PET Hybrid Imaging of the Thorax

  • Deena NerimanEmail author
  • Ali Vahedi
  • Stefan Voo
  • James Connelly
  • Francesco Fraioli


For many years scintigraphy, planar imaging of radioactive emission using a large area detector, formed the backbone of nuclear medicine techniques with low spatial resolution but high sensitivity. Combined with the properties of a tracer, a substance labelled with a radioactive element (radionuclide), the technique could be used for imaging tissue properties or physiological processes. Advances in engineering and computing technology allowed the technique to move into 3-dimensional image reconstruction and then combined with radiological techniques, particularly CT, to provide state-of-the-art hybrid imaging techniques. Positron-emission tomography (PET) is fast becoming the dominant nuclear medicine technique, due to its higher sensitivity and resolution than single-photon-emission computed tomography (SPECT). It has been widely used for investigating malignant diseases and increasingly used for inflammatory diseases and infection. Whilst computed tomography (CT) images represent a snapshot of patient anatomy, radiopharmaceuticals and PET provide the means to image pathophysiology.


PET SUV PET tracers PET lymphoma PET mesothelioma PET oesophagus PET lung PET thymoma PET infection PET PUO PET immunodeficiency PET Vasculitis PET Sarcoidosis PET ILD PET autoimmune Nuclear MPS Nuclear MPI Nuclear chest PET cardiac PET chest 



Thanks to Dr. Leon Menezes for the cardiac sarcoid case, and to Dr. Ben Thomas and Dr. Trine Hjørnevik for commenting on the physics and technical part of the manuscript.


  1. 1.
    Cherry SR, Sorenson JA, Phelps ME. Physics in nuclear medicine. 4th ed. Amsterdam: Elsevier; 2012.Google Scholar
  2. 2.
    Conti M, Eriksson L. Physics of pure and non-pure positron emitters for PET: a review and a discussion. EJNMMI Phys. 2016;3:8.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Fraioli F, Punwani S. Clinical and research applications of simultaneous positron emission tomography and MRI. Br J Radiol. 2014;87(1033):20130464.CrossRefPubMedGoogle Scholar
  4. 4.
    Kinahan PE, Fletcher JW, et al. PET/CT standardized uptake values (SUVs) in clinical practice and assessing response to therapy. Semin Ultrasound CT MR. 2010;31(6):496–505. Scholar
  5. 5.
    Scarsbrook A, Barrington S. Evidence-based indications for the use of PET-CT in the United Kingdom 2016. Royal college of radiologists. 2016. Accessed 3 April 2017.
  6. 6.
    Gupta NC, Maloof J, Gunel E. Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET. J Nucl Med. 1996;37(6):943–8.PubMedGoogle Scholar
  7. 7.
    Inoue T, Kim EE, Komaki R, et al. Detecting recurrent or residual lung cancer with FDG-PET. J Nucl Med. 1995;36(5):788–93.PubMedGoogle Scholar
  8. 8.
    Ruilong Z, Daohai X, Li G, et al. Diagnostic value of 18F-FDG-PET/CT for the evaluation of solitary pulmonary nodules: a systematic review and meta-analysis. Nucl Med Commun. 2017;38(1):67–75.CrossRefPubMedGoogle Scholar
  9. 9.
    Yilmaz F, Tastekin G. Sensitivity of (18)F-FDG PET in evaluation of solitary pulmonary nodules. Int J Clin Exp Med. 2015;8(1):45–51. eCollection 2015.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Boellaard R, Delgado-Bolton R, Oyen WJG, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54. Scholar
  11. 11.
    Novello S, Barlesi F, Califano R, Cufer T, Ekman S, Giaj Levra M, Kerr K, Popat S, Reck M, Senan S, Simo GV, Vansteenkiste J, Peters S. Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines. 2016. Accessed 10 May 2017.
  12. 12.
    Dwamena BA, Sonnad SS, Angobaldo JO, Wahl RL. Metastases from non-small cell lung cancer: mediastinal staging in the 1990s—meta-analytic comparison of PET and CT. Radiology. 1999;213(2):530–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Akhurst T, Downey RJ, Ginsberg MS, et al. An initial experience with FDG-PET in the imaging of residual disease after induction therapy for lung. Cancer. Ann Thorac Surg. 2002;73(1):259–64.CrossRefPubMedGoogle Scholar
  14. 14.
    Chopra A, Ford A, De Noronha R, Matthews S. Incidental findings on positron emission tomography/CT scans performed in the investigation of lung cancer. Br J Radiol. 2012;85(1015):e229–37. Scholar
  15. 15.
    Lee SM, Goo JM, Park CM, et al. Preoperative staging of non-small cell lung cancer: prospective comparison of PET/MR and PET/CT. Eur Radiol. 2016;26(11):3850–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Marom EM, McAdams HP, Erasmus JJ, et al. Staging non-small cell lung cancer with whole-body PET. Radiology. 1999;212(3):803–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Hellwig D, Ukena D, Paulsen F, et al. Meta-analysis of the efficacy of positron emission tomography with F-18-fluorodeoxyglucose in lung tumors. Basis for discussion of the German consensus conference on PET in oncology 2000. Pneumologie. 2001;55(8):367–77.CrossRefPubMedGoogle Scholar
  18. 18.
    Sheikhbahaei S, Mena E, Yanamadala A, Reddy S, Solnes LB, Wachsmann J, Subramaniam RM. The value of FDG PET/CT in treatment response assessment, follow-up, and surveillance of lung cancer. Am J Roentgenol. 2017;208:420–33. Scholar
  19. 19.
    Fraioli F, Kayani I, Smith L-J, et al. Positive 18F Fluorodeoxyglucose-positron emission tomography/computer tomography predicts Preinvasive Endobronchial lesion progression to invasive cancer. Am J Respir Crit Care Med. 2016;193:576–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Weller A, O’Brien MER, Ahmed M. Mechanisms and non-mechanism based imaging biomarkers for assessing biological response to treatment in non-small cell lung cancer. Eur J Cancer. 2016;59:65–78.CrossRefPubMedGoogle Scholar
  21. 21.
    Kalemkerian GP. Staging and imaging of small cell lung cancer. Cancer Imaging. 2011;11(1):253–8.CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Bodei L, Sundin A, Kidd M, Prasad V, Modlin IM. The status of neuroendocrine tumor imaging: from darkness to light? Neuroendocrinology. 2015;101:1–17. Scholar
  23. 23.
    Caplin ME, Baudin E, Ferolla P, et al. Pulmonary neuroendocrine (carcinoid) tumors: European neuroendocrine tumor society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. Ann Oncol. 2015;26(8):1604–20. Scholar
  24. 24.
    Deppen SA, Blume J, Bobbey A, et al. 68Ga-DOTATATE compared with 111In-DTPA-octreotide and conventional imaging for pulmonary and gastroenteropancreatic neuroendocrine tumors: a systematic review and meta-analysis. J Nucl Med. 2016;57(6):872–8.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Barrington SF, Mikhaeel NG, Kostakoglu L, et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the international conference on malignant lymphomas imaging working group. J Clin Oncol. 2014;32(27):3048–58. Scholar
  26. 26.
    Cheson BD, Ansell S, Schwartz L, Gordon LI, Advani R, Jacene HA, Hoos A, Barrington SF, Armand P. Refinement of the Lugano classification response criteria for lymphoma in the era of immunomodulatory therapy. 2016. Accessed 10 May 2017.
  27. 27.
    Baas P, Dl F, Kerr KM, Van Schil PE, Haas RL, Peter S. Malignant pleural mesothelioma: ESMO clinical practice guidelines. Ann Oncol. 2015;26(5):v31–9. Scholar
  28. 28.
    Kruse M, Sherry SJ, Paidpally V, Mercier G, Subramaniam RM. FDG PET/CT in the management of primary pleural tumors and pleural metastases. AJR Am J Roentgenol. 2013;201(2):W215–26. Review.CrossRefPubMedGoogle Scholar
  29. 29.
    Erasmus JJ, Truong MT, Smythe WR, et al. Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: staging implications. J Thorac Cardiovasc Surg. 2005;129(6):1364–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Plathow C, Staab A, Schmaehl A, et al. Computed tomography, positron emission tomography, positron emission tomography/computed tomography, and magnetic resonance imaging for staging of limited pleural mesothelioma: initial results. Investig Radiol. 2008;43(10):737–44. Scholar
  31. 31.
    Basu S, Saboury B, Torigian DA, Alavi A. Current evidence base of FDG-PET/CT imaging in the clinical management of malignant pleural mesothelioma: emerging significance of image segmentation and global disease assessment. Mol Imaging Biol. 2011;13(5):801–11. Scholar
  32. 32.
    Carretta A, Landoni C, Melloni G, Ceresoli GL, et al. P.18-FDG positron emission tomography in the evaluation of malignant pleural diseases - a pilot study. Eur J Cardiothorac Surg. 2000;17(4):377–83.CrossRefPubMedGoogle Scholar
  33. 33.
    Sung YM, Lee KS, Kim BT, Choi JY, Shim YM, Yi CA. 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med. 2006;47(10):1628–34.PubMedGoogle Scholar
  34. 34.
    Lordick F, Mariette C, Haustermans K, Obermannová R, Arnold D. Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(5):v50–7. Scholar
  35. 35.
    van Westreenen HL, Westerterp M, Bossuyt PM, et al. Systematic review of the staging performance of18F-fluorodeoxyglucose positron emission tomography in esophageal cancer. J Clin Oncol. 2004;22(18):3805–12. Review.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Van Vliet EP, Heijenbrok-Kal MH, Hunink MG, et al. Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer. 2008;98(3):547–57. Scholar
  37. 37.
    Cuenca X, Hennequin C, Hindié E, Rivera S, et al. Evaluation of early response to concomitant chemoradiotherapy by interim 18F-FDG PET/CT imaging in patients with locally advanced oesophageal carcinomas. Eur J Nucl Med Mol Imaging. 2013;40(4):477–85. Scholar
  38. 38.
    Love C, Tomas MB, Tronco GG, Palestro CJ. FDG PET of infection and inflammation. Radiographics. 2005;25(5):1357–68.CrossRefPubMedGoogle Scholar
  39. 39.
    Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. Int J Infect Dis. 2015;32:87–93.CrossRefPubMedGoogle Scholar
  40. 40.
    Kim IJ, Lee JS, Kim SJ, Kim YK. Double-phase 18F-FDG PET-CT for determination of pulmonary tuberculoma activity. Eur J Nucl Med Mol Imaging. 2008;35(4):808–14.CrossRefPubMedGoogle Scholar
  41. 41.
    Martinez V, Castilla-Lievre MA, Guillet-Caruba C, Grenier G. (18)F-FDG PET/CT in tuberculosis: an early non-invasive marker of therapeutic response. Int J Tuberc Lung Dis. 2012;16(9):1180–5. Scholar
  42. 42.
    Sathekge M, Maes A, D’Asseler Y, Vorster M, et al. Tuberculous lymphadenitis: FDG PET and CT findings in responsive and nonresponsive disease. Eur J Nucl Med Mol Imaging. 2012;39(7):1184–90. Scholar
  43. 43.
    Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging and scintigraphy. Semin Plast Surg. 2009;23(2):80–9.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Ito K, Kubota K, Morooka M, Hasuo K, et al. Clinical impact of (18)F-FDG PET/CT on the management and diagnosis of infectious spondylitis. Nucl Med Commun. 2010;31(8):691–8. Scholar
  45. 45.
    Sharma P, Mukherjee A, Karunanithi S, Bal C, Kumar R. Potential role of 18F-FDG PET/CT in patients with fungal infections. Am J Roentgenol. 2014;203:180–9.CrossRefGoogle Scholar
  46. 46.
    Davison JM, Subramaniam RM, Surasi DS, et al. FDG PET/CT in patients with HIV. Am J Roentgenol. 2011;197:284–94.CrossRefGoogle Scholar
  47. 47.
    Balink H, Bennink RJ, van Eck-Smit BLF, Verberne HJ. The role of 18F-FGD PET/CT in large vessel vasculitis: appropriateness of current classification criteria? Biomed Res Int. 2014;2014:687608. Scholar
  48. 48.
    Papathanasiou ND, Du Y, Menezes LJ, Almuhaideb A, Shastry M, Beynon H, Bomanji JB. 18FFludeoxyglucose PET/CT in the evaluation of large-vessel vasculitis: diagnostic performance and correlation with clinical and laboratory parameters. Br J Radiol. 2012;85(1014):e188–94.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Bucerius J. Monitoring Vasculitis with 18F-FDG PET. QJ Nucl Med Mol Imaging. 2016;60(3):219–35.Google Scholar
  50. 50.
    Lee YH, Choi SJ, Ji JD, Song GG. Diagnostic accuracy of 18F-FDG PET or PET/CT for large vessel vasculitis: a meta-analysis. Z Rheumatol. 2016;75(9):924–31. Review.CrossRefPubMedGoogle Scholar
  51. 51.
    Soussan M, Nicolas P, Schramm C, Katsahian S, Pop G, Fain O, Mekinian A. Management of large-vessel vasculitis with FDG-PET: a systematic literature review and meta-analysis. Medicine (Baltimore). 2015;94(14):e622.
  52. 52.
    Prabhakar HB, Rabinowitz CB, Gibbons FK, O’Donnell WJ, Shepard J-AO, Aquino SL. Imaging features of sarcoidosis on MDCT, FDG PET, and PET/CT. Am J Roentgenol. 2008;190:S1–6.CrossRefGoogle Scholar
  53. 53.
    Mostard RL, van Kroonenburgh MJ, Drent M. The role of the PET scan in the management of sarcoidosis. Curr Opin Pulm Med. 2013;19(5):538–44.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Deena Neriman
    • 1
    Email author
  • Ali Vahedi
    • 1
  • Stefan Voo
    • 1
  • James Connelly
    • 1
  • Francesco Fraioli
    • 1
  1. 1.University College London HospitalsLondonUK

Personalised recommendations