CT and PET imaging in non-small cell lung cancer

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Presentation transcript:

CT and PET imaging in non-small cell lung cancer Ursula W. Knoepp, James G. Ravenel Critical Reviews in Oncology / Hematology Volume 58, Issue 1, Pages 15-30 (April 2006) DOI: 10.1016/j.critrevonc.2005.09.001 Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 Solitary pulmonary nodule. Axial CT reveals a 2.5cm irregular nodule in superior segment of right lower lobe. Biopsy revealed adenocarcinoma. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 Value of FDG-PET in solitary pulmonary nodule. (A) Axial CT reveals 1.2cm right upper lobe nodule (arrow). (B) FDG-PET shows increased metabolic activity above background in nodule (arrows) and no increased activity in mediastinum. T1N0 lung cancer at surgery. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 3 False negative PET. (A) Axial CT reveals well circumscribed oblong nodule with eccentric calcification in right upper lobe (arrow). (B) FDG-PET reveals no abnormal activity. Arrowheads point to where nodule should localize. Nodule removed due to growth on CT scan and adenocarcinoma confirmed by pathology. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 4 T2 lung cancer. Axial CT reveals 5cm spiculated mass with internal cavitation. C: carina. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 5 T3 lung cancer. (A) Lung window setting reveal peripheral mass in left lung apex with extensive pleural contact (arrow). (B) Mediastinal window reveals extension into chest wall and bone destruction (arrowheads). Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 6 Pleural metastases identified by PET in malignant pleural effusion. Coronal whole body image reveals multiple areas of increased metabolic activity (arrows). Pleural fluid cytology confirmed malignancy. For orientation: I, thoracic inlet; H, heart; L, liver. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 7 Extensive mediastinal adenopathy in NSCLC. Individual lymph nodes are labeled by Mountain's classification. A, aorta; C, carina; P, main pulmonary artery; RP, right pulmonary artery; RA, right atrium; LA, left atrium; S, superior vena cava. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 8 FDG-PET in lymph node staging. Known left upper lobe lung cancer. Coronal FDG-PET reveals hypermetabolic N2 lymph nodes (inferior arrow) suspected by CT, but also reveals unsuspected bilateral supraclavicular adenopathy (superior arrows) with change in stage from IIIA to IIIB. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 9 Combined PET/CT (Courtesy of Philip Costello, MD Charleston, SC). (A) Right lower lobe mass. (B) Abnormal contour to right hilum. (C) Fused CT with FDG-PET directly confirms both sites as neoplasm. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 10 Indeterminate adrenal lesion at routine staging. (A) Axial contrast enhanced CT reveals 2cm nodule in left adrenal gland (arrow) which measures greater than 20 HU. (B) FDG-PET reveals right upper lobe tumor (T) and mediastinal adenopathy (N), but no abnormal uptake in region of adrenal gland (arrowhead) confirming adenoma. For orientation: I, thoracic inlet; H, heart; L, liver; K, left kidney. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 11 Unsuspected adrenal metastasis. (A) Axial CT reveals small nodule in right adrenal gland (arrow) overlooked at initial staging. A, aorta; RK, top of right kidney. (B) FDG-PET reveals increased uptake in right adrenal gland (arrow). Metastasis confirmed at surgery. T, primary tumor in right lower lobe; K, right kidney; St, stomach. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 12 NSCLC metastasis to pelvis. Bone window setting reveals destruction of anterior left ilium (arrow). Lung cancer confirmed at biopsy. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 13 FDG-PET detection of osseous metastasis. (A) Coronal whole body image in patient status post left pneumonectomy reveals recurrent disease in pneumonectomy space (arrowhead) and hypermetabolic focus in left acetabulum (arrows); L, liver. (B) T2 weighted fat-suppressed MR confirms lesion as region of increased signal (arrows). (C) Axial image during CT-guided biopsy for confirmation of histology (image flipped to preserve anatomic relationships). Notice subtle loss of internal bone structure (black arrows) compared to normal contralateral side (*). Also note the lack of bony remodeling which is normally required for detection with bone scintigraphy. Core needle enters posterolateral on left. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions

Fig. 14 Utility of FDG-PET in assessment of disease response. (A) Axial CT performed six months apart reveals left upper lobe collapse (T) with residual soft tissue density following combined chemotherapy and radiation therapy. (B) Contemporaneous FDG-PET reveals increased metabolic activity prior to therapy and complete metabolic response at follow-up. Critical Reviews in Oncology / Hematology 2006 58, 15-30DOI: (10.1016/j.critrevonc.2005.09.001) Copyright © 2005 Elsevier Ireland Ltd Terms and Conditions