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Radionuclide Imaging of Infection and Inflammation pp 269–292Cite as

Nuclear Medicine Imaging of Lung Infection

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Abstract

Acute or chronic infection of the upper or lower respiratory tract caused by microorganisms (bacteria, viruses, fungi, or parasites) causes discomfort and affects the day-to-day life of patients and can become severely complicated. The diagnosis of lung infection is generally based on clinical findings associated with the detection of parenchymal infiltrate at chest X-ray or CT scan. However, in some instances, radiological imaging alone cannot distinguish an acute exacerbation from sequela of a prior infection.

Nuclear medicine imaging techniques have been extensively used in patients with lung infection, mostly for TB-associated or HIV-associated infections. Single-photon emitting agents used for identifying lung infection include 67Ga-citrate, 111In-oxine-leukocytes, 99mTc-HMPAO-leukocytes, preferably employing SPECT/CT imaging. More recently, the use of [18F]FDG for PET imaging (currently PET/CT) has been steadily growing and is now the preferred radionuclide imaging modality not only for identifying sites of lung infection but also for assessing the efficacy of therapy, especially in TB infection and in HIV-associated infections. PET/CT with [18F]FDG is also being increasingly used in patients with ventilator-associated pneumonia.

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References

  1. Driver C. Pneumonia part 1: pathology, presentation and prevention. Br J Nurs. 2012;21:103–6.

    Article  PubMed  Google Scholar 

  2. Anevlavis S, Bouros D. Community acquired bacterial pneumonia. Expert Opin Pharmacother. 2010;11:361–74.

    Article  CAS  PubMed  Google Scholar 

  3. Winther B. Rhinovirus infections in the upper airway. Proc Am Thorac Soc. 2011;8:79–89.

    Article  PubMed  Google Scholar 

  4. Rosen MJ. Epidemiology and risk of pulmonary disease. Semin Respir Infect. 1999;14:301–8.

    CAS  PubMed  Google Scholar 

  5. Lynch T, Bialy L, Kellner JD, et al. A systematic review on the diagnosis of pediatric bacterial pneumonia: when gold is bronze. PLoS One. 2010;5(8):e11989. https://doi.org/10.1371/journal.pone.0011989.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Franquent T. Imaging techniques in the examination of the distal airways: asthma and COPD. Arch Bronconeumol. 2011;47:20–6.

    Article  Google Scholar 

  7. Roberts HR, Wells AU, Milne DG, et al. Airflow obstruction in bronchiectasis: correlations between computed tomography features and pulmonary function test. Thorax. 2000;55:198–204.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Franquet T, Chung JH. Imaging of pulmonary infection. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the chest, breast, heart and vessels 2019–2022: diagnostic and interventional imaging. Cham: Springer; 2019. p. 65–77.

    Chapter  Google Scholar 

  9. Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl 3):iii1–55.

    Article  PubMed  Google Scholar 

  10. Haworth CS, Floto RA. Introducing the new BTS guideline: management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017;72:969–70.

    Article  PubMed  Google Scholar 

  11. Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017;72(Suppl 2):ii1–ii64.

    Article  PubMed  Google Scholar 

  12. TB/HIV—a clinical manual. Geneva: World Health Organization; 2004. http://www.who.int/tb/publications/who_htm_tb_2004_329/en/index.html. Last Accessed 8 Apr 2020.

  13. Prvulovich EM, Buscombe JR, Miller RF. The role of nuclear medicine in the investigation of patients with AIDS. Br J Hosp Med. 1996;55:549–53.

    CAS  PubMed  Google Scholar 

  14. Ankrah AO, Glaudemans AWJM, Maes A, et al. Tuberculosis. Semin Nucl Med. 2018;48:108–30.

    Article  PubMed  Google Scholar 

  15. Sathekge MM, Ankrah AO, Lawal I, Vorster M. Monitoring response to therapy. Semin Nucl Med. 2018;48:166–81.

    Article  PubMed  Google Scholar 

  16. Vorster M, Buscombe J, Saad Z, Sathekge M. Past and future of Ga-citrate for infection and inflammation imaging. Curr Pharm Des. 2018;24:787–94.

    Article  CAS  PubMed  Google Scholar 

  17. Levenson SM, Warren RD, Richman SD, et al. Abnormal pulmonary gallium accumulation in P. carinii pneumonia. Radiology. 1976;19:395–8.

    Article  Google Scholar 

  18. Niden AH, Mishkin FS, Khurana MML, et al. 67Ga lung scan: an aid in the differential diagnosis of pulmonary embolism and pneumonitis. JAMA. 1977;237:1206–11.

    Article  CAS  PubMed  Google Scholar 

  19. Siemsen JK, Grebe SF, Waxman AD. The use of gallium-67 in pulmonary disorders. Semin Nucl Med. 1978;8:235–49.

    Article  CAS  PubMed  Google Scholar 

  20. Bekerman C, Hoffer PB, Bittran JD, et al. Gallium-67 citrate imaging studies of the lung. Semin Nucl Med. 1980;10:286–301.

    Article  CAS  PubMed  Google Scholar 

  21. Hoffer P. Gallium and infection. J Nucl Med. 1980;21:484–8.

    CAS  PubMed  Google Scholar 

  22. Giraudo C, Evangelista L, Fraia AS, et al. Molecular imaging of pulmonary inflammation and infection. Int J Mol Sci. 2020;21(3):E894. https://doi.org/10.3390/ijms21030894.

    Article  CAS  PubMed  Google Scholar 

  23. Schuster DM, Alazraki N. Gallium and other agents in diseases of the lung. Semin Nucl Med. 2002;32:193–211.

    Article  PubMed  Google Scholar 

  24. Goldfarb CR, Colp C, Ongseng F, et al. Gallium scanning in the ‘new’ tuberculosis. Clin Nucl Med. 1997;22:470–4.

    Article  CAS  PubMed  Google Scholar 

  25. Yamaga LY, Benard G, Hironaka FH, et al. The role of gallium-67 scan in defining the extent of disease in an endemic deep mycosis, paracoccidioidomycosis: a predominantly multifocal disease. Eur J Nucl Med Mol Imaging. 2003;30:888–94.

    Article  CAS  PubMed  Google Scholar 

  26. Liu SF, Liu JW, Lin MC, et al. Monitoring treatment responses in patients with pulmonary TB using serial lung gallium-67 scintigraphy. AJR Am J Roentgenol. 2007;188:W403–8.

    Article  PubMed  Google Scholar 

  27. Lal FM, Liam CK, Paramsothy M, et al. The role of 67gallium scintigraphy and high resolution computed tomography as predictors of disease activity in sputum smear-negative tuberculosis. Int J Tuberc Lung Dis. 1997;1:563–9.

    Google Scholar 

  28. Walsh TJ, Beckerman C, Chausow A, et al. The value of gallium-67 scanning in pulmonary tuberculosis. Am Rev Respir Dis. 1985;132:746747.

    Google Scholar 

  29. Yeh JJ, Huang YC, Teng WB, et al. The role of gallium-67 scintigraphy in comparing inflammatory activity between tuberculous and nontuberculous mycobacterial pulmonary diseases. Nucl Med Commun. 2011;32:392–401.

    Article  PubMed  Google Scholar 

  30. Herron T, Gossman W. 111 Indium white blood cell scan (indium leukocyte imaging, indium-111 scan). Treasure Island, FL: StatPearls Publishing; 2020.

    Google Scholar 

  31. Peters AM. The utility of [99mTc]HMPAO-leukocytes for imaging infection. Semin Nucl Med. 1994;24:110–27.

    Article  CAS  PubMed  Google Scholar 

  32. Altiay G, Cermik TF. 99mTc-HMPAO labeled white blood cell scintigraphy in the diagnosis and monitoring of response of the therapy in patients with active bronchiectasis. Rev Esp Med Nucl. 2012;31:9–14.

    CAS  Google Scholar 

  33. Kramer EL, Divgi CR. Pulmonary applications of nuclear medicine. Clin Chest Med. 1991;12:55–75.

    CAS  PubMed  Google Scholar 

  34. Oates E, Ramberg K. Imaging of intrathoracic disease with indium-111-labeled leukocytes. J Thorac Imaging. 1990;5:78–88.

    Article  CAS  PubMed  Google Scholar 

  35. Currie DC, Saverymuttu SH, Peters AM, et al. Indium-111-labeled granulocyte accumulation in respiratory tract of patients with bronchiectasis. Lancet. 1987;1(8546):1335–9.

    Article  CAS  PubMed  Google Scholar 

  36. Fineman DS, Palestro CJ, Kim CK, et al. Detection of abnormalities in febrile AIDS patients with In-111-labeled leukocyte and Ga-67 scintigraphy. Radiology. 1989;170:677–80.

    Article  CAS  PubMed  Google Scholar 

  37. Segall GM, McDougall IR. Diagnostic value of lung uptake of indium-111 oxine-labeled white blood cells. AJR Am J Roentgenol. 1986;147:601–6.

    Article  CAS  PubMed  Google Scholar 

  38. Oyen WJ, Claessens RA, van der Meer JW, et al. Detection of subacute infectious foci with indium-111-labeled autologous leukocytes and indium-111-labeled human nonspecific immunoglobulin G: a prospective comparative study. J Nucl Med. 1991;32:1854–60.

    CAS  PubMed  Google Scholar 

  39. Meduri GU, Belenchia JM, Massie JD, et al. The role of gallium-67 scintigraphy in diagnosing sources of fever in ventilated patients. Intensive Care Med. 1996;22:395–403.

    Article  CAS  PubMed  Google Scholar 

  40. Kao CH, Wang YL, Liao SQ, Wang SJ. Tc-99m HMPAO labelled WBCs in the detection of occult sepsis in the intensive care unit. Intensive Care Med. 1992;1:15–9.

    Article  Google Scholar 

  41. Minoja G, Chiaranda M, Fachinetti A, et al. The clinical use of 99m-Tc-labeled WBC scintigraphy in critically ill surgical and trauma patients with occult sepsis. Intensive Care Med. 1996;9:867–71.

    Article  Google Scholar 

  42. Slavin JD Jr, Sherigar RM, Spencer RP, et al. In-111 octreotide lung uptake in hypersensitive pneumonitis caused by fungal infection. Clin Nucl Med. 1998;23:847–8.

    Article  PubMed  Google Scholar 

  43. Vanhagen PM, Krenning EP, Reubi JC, et al. Somatostatin analogue scintigraphy in granulomatous diseases. Eur J Nucl Med. 1994;21:497–502.

    Article  CAS  PubMed  Google Scholar 

  44. Utsunomiya K, Narabayashi I, Nishigaki H, et al. Clinical significance of thallium-201 and gallium-67 scintigraphy in pulmonary tuberculosis. Eur J Nucl Med. 1997;24:252–7.

    CAS  PubMed  Google Scholar 

  45. Gulaldi NC, Bayhan H, Ercan MT, et al. The visualization of pulmonary tuberculosis with Tc-99m(V)DMSA and Tc-99m citrate in comparison to Ga-67 citrate. Clin Nucl Med. 1995;20:1012–4.

    Article  CAS  PubMed  Google Scholar 

  46. Stefanescu C, Rusu V, Boişteanu D, et al. 99mTc isonitrils biophysical aspects in pulmonary tuberculosis. Part I. In vivo evaluation of 99mT MIBI and 99mT Tetrofosmin biophysical localization mechanisms. Rev Med Chir Soc Med Nat Iasi. 2006;110:944–9.

    PubMed  Google Scholar 

  47. Vaidyanathan S, Patel CN, Scarsbrook AF, Chowdhury FU. FDG PET/CT in infection and inflammation—current and emerging clinical applications. Clin Radiol. 2015;70:787–800.

    Article  CAS  PubMed  Google Scholar 

  48. Dibble EH, Yoo DC, Baird GL, Noto RB. FDG PET/CT of infection: should it replace labeled leukocyte scintigraphy of inpatients? AJR Am J Roentgenol. 2019;213:1358–65.

    Article  PubMed  Google Scholar 

  49. Kung BT, Seraj SM, Zadeh MZ, et al. An update on the role of 18F-FDG-PET/CT in major infectious and inflammatory diseases. Am J Nucl Med Mol Imaging. 2019;9:255–73.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Arnon-Sheleg E, Israel O, Keidar Z. PET/CT imaging in soft tissue infection and inflammation—an update. Semin Nucl Med. 2020;50:35–49.

    Article  PubMed  Google Scholar 

  51. Lorenzen J, Buchert M, Bleckmann C, et al. A search for the focus in patients with fever of unknown origin: is positron-emission tomography with F-18-fluorodeoxyglucose helpful? RöFo Fortschr Geb Rontgenstr Nuklearmed. 1999;171:49–53.

    Article  CAS  PubMed  Google Scholar 

  52. Watanabe S, Nakamura Y, Kariatsumari K, et al. Pulmonary paragonimiasis mimicking lung cancer on FDG–PET imaging. Anticancer Res. 2003;23:3437–40.

    PubMed  Google Scholar 

  53. Wilkinson MD, Fulham MJ, McCaughan BC, et al. Invasive aspergillosis mimicking stage IIIA non-small-cell lung cancer on FDG positron emission tomography. Clin Nucl Med. 2003;28:234–5.

    PubMed  Google Scholar 

  54. Bleeker-Rovers CP, Warris A, Drenth JP, et al. Diagnosis of Candida lung abscesses by 18F-fluorodeoxyglucose positron emission tomography. Clin Microbiol Infect. 2005;11:493–5.

    Article  CAS  PubMed  Google Scholar 

  55. Chang JM, Lee HJ, Goo JM, et al. False positive and false negative FDG-PET scans in various thoracic diseases. Korean J Radiol. 2006;7:57–69.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Mascarenhas NB, Lam D, Lynch GR, et al. PET imaging of cerebral and pulmonary Nocardia infection. Clin Nucl Med. 2006;31:131–3.

    Article  PubMed  Google Scholar 

  57. Intriago B, Danùs M, Calvo N, et al. Influenza-like infection can result in diffuse fluorodeoxyglucose uptake in the lungs. Clin Nucl Med. 2009;34:737–8.

    Article  PubMed  Google Scholar 

  58. Soussan M, Brillet PY, Mekinian A, et al. Patterns of pulmonary tuberculosis on FDG-PET/CT. Eur J Radiol. 2012;81:2872–6.

    Article  PubMed  Google Scholar 

  59. Song KD, Lee KS, Chung MP, et al. Pulmonary cryptococcosis: imaging findings in 23 non-AIDS patients. Korean J Radiol. 2010;11:407–16.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Franzen D, Latshang T, Frauenfelder T, et al. [Be cautious with a prognosis!]. Ther Umsch. 2010;67:605–7.

    Google Scholar 

  61. Kawate E, Yamazaki M, Kohno T, et al. Two cases with solitary pulmonary nodule due to nontuberculous mycobacterial infection showing intense 18F-fluorodeoxyglucose uptake on positron emission tomography scan. Geriatr Gerontol Int. 2010;10:251–4.

    Article  PubMed  Google Scholar 

  62. Sathekge M, Maes A, Kgomo M, et al. Impact of FDG PET on the management of TBC treatment: a pilot study. Nuklearmedizin. 2010;49:35–40.

    Article  CAS  PubMed  Google Scholar 

  63. Hadley GP, Naude F. Malignant solid tumor, HIV infection and tuberculosis in children: an unholy triad. Pediatr Surg Int. 2009;25:697–701.

    Article  CAS  PubMed  Google Scholar 

  64. Liu Y. Demonstrations of AIDS-associated malignancies and infections at FDG PET-CT. Ann Nucl Med. 2011;25:536–46.

    Article  PubMed  Google Scholar 

  65. Sathekge M, Goethals I, Maes A, et al. Positron emission tomography in patients suffering from HIV-1 infection. Eur J Nucl Med Mol Imaging. 2009;36:1176–84.

    Article  PubMed  Google Scholar 

  66. Win Z, Todd J, Al-Nahhas A. FDG-PET imaging in pneumocystis carinii pneumonia. Clin Nucl Med. 2005;30:690–1.

    Article  PubMed  Google Scholar 

  67. Sojan SM, Chew G. Pneumocystis carinii pneumonia on F-18 FDG PET. Clin Nucl Med. 2005;30:763–4.

    Article  PubMed  Google Scholar 

  68. Bharucha T, Rutherford A, Skeoch S, et al. Diagnostic yield of FDG-PET/CT in fever of unknown origin: a systematic review, meta-analysis, and Delphi exercise. Clin Radiol. 2017;72:764–71.

    Article  CAS  PubMed  Google Scholar 

  69. Kouijzer IJE, Mulders-Manders CM, Bleeker-Rovers CP, Oyen WJG. Fever of unknown origin: the value of FDG-PET/CT. Semin Nucl Med. 2018;48:100–7.

    Article  PubMed  Google Scholar 

  70. Schönau V, Vogel K, Englbrecht M, et al. The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis. 2018;77:70–7.

    Article  PubMed  CAS  Google Scholar 

  71. Warwick JM, Sathekge MM. PET/CT scanning with a high HIV/AIDS prevalence. Transfus Apher Sci. 2011;44:167–72.

    Article  CAS  PubMed  Google Scholar 

  72. Masekela R, Gongxeka H, Green RJ. Positron emission tomography in the prediction of inflammation in children with human immunodeficiency virus related bronchiectasis. Hell J Nucl Med. 2012;15:23–7.

    PubMed  Google Scholar 

  73. Davison JM, Subramaniam RM, Surasi DS, et al. FDG PET/CT in patients with HIV. AJR Am J Roentgenol. 2011;197:284–94.

    Article  PubMed  Google Scholar 

  74. Basu S, Saboury B, Werner T, et al. Clinical utility of FDG PET and PET/CT in non-malignant thoracic disorders. Mol Imaging Biol. 2011;13:1051–60.

    Google Scholar 

  75. Ozsahin H, von Planta M, Müller I, et al. Successful treatment of invasive aspergillosis in chronic granulomatous disease by bone marrow transplantation, granulocyte colony-stimulating factor-mobilized granulocytes, and liposomal amphotericin-B. Blood. 1998;92:2719–24.

    Article  CAS  PubMed  Google Scholar 

  76. Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care. 2014;18:208.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Chang I, Schibler A. Ventilator associated pneumonia in children. Paediatr Respir Rev. 2016;20:10–6.

    PubMed  Google Scholar 

  78. Spalding MC, Cripps MW, Minshall CT. Ventilator-associated pneumonia: new definitions. Crit Care Clin. 2017;33:277–92.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Cook DJ, Kollef MH. Risk factors for ICU-acquired pneumonia. JAMA. 1998;279:1605–6.

    Article  CAS  PubMed  Google Scholar 

  80. Georges H, Leroy O, Guery B, et al. Predisposing factors for nosocomial pneumonia in patients receiving mechanical ventilation and requiring tracheotomy. Chest. 2000;118:767–74.

    Article  CAS  PubMed  Google Scholar 

  81. Holzapfel L, Chastang C, Demingeon G, et al. A randomized study assessing the systematic search for maxillary sinusitis in nasotracheally mechanically ventilated patients. Influence of nosocomial maxillary sinusitis on the occurrence of ventilator-associated pneumonia. Am J Respir Crit Care Med. 1999;159:695–701.

    Article  CAS  PubMed  Google Scholar 

  82. Fàbregas N, Ewig S, Torres A, et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies. Thorax. 1999;54:867–73.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Wunderink RG, Woldenberg LS, Zeiss J, et al. The radiologic diagnosis of autopsy-proven ventilator-associated pneumonia. Chest. 1992;101:458–63.

    Article  CAS  PubMed  Google Scholar 

  84. Simons KS, Pickkers P, Bleeker-Rovers CP, et al. F-18-fluorodeoxyglucose positron emission tomography combined with CT in critically ill patients with suspected infection. Intensive Care Med. 2010;36:504–11.

    Article  PubMed  Google Scholar 

  85. Qin C, Liu F, Yen TC, Lan X. 18F-FDG PET/CT findings of COVID-19: a series of four highly suspected cases. Eur J Nucl Med Mol Imaging. 2020;47:1281–6.

    Article  CAS  PubMed  Google Scholar 

  86. Zou S, Zhu X. FDG PET/CT of COVID-19. Radiology. 2020;296(2):E118. https://doi.org/10.1148/radiol.2020200770.

    Article  PubMed  Google Scholar 

  87. Joob B, Wiwanitkit V. 18F-FDG PET/CT and COVID-19. Eur J Nucl Med Mol Imaging. 2020;47:1348.

    Google Scholar 

  88. Deng Y, Lei L, Chen Y, Zhang W. The potential added value of FDG PET/CT for COVID-19 pneumonia. Eur J Nucl Med Mol Imaging. 2020;47:1634–5.

    Google Scholar 

  89. Polverari G, Arena V, Ceci F, et al. 18F-FDG uptake in asymptomatic SARS-CoV-2 (COVID-19) patient, referred to PET/CT for non-small cells lung cancer restaging. J Thorac Oncol. 2020;15:1078–80.

    Google Scholar 

  90. Albano D, Bertagna F, Bertolia M, et al. Incidental findings suggestive of Covid-19 in asymptomatic patients undergoing nuclear medicine procedures in a high prevalence region. J Nucl Med. 2020;61:632–6.

    Google Scholar 

  91. Lütje S, Marinova M, Kütting D, et al. Nuclear medicine in SARS-CoV-2 pandemia: 18F-FDG-PET/CT to visualize COVID-19. Nuklearmedizin. 2020;59:276–80.

    Google Scholar 

  92. Setti L, Kirienko M, Dalto SC, et al. FDG-PET/CT findings highly suspicious for COVID-19 in an Italian case series of asymptomatic patients. Eur J Nucl Med Mol Imaging. 2020;47:1649–56.

    Google Scholar 

  93. Tian J, Yang X, Yu L, et al. A multicenter clinical trial on the diagnostic value of dual-tracer PET/CT in pulmonary lesions using 3′-deoxy-3′-18F-fluorothymidine and 18F-FDG. J Nucl Med. 2008;49:186–94.

    Article  PubMed  Google Scholar 

  94. Hara T, Kosaka N, Suzuki T, et al. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study. Chest. 2003;124:893–901.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Special thanks are due to Drs. Elena Lazzeri and Annibale Versari for providing images that have been included in this chapter.

Author information

Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Martina Sollini

  2. Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy

    Giuliano Mariani

Authors
  1. Martina Sollini
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  2. Giuliano Mariani
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Corresponding author

Correspondence to Giuliano Mariani .

Editor information

Editors and Affiliations

  1. Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa, Italy

    Elena Lazzeri

  2. Department of Medical-Surgical Sciences and of Translational Medicine, Sapienza University of Rome, Roma, Italy

    Alberto Signore

  3. Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy

    Paola Anna Erba

  4. Nuclear Medicine Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy

    Napoleone Prandini

  5. Nuclear Medicine, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy

    Annibale Versari

  6. Nuclear Medicine Department, Private Hospital “PIO XI”, Roma, Italy

    Giovanni D´Errico

  7. Department of Translational Research and Advanced Technologies in Medicine and Surgery, Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy

    Giuliano Mariani

Appendices

Examples of Lung Infection Imaging

13.1.1 Chest X-ray and 99mTc-HMPAO-Leukocyte Scintigraphy in Patient with Lung Infection (Figs. 13.1, 13.2, and 13.3)

Fig. 13.1
figure 1

Chest X-ray: posteroanterior (left) and lateral (right) projections

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Fig. 13.2
figure 2

99mTc-HMPAO-leukocyte scintigraphy: planar anterior (right) and posterior (left) images at 4 h (upper) and 24 h (lower), showing a mild accumulation of labeled leukocytes in the inferior lobe of right lung

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Fig. 13.3
figure 3

99mTc-HMPAO-leukocyte scintigraphy: transaxial SPECT (upper), CT (middle), and fused SPECT/CT sections (lower) allow the identification of the exact site of leukocyte accumulation

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13.1.2 [18F]FDG PET/CT in Patient with Tuberculosis Infection of Left Pleura (Figs. 13.4, 13.5, 13.6, and 13.7)

Fig. 13.4
figure 4

[18F]FDG PET/CT: maximum intensity projection (MIP), showing diffusely increased [18F]FDG uptake in left chest and in mediastinum

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Fig. 13.5
figure 5

[18F]FDG PET/CT: PET (upper), CT (middle), and fused PET/CT (lower) transaxial sections of chest, showing increased [18F]FDG uptake in left lung and pleural tissues

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Fig. 13.6
figure 6

[18F]FDG PET/CT: PET (left), CT (middle), and fused PET/CT (right) coronal sections of chest, showing increased [18F]FDG uptake in left lung and pleural tissues; [18F]FDG uptake is localized at left lung and at all left pleural tissues (a) while pleural effusion does not exhibit increased tracer uptake (b)

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Fig. 13.7
figure 7

[18F]FDG PET/CT: PET (left), CT (middle), and fused PET/CT (right) sagittal sections of chest, showing increased [18F]FDG uptake in left lung and pleural tissues; [18F]FDG uptake is localized at left lung and at all left pleural tissues (a) while pleural effusion does not exhibit increased tracer uptake (b)

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13.1.3 [18F]FDG PET/CT in Patient with “Ab Ingestis” Pneumonia (Fig. 13.8)

Fig. 13.8
figure 8

[18F]FDG PET/CT: (left) Maximum intensity projection (MIP) image and (right) transaxial section of PET (upper), CT (middle), and fused PET/CT (lower), showing increased tracer uptake in posterior fields of both lungs

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13.1.4 [18F]FDG PET/CT in Patient with Hypereosinophilic Syndrome (Fig. 13.9)

Fig. 13.9
figure 9

Transaxial [18F]FDG PET/CT sections (PET, upper; CT, middle; fused PET/CT, lower) in a patient with pleuropericarditis and multiple pulmonary opacities, showing intense [18F]FDG uptake at both lungs; biopsy demonstrated hypereosinophilic syndrome

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13.1.5 [18F]FDG PET/CT in Patient with Atypical Mycobacteria Pneumonia (Fig. 13.10)

Fig. 13.10
figure 10

Transaxial [18F]FDG PET/CT sections (PET, top; CT, middle; fused PET/CT, bottom) in a woman with several episodes of pneumonia; biopsy performed after [18F]FDG PET/CT revealed pneumonia sustained by atypical mycobacteria

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13.1.6 [18F]FDG PET/CT in Patients with Incidentally Detected Interstitial Pneumonia Associated with the Covid-19 Virus (SARS-CoV-2) (Figs. 13.11 and 13.12)

Fig. 13.11
figure 11

[18F]FDG PET/CT performed in a 45-year-old woman for restaging after chemotherapy for recurring colorectal cancer. The patient did not complain of fever, cough, or dyspnea, but lived in an area with very high incidence of Covid-19 infection. MIP image on the left. On the right: selected coronal (above) and transaxial slices (below) for CT, PET, and fused PET/CT images (from left to right). Multiple areas with increased [18F]FDG uptake corresponding to bilateral interstitial alveolar infiltrates. (Images provided by courtesy of Drs. L. Setti, M. Kirienko, SC Dalto, M. Bonacina, and E. Bombardieri, Nuclear Medicine Department, Humanitas Gavazzeni, Bergamo, Italy)

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Fig. 13.12
figure 12

[18F]FDG PET/CT performed in a 70-year-old man for staging after the discovery of metastasis in cervical lymph nodes from a squamocellular cancer with unknown primary. The patient did not complain of fever cough or dyspnea but lived in an area with very high incidence of Covid-19 infection. MIP image on the left. On the right: selected coronal (above) and transaxial slices (below) for CT PET and fused PET/CT images (from left to right). Multiple areas with increased [18F]FDG uptake consistent with viral pneumonia. (Images provided by courtesy of Drs. L. Setti, M. Kirienko, SC Dalto, M. Bonacina, and E. Bombardieri, Nuclear Medicine Department, Humanitas Gavazzeni, Bergamo, Italy)

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Clinical Cases

13.1.1 Case 13.1

  • Josep Martin-Comin 

13.1.1.1 Background

A 20-year-old man without previous history of illness or allergies was stabbed in the back. No signs or symptoms of TB were present. Chest X-ray and CT findings were: lung wound due to stab on the back and areas with opacification of air spaces within the lung parenchyma (in the left inferior lobe) associated with pleural effusion (bleeding) and left hilar and mediastinal lymphadenopathy. Passive atelectasis.

13.1.1.2 Differential Diagnosis

Lung neoplasm and granulomatous/infectious process.

13.1.1.3 Radiopharmaceutical Activity

[18F]FDG 3.7 MBq/kg.

13.1.1.4 Imaging

PET/CT protocol acquisition: scan was performed for 60–120 min p.i. Acquisition of the scan included: (1) scout view (120 kV, 10 mA) in order to define the limits of body to explore, (2) whole-body CT scan (from skull base to proximal femur: 140 kV, 80 mA), and (3) craniocaudal whole-body PET (2D, 3–5 min/field of view, FOV). Images were reconstructed with soft tissue and lung filters using iterative OSEM, with and without attenuation correction using the low-dose transmission CT scan (Figs. 13.13, 13.14, and 13.15).

Fig. 13.13
figure 13

Maximum intensity projection (MIP) image shows increased and heterogeneous [18F]FDG uptake in the left inferior lung

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Fig. 13.14
figure 14

(a) Transaxial CT slice shows opacification of airspaces within the lung parenchyma (in the left inferior lobe) associated with pleural effusion (bleeding) and left hilar and mediastinal lymphadenopathy. Passive atelectasis. (b) Transaxial slice from [18F]FDG PET/CT fusion in lung window shows increased and heterogeneous [18F]FDG uptake in the left inferior lung corresponding to multiple consolidation areas with cavity lesion, and subpleural nodules with poorly defined margins, associated with pleural effusion and stab wound

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Fig. 13.15
figure 15

Sequential transaxial slices from [18F]FDG PET/CT fusion in mediastinum window demonstrate increased uptake of [18F]FDG in the bilateral hilar and mediastinal nodes

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13.1.1.5 Conclusion/Teaching Point

The conclusion of these findings is based on analyzing the characteristics of the morphometabolic changes, considering the young age of the patient. PET without CT cannot distinguish between tuberculosis and lung neoplasm, but CT findings of the hybrid PET/CT acquisition support the diagnosis of tuberculosis. The cutaneous purified protein derivative (PPD) test was positive (18 mm), and sputum smears were positive for Mycobacterium tuberculosis. The patient was treated with tuberculostatics.

13.1.2 Case 13.2

  • Paola A. Erba 

13.1.2.1 Background

An 80-year-old man previously submitted to axillo-bifemoral vascular prosthesis presented with fever and cough. Abnormalities in the chest X-ray and CT: opacity in the superior lobe of the right lung of equivocal interpretation. Bronchoscopy with bronchoalveolar washing was inconclusive.

Due to persistence of fever associated with suspected vascular periprosthetic infection, [18F]FDG PET/CT was performed (Fig. 13.16). Since the PET/CT findings were inconclusive, 99mTc-HMPAO-leukocyte scintigraphy was performed (Figs. 13.17, 13.18 and 13.19). 99mTc-HMPAO-leukocyte scintigraphy ruled out ongoing active infection.

Fig. 13.16
figure 16figure 16

[18F]FDG PET/CT. Transaxial CT, PET, and fused PET/CT sections of chest (a) show increased [18F]FDG uptake in the right lung. Transaxial CT, PET, and fused PET/CT sections of abdomen (b) show a mildly increased [18F]FDG uptake in aortic region, site of previous surgery

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Fig. 13.17
figure 17

99mTc-HMPAO-leukocyte scintigraphy. Whole-body scan, anterior (a) and posterior (b) views, 30 min p.i

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Fig. 13.18
figure 18

99mTc-HMPAO-leukocyte scintigraphy. Planar anterior (left) and posterior (right) images of chest, 30 min (upper), 4 h (middle), and 24 h (lower) p.i. The images show no pathologic accumulation in the lung region. The focal uptake of radiopharmaceutical in the axillary right region corresponds to the external portion of the central venous catheter

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Fig. 13.19
figure 19figure 19

99mTc-HMPAO-leukocyte scintigraphy. SPECT/CT acquisitions of chest (a) and abdomen (b) do not show pathologic accumulation of labeled leukocytes (CT, upper left; SPECT, upper right; fused, bottom left)

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13.1.2.2 Differential Diagnosis

Lung neoplasm and infectious process.

13.1.2.3 Radiopharmaceutical Activity

[18F]FDG, 3.7 MBq/kg; 99mTc-HMPAO-leukocytes, 640 MBq.

13.1.2.4 Imaging

PET/CT acquisition protocol: the scan was performed at 60–120 min p.i. Acquisition of the scan included: (1) scout view (120 kV, 10 mA) in order to define the limits of the body to explore, (2) whole-body CT scan (from skull base to proximal femur: 140 kV, 80 mA), and (3) whole-body PET (3D, 3 min/FOV).

99mTc-HMPAO-leukocyte scintigraphy: whole-body scan was performed 30 min p.i. Planar anterior and posterior acquisitions of the chest were acquired at 30 min, 4 h, and 24 h p.i. and SPECT/CT imaging of the abdomen was acquired 3 h, whereas SPECT/CT imaging of the chest was acquired at 24 h.

13.1.2.5 Conclusion/Teaching Point

This clinical case highlights the different specificity of [18F]FDG PET/CT and of scintigraphy with radiolabeled leukocytes. [18F]FDG allows the identification of inflammatory processes as well as infection; radiolabeled leukocytes allow the identification of only neutrophil-mediated processes, which are present in the majority of infections.

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Sollini, M., Mariani, G. (2021). Nuclear Medicine Imaging of Lung Infection. In: Lazzeri, E., et al. Radionuclide Imaging of Infection and Inflammation. Springer, Cham. https://doi.org/10.1007/978-3-030-62175-9_13

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