Molecular imaging of pulmonary cancer and inflammation - PubMed (original) (raw)

Review

Molecular imaging of pulmonary cancer and inflammation

Chaitanya R Divgi. Proc Am Thorac Soc. 2009.

Abstract

Molecular imaging (MI) may be defined as imaging in vivo using molecules that report on biologic function. This review will focus on the clinical use of radioactive tracers (nonpharmacologic amounts of compounds labeled with a radioactive substance) that permit external imaging using single photon emission computed tomography (planar, SPECT) or positron emission tomography (PET) imaging. Imaging of lung cancer has been revolutionized with the use of fluorine-18-labeled fluorodeoxyglucose (18F-FDG), an analog of glucose that can be imaged using PET. The ability to carry out whole body imaging after intravenous injection of 18F-FDG allows accurate staging of disease, helping to determine regional and distant nodal and other parenchymal involvement. Glycolysis is increased in nonmalignant conditions, including inflammation (e.g., sarcoidosis), and 18F-FDG PET is a sensitive method for evaluation of active inflammatory disease. Inflammatory disease has been imaged, even before the advent of PET, with planar and SPECT imaging using gallium-67, a radiometal that binds to transferrin. Metabolic alteration in pulmonary pathology is currently being studied, largely in lung cancer, primarily with PET, with a variety of other radiotracers. Prominent among these is thymidine; fluorine-18-labeled thymidine PET is being increasingly used to evaluate proliferation rate in lung and other cancers. This overview will focus on the clinical utility of 18F-FDG PET in the staging and therapy evaluation of lung cancer as well as in imaging of nonmalignant pulmonary conditions. PET and SPECT imaging with other radiotracers of interest will also be reviewed. Future directions in PET imaging of pulmonary pathophysiology will also be explored.

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Figures

Figure 1.

Patient with lung cancer, imaged with fluorodeoxyglucose (FDG) positron emission tomorgraphy (PET)/computed tomography (CT). The patient had known right lung cancer and hilar metastasis (A, arrows); right supraclavicular nodal metastasis (B, arrow) and left femoral osseous metastasis (C, arrow) were revealed on FDG PET/CT, changing management.

Figure 1.

Figure 2.

Same patient as in Figure 1, before (left) and after (right) therapy. The bone lesion (arrows) is much less glycolytically active after therapy, though it appears unchanged on companion CT.

Figure 3.

Chest FDG PET of a patient with active sarcoidosis. Bilateral inflamed mediastinal nodes (arrows) are a characteristic feature of this disease.

Figure 4.

An anterior chest planar image of a patient with HIV and symptoms of Pneumocystis carinii pneumonia. There is uptake of gallium-67 in both lungs (arrow).

Figure 5.

A chest FDG PET three-dimensional projection of patient with metastatic thyroid cancer, imaged 3 days after oral iodine-124. Diffuse lung metastases (arrow) are clearly visualized.

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Molecular imaging of pulmonary cancer and inflammation - PubMed (original) (raw)