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The extent of disease\u2014isolated versus disseminated STB\u2014remains poorly defined. We applied whole-body 18F-FDG-PET\/CT to characterise the clinical and radiographic phenotype of STB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats: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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-026-02750-w","type":"journal-article","created":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T13:12:51Z","timestamp":1772543571000},"page":"1335-1345","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Whole-body PET\/CT reveals systemic dissemination in spinal tuberculosis: findings from the Spinal TB X cohort"],"prefix":"10.1007","volume":"54","author":[{"given":"Julian","family":"Scherer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra L.","family":"Mukasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Wolmarans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fareda","family":"Jakoet-Bassier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashleigh","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reto","family":"Guler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tessa","family":"Kotze","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeksun","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maritz","family":"Laubscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Christoph","family":"Pape","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Held","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedrich","family":"Thienemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"2750_CR1","doi-asserted-by":"publisher","first-page":"319","DOI":"10.3171\/jns.1992.76.2.0319","volume":"76","author":"ES Flamm","year":"1992","unstructured":"Flamm ES. 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