CLINICAL ARTICLE Comparison of PET/CT with other imaging modalities in women with genital tuberculosis Jai B. Sharma a , Debjyoti Karmakar a, ⁎, Rakesh Kumar b , Shamim A. Shamim b , Sunesh Kumar a , Neeta Singh a , Kallol K. Roy a , Rama M. Reddy b a Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India b Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India abstract article info Article history: Received 30 October 2011 Received in revised form 16 February 2012 Accepted 24 April 2012 Keywords: Computed tomography Genital tuberculosis Magnetic resistance imaging Positron emission tomography Tubercular tubo-ovarian masses Ultrasound Objective: To compare findings with 2-deoxy-2-( 18 F)fluoro-D-glucose positron emission tomography com- bined with computed tomography ( 18 F-FDG-PET/CT) with findings obtained using ultrasound (US), magnetic resonance imaging (MRI), and CT in patients with proven tubercular tubo-ovarian masses. Methods: Seven- teen patients with proven tubercular tubo-ovarian masses underwent 18 F-FDG-PET/CT imaging and the find- ings were compared with US (for all patients), MRI (for 9 patients), CT (for 4 patients), and laparotomy or laparoscopic findings (for 14 patients). Results: Eleven patients (64.7%) had unilateral tubo-ovarian masses, with activity in 6 masses (35.3%); 4 patients (23.5%) had bilateral tubo-ovarian masses, with activity in all masses; and 2 patients (11.76%) had unilateral space-occupying lesions, with activity in 1 lesion. The detec- tion rates of tubo-ovarian masses with 18 F-FDG-PET/CT were similar to, but the characterization of adnexal masses was less than, those obtained with CT or MRI. Finally, 18 F-FDG-PET/CT was equally accurate as lapa- roscopy or laparotomy in detecting the presence, laterality, and activity of tubo-ovarian masses. Conclusion: Imaging with 18 F-FDG-PET/CT is noninvasive and appears to be clinically useful for the diagnosis of tubercu- lar tubo-ovarian masses. © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction Tuberculosis (TB) is a re-emerging public health problem globally, with the HIV epidemic probably contributing to the upsurge in female genital TB in low-income countries [1]. Genital TB, usually secondary to pulmonary or abdominal TB, can present with a spectrum of man- ifestations. In endemic areas, the differential diagnosis of adnexal masses should be performed [2,3]. Gold standards for the diagnosis of genital TB are the microscopic visualization of acid-fast bacilli in endometrial aspirate, the finding of tuberculous granulomas on histopathologic examination, and the successful culture of tubercle bacilli. However, these methods permit a diagnosis only in small numbers of cases [4]. Polymerase chain reac- tion (PCR) for Mycobacterium tuberculosis is also not very reliable [4]. Laparoscopy is useful in the detection of peritoneal and genital TB whereas hysteroscopy is useful in the detection of tuberculous endo- metritis [5], but these invasive techniques are associated with disease flare-up and increased complication rates in women with genital TB [6,7]. Laparotomy sometimes permits to diagnose genital and perito- neal TB and is useful when ovarian cancer is suspected, but it is also associated with increased complications rates [7]. Still, biopsy speci- mens obtained at laparoscopy or laparotomy can lead to a gold stan- dard diagnostic. Hysterosalpingography is often avoided because of its nonspecificity and because of the possibility of aggravating undiagnosed genital TB, but it may suggest the diagnosis of genital TB in women undergoing investigations for infertility [8]. Although ultrasound is the most used imaging modality in the diagnosis and characterization of tubercular tubo-ovarian masses, computed tomography (CT) can also give useful but usually nonspecific infor- mation [9]. Soft-tissue adnexal masses are better characterized by magnetic resonance imaging (MRI) than by CT or ultrasound [10]; and 2-deoxy-2-( 18 F)fluoro-D-glucose positron emission tomogra- phy ( 18 F-FDG-PET) combined with CT, a novel modality for the de- tection of malignancies and inflammatory masses, differentiates between active and inactive disease by showing an increased uptake of glucose [11]. 2. Materials and methods We present results obtained using 18 F-FDG-PET/CT in a series of 17 consecutive patients with tubercular tubo-ovarian masses. The present prospective study was conducted from January 1, 2008, to July 31, 2009, in women recruited from the Outpatient Unit of the Department of Obstetrics and Gynecology of All India Institute of Medical Sciences, New Delhi, India. The main objective was to confirm the role of PET as International Journal of Gynecology and Obstetrics 118 (2012) 123–128 ⁎ Corresponding author at: Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. Tel.: + 91 9650428656; fax: + 91 1126598665. E-mail address: dkcoolmed@yahoo.com (D. Karmakar). 0020-7292/$ – see front matter © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2012.02.020 Contents lists available at SciVerse ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo