TY - JOUR T1 - PET/CT features of Extrapulmonary Tuberculosis at first clinical presentation - a cross-sectional observational <sup>18</sup>F-FDG imaging study across six countries JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.01959-2019 SP - 1901959 AU - Jamshed Bomanji AU - Rajnish Sharma AU - Bhagwant R. Mittal AU - Sanjay Gambhir AU - Ahmad Qureshy AU - Shamim M.F. Begum AU - Diana Paez AU - Mike Sathekge AU - Mariza Vorster AU - Dragana Sobic Saranovic AU - Pawana Pusuwan AU - Vera Mann AU - Sobhan Vinjamuri AU - Alimuddin Zumla AU - Thomas N.B. Pascual A2 - , Y1 - 2019/01/01 UR - http://erj.ersjournals.com/content/early/2019/11/13/13993003.01959-2019.abstract N2 - Background A large proportion of the huge global burden of Extrapulmonary tuberculosis (EPTB) are treated empirically without accurate definition of disease sites, and extent of multi-organ disease involvement. Positron emission tomography (PET) imaging using 18F-FDG in TB could be a useful imaging technique for localising disease sites and extent of disease.Methods We conducted a study of HIV-negative adult patients with a new clinical diagnosis of EPTB across 8 centres located in 6 countries: India, Pakistan, Thailand, South Africa, Serbia, and Bangladesh to assess the extent of disease and common sites involved at first presentation. 18F-FDG PET/CT scans were performed within 2 weeks of presentation.Findings A total of 358 patients with EPTB (189 females; 169 males) were recruited over 45 months. Age range 18–83 years (females: median 30 years; males: median 38 years). 350/358 (98%) patients (183 female, 167 male) had positive scan. 118/350 (33.7%) had a single extrapulmonary site and 232/350 (66.3%) had more than one site (organ) affected. Lymph nodes, skeletal, pleura and brain were common sites. 100/358 (28%) of EPTB patients had 18F-FDG PET/CT positive sites in the lung. 110 patients were 18F-FDG PET/CT positive in more body sites than were noted clinically at first presentation and 160 patients had the same number of positive body sites.Interpretation 18F-FDG PET/CT scan has potential for further elucidating the spectrum of disease, pathogenesis of EPTB, and monitoring the effects of treatment on active lesions over time, and requires longitudinal cohort studies, twinned with biopsy and molecular studies.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Jamshed Bomanji was the PI and received non-financial support from IAEA, Vienna, during the conduct of the study.Conflict of interest: Dr. Sharma, got grant and non-financial support from IAEA, Vienna, during the conduct of the study.Conflict of interest: Dr. Mittal reports grants and non-financial support from IAEA, Vienna, during the conduct of the study.Conflict of interest: Dr. Gambhir reports grants and non-financial support from IAEA, Vienna, during the conduct of the study.Conflict of interest: Dr. Qureshy reports grants and non-financial support from IAEA, Vienna, during the conduct of the study.Conflict of interest: Dr. S. Begum, obtained grant and non-financial support from IAEA, Vienna, during the conduct of the study.Conflict of interest: Dr. PAEZ has nothing to disclose.Conflict of interest: Dr. Sathekge reports grants from International Atomic Energy association (IAEA), during the conduct of the study.Conflict of interest: Dr. Vorster reports grants from International Atomic Energy Association (IAEA), during the conduct of the study.Conflict of interest: Dr. Sobic Saranovic reports grants and non-financial support from IAEA, Vienna, during the conduct of the study.Conflict of interest: Dr. Pusuwan reports grants and non-financial support from IAEA, Vienna, during the conduct of the study.Conflict of interest: Dr. Mann reports other from UCLH, during the conduct of the study.Conflict of interest: Dr. VINJAMURI has nothing to disclose.Conflict of interest: Dr. Zumla has nothing to disclose.Conflict of interest: Dr. PASCUAL has nothing to disclose. ER -