1. Future of Thoracic PET Scanning
Geoffrey B. Johnson, MD, PhD, Patrick J. Peller, MD, Bradley J. Kemp, PhD, Jay H. Ryu, MD, FCCP 
CHEST 
Volume 147, Issue 1, Pages (January 2015)
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Copyright © 2015 The American College of Chest Physicians Terms and Conditions

2. Figure 1
A, B, Quantitative measurements of tumor burden. Patient A and B have a similar tumor type, grade, stage, and SUVmax. However, they have very different tumor burden, and the MTV and TLG predict a worse prognosis for patient A (each panel has maximum intensity projection [MIP] images, axial PET scan, and axial PET/CT scan with automated volumetric regions of interest drawn around sites of malignancy based on a standard uptake value threshold). MTV = metabolic tumor volume; Sq = squamous; SUVmax = maximum standard uptake value; TLG = total lesion glycolysis.
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3. Figure 2
A, B, Use of 18 F-fluorodeoxyglucose (FDG)-PET/CT scanning for inflammatory conditions. Images show a systemic pattern of inflammatory FDG activity that suggests IgG4-related disease (IgG4-RD aka autoimmune pancreatitis) and not cancer (axial fused PET/CT scan [A] and MIP image [B]). In this 72-y-old man, there is biopsy-proven IgG4-RD in the salivary glands, pancreas, periaortic retroperitoneum, and prostate. In any one location, the FDG activity does not help differentiate cancer from inflammatory IgG4-RD. FDG-PET/CT scanning is not currently approved by the Center for Medicare and Medicaid Services for the evaluation of known inflammatory conditions. However, these conditions can be identified on FDG-PET/CT scans in patients suspected of having cancer. See Figure 1 legend for expansion of other abbreviation.
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4. Figure 3
New PET scan radiotracers will open up new imaging opportunities. Here is an example of metastatic carcinoid imaged with 68Ga-DOTATATE PET/CT scan (showing a MIP image, axial PET scan, axial PET/CT scan, and enhanced axial diagnostic CT scan with arrows on liver metastases of different sizes). This is an octreotide analog that can be used with higher-resolution PET/CT imaging rather than 111In-octreotide single photon emission CT/CT scanning. As seen here, metastases in the liver as small as 4 mm can be seen above background. For the evaluation of small FDG-PET/CT scan-negative lung nodules and staging of carcinoid, 68Ga-DOTATATE and 68Ga-DOTANOC have great promise. These imaging agents are not yet approved by the Food and Drug Administration. See Figure 1 and 2 legends for expansion of abbreviations.
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5. Figure 4
A-C, Recent advances in image reconstruction result in improved PET image resolution. Recently, Food and Drug Administration-approved image processing with Bayesian PL (A) iterative reconstruction shows more accurate measurement of metabolic activity of a 5-mm metastatic nodule than current state-of-the art ToF (B) and older 3D reconstruction (C). With PL, the 5-mm nodule is clearly more active than the mediastinal blood pool in this patient with many liver and lung metastases (A shows FDG-PET scan MIP with arrow on the 5-mm nodule, axial PET scan, and axial PET/CT scan). PL = penalized likelihood; SUVm = maximum standard uptake value; ToF = time of flight. See Figure 1 legend for expansion of other abbreviation.
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