Imaging Modalities in Tuberculosis

Tuberculosis (TB) remains a major global health challenge, with increasing prevalence of multidrug-resistant and extrapulmonary forms complicating diagnosis and management. Imaging plays a pivotal role in the early detection, characterization, and treatment monitoring of TB, particularly when clinical or microbiological findings are inconclusive. Modalities such as chest radiography, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), and ¹⁸F-fluorodeoxyglucose positron emission tomography combined with CT (¹⁸F-fluorodeoxyglucose [¹⁸F-FDG PET-CT]) provide critical insights into pulmonary, extrapulmonary, and disseminated TB. While chest X-ray is a first-line tool, CT and MRI offer superior anatomical detail, and PET-CT adds metabolic evaluation, aiding differentiation of active versus inactive disease and monitoring therapeutic response. Imaging is especially valuable in TB involving the central nervous system (CNS), musculoskeletal system, abdomen, and genitourinary tract. Advanced techniques and artificial intelligence (AI)-driven tools hold promise for enhancing diagnostic accuracy and guiding personalized treatment. This review comprehensively reviews the imaging spectrum of TB, underscoring its evolving role across the disease continuum.