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Idiopathic Pulmonary Fibrosis and Diffuse Parenchymal Lung Disease: Implications from Initial Experience with ¹⁸F-FDG PET/CT

¹ Institute of Nuclear Medicine, University College London, London, United Kingdom; ² Respiratory Medicine, Lister Hospital, Stevenage, United Kingdom; ³ Department of Radiology, Papworth Hospital, Cambridge, United Kingdom; and ⁴ Department of Thoracic Medicine, University College London Hospital, London, United Kingdom

Correspondence: For correspondence or reprints contact: Thida Win, Respiratory Medicine, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, SG1 4AB. E-mail: drthidawin{at}hotmail.com

The purpose of this study was to evaluate integrated ¹⁸F-FDG PET/CT in patients with idiopathic pulmonary fibrosis (IPF) and diffuse parenchymal lung disease (DPLD). Methods: Thirty-six consecutive patients (31 men and 5 women; mean age ± SD, 68.7 ± 9.4 y) with IPF (n = 18) or other forms of DPLD (n = 18) were recruited for PET/CT and high-resolution CT (HRCT), acquired on the same instrument. The maximal pulmonary ¹⁸F-FDG metabolism was measured as a standardized uptake value (SUV_max). At this site, the predominant lung parenchyma HRCT pattern was defined for each patient: ground-glass or reticulation/honeycombing. Patients underwent a global health assessment and pulmonary function tests. Results: Raised pulmonary ¹⁸F-FDG metabolism in 36 of 36 patients was observed. The parenchymal pattern on HRCT at the site of maximal ¹⁸F-FDG metabolism was predominantly ground-glass (7/36), reticulation/honeycombing (26/36), and mixed (3/36). The mean SUV_max in patients with ground-glass and mixed patterns was 2.0 ± 0.4, and in reticulation/honeycombing it was 3.0 ± 1.0 (Mann–Whitney U test, P = 0.007). The mean SUV_max in patients with IPF was 2.9 ± 1.1, and in other DPLD it was 2.7 ± 0.9 (Mann–Whitney U test, P = 0.862). The mean mediastinal lymph node SUV_max (2.7 ± 1.3) correlated with pulmonary SUV_max (r = 0.63, P < 0.001). Pulmonary ¹⁸F-FDG uptake correlated with the global health score (r = 0.50, P = 0.004), forced vital capacity (r = 0.41, P = 0.014), and transfer factor (r = 0.37, P = 0.042). Conclusion: Increased pulmonary ¹⁸F-FDG metabolism in all patients with IPF and other forms of DPLD was observed. Pulmonary ¹⁸F-FDG uptake predicts measurements of health and lung physiology in these patients. ¹⁸F-FDG metabolism was higher when the site of maximal uptake corresponded to areas of reticulation/honeycomb on HRCT than to those with ground-glass patterns.

Key Words: lung diseases • interstitial • positron emission tomography • cone-beam computed tomography

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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