rev Respir Dis 132:746–747PubMedGoogle Scholar
  104. Wang Y, Sabow LT, Dee WF (1972) 131-1 study of thyroid tuberculosis mimicking thyroid carcinoma. CRC Crit Rev Radiol Sei 3:101–103Google Scholar
  105. Wiggelinkhuizen J, Mann M (1980) The radioactive bromide partition test in the diagnosis of tuberculous meningitis in children. J Pediatr 97:843–847PubMedCrossRefGoogle Scholar
  106. Winzelberg GG (1981) Radionuclide evaluation of miliary tuberculosis. Clin Nucl Med 6:330–331PubMedCrossRefGoogle Scholar
  107. Yang S-O et al (1992) Detection of extrapulmonary tuberculosis with gallium-67 scan and computed tomography. J Nucl Med 33:2118–2123PubMedGoogle Scholar
  108. Young T-H et al (1996) Esophageal tuberculosis with supraclavicular lymph node involvement demonstrated by Ga-67 imaging. Clin Nucl Med 21:344PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • David Hamilton
    • 1
  • Jawda Al-Nabulsi
    • 1
  1. 1.Department of Nuclear MedicineRiyadh Armed Forces HospitalRiyadhSaudi Arabia

Personalised recommendations