Article Figures & Data
Figures
- FIGURE 1.
A case study for using the TNM method. A 64-y-old man with lung cancer in right upper lobe, stage T2a N3 M1b. (A) Axial CT image shows mass (arrow) in right upper lobe close to hilum. Prominent subcarinal lymph node (arrowhead) is seen. (B) Axial coregistered PET/CT image confirms highly 18F-FDG–avid tumor (long arrow) and presence of subcarinal nodal metastases (arrowhead) and right hilar metastases (short arrow). (C) Axial CT image at level of gastroesophageal junction shows slightly hyperdense liver lesion (arrows) in region of intrahepatic segment of inferior vena cava, being hardly appreciated. (D) Axial coregistered PET/CT image reveals intense 18F-FDG uptake of lesion (arrows), compatible with metastasis. (E) Coronal PET maximum-intensity projection image confirms nodal metastases in right hilum, mediastinum, and right supraclavicular region (arrowheads) and multiple liver metastases. Primary tumor (short arrow) is seen as well. (F and G) Axial liver acquisition volume acceleration (LAVA) (water-only) image (repetition time, 4.3 ms; echo time, 1.3 ms; flip angle, 12°) (F) and coregistered PET/LAVA image (G) show primary tumor (long arrow) in right upper lobe, nodal metastases in right hilum (short arrow), and subcarinal region (arrowhead). (H and I) Axial LAVA (water-only) image (repetition time, 4.3 ms; echo time, 1.3 ms; flip angle, 12°) (H) and coregistered PET/LAVA image (I) show liver metastasis (long arrows) with more anatomic detail. Intrahepatic segment of inferior vena cava (arrowhead) is compressed but not infiltrated. Fat plane between liver and right crus of diaphragm (short arrow) is preserved. Martin W. Huellner. TNM staging of non-small cell lung cancer: comparison of PET/MR and PET/CT. J Nucl Med. 2016;57(1):21–26.
- FIGURE 2.
Chest radiograph showing mass in right mid zone. Sandip Basu. 18-F FDG PET/CT imaging features of IgG4-related pulmonary inflammatory pseudotumor at initial diagnosis and during early treatment monitoring. J Nucl Med Technol. 2016;44(3):207–209.
- FIGURE 3.
Contrast-enhanced CT of chest showing heterogeneously enhancing mass with calcification in right middle lobe. Sandip Basu. 18-F FDG PET/CT imaging features of IgG4-related pulmonary inflammatory pseudotumor at initial diagnosis and during early treatment monitoring. J Nucl Med Technol. 2016;44(3):207–209.
- FIGURE 4.
Patient with lung adenocarcinoma in right lower lobe, as depicted by arrow. (A) CT scan. (B) 4′-[methyl-11C] thiothymidine PET. (C) 18F-FDG PET. (D) Ki-67 immunohistochemistry. B and C depict radioactivity accumulation in lung lesions. D shows positive nuclei (colored brown) with estimated proliferation rate of 81%. Ryogo Minamimoto. 4′-[Methyl-11C]-thiothymidine PET/CT for proliferation imaging in non-small cell lung cancer. J Nucl Med. 2012;53(2):199–206.
- FIGURE 5.
Transaxial CT (left), attenuation-corrected 18F-αvβ6-binding peptide PET (middle; scale: SUVmax of 5), and fused 18F-αvβ6-binding peptide PET/CT (right) images through upper lungs (top) and lower lungs (bottom), showing increased uptake and areas of bilateral patchy opacity. Cameron C. Foster. αvβ6--targeted molecular PET/CT imaging of the lungs after SARS-CoV-2 infection. J Nucl Med. 2020;61:1717–1719.
- FIGURE 6.
(A) Baseline PET/CT scans showing metabolically active lesion with calcification in right middle lobe. (B) Follow-up PET/CT at 6 wk after initiation of corticosteroid therapy showing decreased uptake in previously active areas. Sandip Basu. 18-F FDG PET/CT imaging features of IgG4-related pulmonary inflammatory pseudotumor at initial diagnosis and during early treatment monitoring. J Nucl Med Technol. 2016;44(3):207–209.
- FIGURE 7.
18F-FDG PET/CT maximum-intensity projection and axial fused PET/CT images showing focal-on-diffuse hypermetabolic activity in left ventricular myocardium consistent with cardiac sarcoidosis (A) and resolution of myocardial activity after immunomodulator therapy (B). William Rieter. 18F-FDG PET-CT in the clinical management of cardiac sarcoidosis: a regional academic referral center experience. J Nucl Med. 2018;59:1527.
- FIGURE 8.
Coronal slices of 18F-FDG PET scan of patient with mesothelioma demonstrating contiguous involvement of right pleural surface, including infiltration of oblique fissure. There is additional subcarinal, precarinal, right paratracheal, and right hilar lymph node involvement. Roslyn J. Francis. Early prediction of response to chemotherapy and survival in malignant pleural mesothelioma using a novel semiautomated 3-dimensional volume-based analysis of serial 18F-FDG PET scans. J Nucl Med. 2007;48(9):1449–1458.
- FIGURE 9.
Whole-body images acquired after administration of 177Lu-DOTATATE in different therapy cycles. Thomas A. Hope. NANETS/SNMMI procedure standard for somatostatin receptor-based peptide receptor radionuclide therapy with 177Lu-DOTATATE. J Nucl Med. 2019;60:937–943.
- FIGURE 10.
Mismatch in percentages of exhalation (EX) and inhalation (IN) between CT and PET. Tezontl Rosario. Phased versus midventilation attenuation-corrected respiration-correlated PET for patients with non-small cell lung cancer. J Nucl Med Technol. 2009;37(4):208–214.
- FIGURE 11.
18F-FDG PET/CT of patient with hypermetabolic left lower lobe lung nodule with respiration-gated imaging (CT, PET, and fused images) (A) and non–respiration-gated imaging (CT, PET, and fused images) (B). Eric Fair. Retrospective quantitative analysis comparing respiratory gated to nonrespiratory gated 18F-FDG PET/CT imaging in patients undergoing evaluation for primary lung cancer. J Nucl Med. 2019;60:1324.
- FIGURE 12.
Axial 18F-FDG PET image of brain demonstrates focal hypometabolism in right frontal lobe (A), corresponding to vasogenic edema on low-dose CT images (B). Subsequent axial T2-FLAIR and contrast-enhanced MR images confirm metastasis with adjacent vasogenic edema (C and D). Emily S. Nia. Incidence of brain metastases on follow-up 18F-FDG PET/CT scans of non-small cell lung cancer patients: Should we include the brain? J Nucl Med Technol. 2017;45(3):193–197.
- FIGURE 13.
(A) 51-y-old man with sarcoidosis. Axial fused PET/CT images show intense 18F-FDG uptake at subcarinal nodes and left hilar lymphadenopathy. Hypermetabolic right lung nodule is also noted (arrow). (B) 65-y-old man with sarcoidosis. Axial fused PET/CT images show increased 18F-FDG uptake in right upper lobe associated with interstitial nodules having perilymphatic/peribronchovascular distribution. Increased uptake at mediastinal nodes and bilateral hilar lymphadenopathy are also noted. Panithaya Chareonthaitawee. Joint SNMMI-ASNC expert consensus document on the role of 18F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring. J Nucl Med. 2017;58(8):1341–1353.
- FIGURE 14.
(A and B) 18F-FDG–avid, histologically proven NSCLC in left upper lobe of 59-y-old woman on T2-weighted BLADE (balanced steady-state free-precession line acquisition with undersampling) MR image with measured maximum diameter of 3.7 cm (A) and fused 18F-FDG PET/MR image (B). (C and D) Identical tumor mass of same patient in left upper lobe on CT image with measured maximum diameter of 3.8 cm (C) and 18F-FDG PET/CT image (D). Primary tumor was correctly staged as T2a on 18F-FDG PET/MRI and 18F-FDG PET/CT. Philipp Heusch. Thoracic staging in lung cancer prospective comparison of 18F-FDG PET/MR imaging and 18F-FDG PET/CT. J Nucl Med. 2014;55(3):373–378.
- FIGURE 15.
18F-FDG PET/CT in 53-y-old patient with NET of pancreas (grade 3 tumor) referred for restaging. At time of PET scan, patient was asymptomatic. Current 18F-FDG PET/CT displays new hypermetabolic area in right upper and lower lobe (SUVmax, 5.5), in topographic correlation to predominantly peripheral and subpleural ground-glass opacities with incipient partly round consolidations consistent with atypical inflammation. Later, COVID-19 infection was confirmed. Johannes Czernin. Nuclear medicine operations in the times of COVID-19: strategies, precautions, and experiences. J Nucl Med. 2020;61:626–629.
- FIGURE 16.
18F-FDG PET/CT fused axial (A, D, and G), fused coronal (B, E, and H), and maximum-intensity projection (C, F, and I) images of 58-y-old man with metastatic adenocarcinoma of left lung showing 18F-FDG avidity with mediastinal lymph nodes and bilateral lung nodules on baseline PET/CT (G, H, and I). After 4 cycles of nivolumab, PET/CT (C, D, and E) showed progression by both immune RECIST and immune adaptive PERCIST; however, findings were considered immune unconfirmed progressive disease because of immunotherapy, and patient was clinically stable. After 6 cycles of nivolumab, PET/CT showed partial response by both criteria. Hence, this case highlighted pseudoprogression. Manoj Gupta. A comparative study of immune RECIST and immune adaptive PERCIST in non-small cell lung cancer patients treated with nivolumab. J Nucl Med. 2020;61(suppl 1):242.
Tables
Classification Description Tumor Tx Primary tumor not assessable T0 No evidence of primary tumor T IS Carcinoma in situ T1 Tumor ≤ 3 cm T1 MIN Minimally invasive adenocarcinoma T1a Tumor ≤ 1 cm T1b Tumor > 1 cm but ≤ 2 cm T1c Tumor > 2 cm but ≤ 3 cm T2 Tumor > 3 cm to ≤ 5 cm or tumor of any size that invades visceral pleura, involves main bronchus but not carina, shows atelectasis or obstructive pneumonitis that extends to hilum and involving part of lung T2a Tumor > 3 cm to 4 cm T2b Tumor > 4 cm to 5 cm T3 Tumor > 5 cm to 7 cm or tumor of any size that directly invades chest wall, pericardium, or phrenic nerve or shows one or more nodules in same lung lobe as primary tumor T4 Tumor > 7 cm or tumor of any size that invades mediastinum, diaphragm, heart, trachea, esophagus, or vertebral body or shows one or more nodules in another lobe of lung on ipsilateral side Node Nx Regional lymph nodes not assessable N0 No regional lymph node metastasis N1 Metastasis in ipsilateral peribronchial or hilar nodes and intrapulmonary nodes N2 Metastasis in ipsilateral mediastinal or subcarinal nodes N3 Metastases in contralateral mediastinal or hilar lymph nodes or in ipsilateral/contralateral scalene/supraclavicular lymph nodes Metastasis M0 No distant metastasis M1 Distant metastasis M1a Separate tumor nodules in contralateral lobe; tumor with pleural or pericardial nodules or malignant pleural or pericardial effusion M1b Single extrathoracic metastasis in single organ M1c Multiple extrathoracic metastases in one or several organs Modified from IASLC 8th edition Lung Cancer Staging, 2016.
Stage T N M Occult carcinoma TX N0 M0 0 T IS N0 M0 IA1 T1 MIN N0 M0 T1a N0 M0 IA2 T1b N0 M0 IA3 T1c N0 M0 IB T2a N0 M0 IIA T2b N0 M0 IIB T1a N1 M0 T1b N1 M0 T1c N1 M0 T2a N1 M0 T2b N1 M0 T3 N0 M0 IIIA T1a N2 M0 T1b N2 M0 T1c N2 M0 T2a N2 M0 T2b N2 M0 T3 N1 M0 T4 N0 M0 T4 N1 M0 IIIB T1a N3 M0 T1b N3 M0 T1c N3 M0 T2a N3 M0 T2b N3 M0 T3 N2 M0 T4 N2 M0 IIIC T3 N3 M0 T4 N3 M0 IVA Any T 1–4 Any N 1–3 M1a Any T 1–4 Any N 1–3 M1b IVB Any T 1–4 Any N 1–3 M1c Modified from IASLC 8th edition Lung Cancer Staging, 2016.
Radiopharmaceutical Indication 18F-misonidazole Hypoxic imaging 18F-fluoro-methyl-tyrosine Amino acid metabolism 18F-fluorothymidine DNA synthesis, proliferation marker 18F-fluoro-azomycin-arabinoside Hypoxia imaging 68Ga-neomannosylated human serum albumin Sentinel node identification 11C-methionine Amino acid metabolism, proliferation marker 6-18F-fluoro-O-pivaloyl-l-dopa Amino acid metabolism 11C-acetate Fatty acid metabolism 11C-choline Fatty acid metabolism 64Cu-diacetyl-bis(N4-methylsemicarbazone) Hypoxia imaging
