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Introduction <p>Spinal tuberculosis (STB) is a severe form of extrapulmonary tuberculosis associated with diagnostic delay and substantial morbidity. The extent of disease—isolated versus disseminated STB—remains poorly defined. We applied whole-body 18F-FDG-PET/CT to characterise the clinical and radiographic phenotype of STB.</p> Material and methods <p>The Spinal TB X cohort (NCT05610098) is a prospective study of HIV-infected and uninfected patients with suspected STB in Cape Town, South Africa. We analysed the first ten patients with microbiologically confirmed STB. Demographic, clinical, microbiological, histological, and PET/CT data were collected. Isolated STB was defined as spinal involvement only, while disseminated STB was defined as additional organ involvement confirmed by microbiology and/or PET/CT. The study was approved by the Human Research Ethics Committee of the University of Cape Town (HREC 243/2022). Written informed consent was obtained from all participants.</p> Results <p>Ten patients (median age 44 years [IQR 26], 80% male, 30% HIV-positive) were included. A total of 14 spinal lesions involving 44 vertebrae were detected; psoas abscesses were present in six patients. Mean SUVmax and SUVmean of spinal lesions were 15.2 (SD 4.6) and 6.9 (SD 1.5), respectively; mean total lesion glycolysis (TLG) was 363.2 SUVbw*mL (SD 341.9). Based on microbiology alone, 40% had disseminated STB, combining microbiology with PET/CT findings, 60% had disseminated disease.</p> Conclusion <p>Whole-body PET/CT revealed a high frequency of disseminated disease, underscoring the systemic nature of TB even when clinical presentation is spinal. Isolated STB may represent a distinct phenotype. PET/CT shows promise for assessing disease burden and warrants further evaluation.</p>

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Whole-body PET/CT reveals systemic dissemination in spinal tuberculosis: findings from the Spinal TB X cohort

  • 期刊论文

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  • 发表日期：

    2026年3月3日

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  • Julian Scherer,
  • Sandra L. Mukasa,
  • Karen Wolmarans,
  • Fareda Jakoet-Bassier,
  • Ashleigh Taylor,
  • Reto Guler,
  • Tessa Kotze,
  • Taeksun Song,
  • Robert Dunn,
  • Maritz Laubscher,
  • Hans-Christoph Pape,
  • Michael Held,
  • Friedrich Thienemann

摘要

Introduction

Spinal tuberculosis (STB) is a severe form of extrapulmonary tuberculosis associated with diagnostic delay and substantial morbidity. The extent of disease—isolated versus disseminated STB—remains poorly defined. We applied whole-body 18F-FDG-PET/CT to characterise the clinical and radiographic phenotype of STB.

Material and methods

The Spinal TB X cohort (NCT05610098) is a prospective study of HIV-infected and uninfected patients with suspected STB in Cape Town, South Africa. We analysed the first ten patients with microbiologically confirmed STB. Demographic, clinical, microbiological, histological, and PET/CT data were collected. Isolated STB was defined as spinal involvement only, while disseminated STB was defined as additional organ involvement confirmed by microbiology and/or PET/CT. The study was approved by the Human Research Ethics Committee of the University of Cape Town (HREC 243/2022). Written informed consent was obtained from all participants.

Results

Ten patients (median age 44 years [IQR 26], 80% male, 30% HIV-positive) were included. A total of 14 spinal lesions involving 44 vertebrae were detected; psoas abscesses were present in six patients. Mean SUVmax and SUVmean of spinal lesions were 15.2 (SD 4.6) and 6.9 (SD 1.5), respectively; mean total lesion glycolysis (TLG) was 363.2 SUVbw*mL (SD 341.9). Based on microbiology alone, 40% had disseminated STB, combining microbiology with PET/CT findings, 60% had disseminated disease.

Conclusion

Whole-body PET/CT revealed a high frequency of disseminated disease, underscoring the systemic nature of TB even when clinical presentation is spinal. Isolated STB may represent a distinct phenotype. PET/CT shows promise for assessing disease burden and warrants further evaluation.