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PET/CT imaging in lung cancer: indications and findings.

Hochhegger B, Alves GR, Irion KL, Fritscher CC, Fritscher LG, Concatto NH, Marchiori E - J Bras Pneumol (2015 May-Jun)

Bottom Line: In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer.However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders.Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment.

View Article: PubMed Central - PubMed

Affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

ABSTRACT
The use of PET/CT imaging in the work-up and management of patients with lung cancer has greatly increased in recent decades. The ability to combine functional and anatomical information has equipped PET/CT to look into various aspects of lung cancer, allowing more precise disease staging and providing useful data during the characterization of indeterminate pulmonary nodules. In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer. However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders. Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment. This review article aimed to summarize the basic principles, indications, cancer staging considerations, and future applications related to the use of PET/CT in lung cancer.

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PET/CT scan of the chest, revealing numerous areas of high 18F-fluorodeoxyglucose uptake in a 72-year-old male patient with osteoarthritis. In this case, the greater uptake arose from the abnormal inflammatory status, which led to higher glucose consumption.
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f05: PET/CT scan of the chest, revealing numerous areas of high 18F-fluorodeoxyglucose uptake in a 72-year-old male patient with osteoarthritis. In this case, the greater uptake arose from the abnormal inflammatory status, which led to higher glucose consumption.

Mentions: As a general rule, SUVmax values ≥ 2.5 are considered indicative of malignant processes, whereas tumors showing an SUVmax < 2.5 are more likely to be benign. However, many conditions that increase metabolic activity can lead to increased FDG uptake on PET/CT imaging (Figure 5), thus producing numerous challenging situations. Such conditions include infections (such as tuberculosis and aspergillosis), inflammation (iatrogenic or caused by rheumatoid arthritis or amyloidosis), and even pulmonary infarction. In addition, the physiological uptake of FDG that is typically present in the brain, heart, gastrointestinal tract, genitourinary tract, and striated muscles can occasionally give the impression of increased FDG uptake on PET/CT imaging, leading to false-positive results.(14) Another cause of false-negative FDG uptake is inherent to the technological limitations of PET/CT and to the properties of tumor cells. Lesions that measure less than two to three times the spatial resolution of the scanner will usually appear less active due to the partial volume effect. Furthermore, lesions containing few cells, or cells with low metabolic rates, such as highly differentiated tumors, can also create pitfalls in PET/CT interpretation.(8)


PET/CT imaging in lung cancer: indications and findings.

Hochhegger B, Alves GR, Irion KL, Fritscher CC, Fritscher LG, Concatto NH, Marchiori E - J Bras Pneumol (2015 May-Jun)

PET/CT scan of the chest, revealing numerous areas of high 18F-fluorodeoxyglucose uptake in a 72-year-old male patient with osteoarthritis. In this case, the greater uptake arose from the abnormal inflammatory status, which led to higher glucose consumption.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541763&req=5

f05: PET/CT scan of the chest, revealing numerous areas of high 18F-fluorodeoxyglucose uptake in a 72-year-old male patient with osteoarthritis. In this case, the greater uptake arose from the abnormal inflammatory status, which led to higher glucose consumption.
Mentions: As a general rule, SUVmax values ≥ 2.5 are considered indicative of malignant processes, whereas tumors showing an SUVmax < 2.5 are more likely to be benign. However, many conditions that increase metabolic activity can lead to increased FDG uptake on PET/CT imaging (Figure 5), thus producing numerous challenging situations. Such conditions include infections (such as tuberculosis and aspergillosis), inflammation (iatrogenic or caused by rheumatoid arthritis or amyloidosis), and even pulmonary infarction. In addition, the physiological uptake of FDG that is typically present in the brain, heart, gastrointestinal tract, genitourinary tract, and striated muscles can occasionally give the impression of increased FDG uptake on PET/CT imaging, leading to false-positive results.(14) Another cause of false-negative FDG uptake is inherent to the technological limitations of PET/CT and to the properties of tumor cells. Lesions that measure less than two to three times the spatial resolution of the scanner will usually appear less active due to the partial volume effect. Furthermore, lesions containing few cells, or cells with low metabolic rates, such as highly differentiated tumors, can also create pitfalls in PET/CT interpretation.(8)

Bottom Line: In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer.However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders.Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment.

View Article: PubMed Central - PubMed

Affiliation: Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

ABSTRACT
The use of PET/CT imaging in the work-up and management of patients with lung cancer has greatly increased in recent decades. The ability to combine functional and anatomical information has equipped PET/CT to look into various aspects of lung cancer, allowing more precise disease staging and providing useful data during the characterization of indeterminate pulmonary nodules. In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer. However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders. Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment. This review article aimed to summarize the basic principles, indications, cancer staging considerations, and future applications related to the use of PET/CT in lung cancer.

Show MeSH
Related in: MedlinePlus