The Contribution of Nuclear Medicine to Pulmonary Imaging

Part of the Medical Radiology book series (MEDRAD)


A variety of nuclear medicine imaging techniques have been applied to imaging of the chest. Several radiopharmaceuticals were designed specifically to diagnose changes in pulmonary physiology caused by pathologic processes. Intravenous injection of 99mTc macroaggregated albumin (MAA) permits identification of local and regional changes in pulmonary arterial perfusion, initially used to identify changes related to pulmonary embolism and later applied to evaluation of pulmonary arterial flow distribution in patients with congenital heart disease. Ventilation studies with noble gases such as 133Xe and 81mkrypton allow recognition of local and regional changes in ventilation and are used with 99mTc MAA perfusion imaging for the identification of pulmonary emboli. Radioaerosols, particularly 99mTc DTPA, can also demonstrate local and regional ventilation abnormalities. Aspiration of saliva can be detected by the radionuclide salivagram. Positron emission tomography (PET) after intravenous injection of [18F]fluoro-2-deoxyglucose (FDG) can be used to localize and follow neoplastic and inflammatory processes in the chest.


Positron Emission Tomography Single Photon Emission Compute Tomography Brown Adipose Tissue Congenital Diaphragmatic Hernia Pulmonary Artery Stenosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Allen-Auerbach M, Yeom K, Park J et al (2006) Standard PET/CT of the chest during shallow breathing is inadequate for comprehensive staging of lung cancer. J Nucl Med 47:298–301PubMedGoogle Scholar
  2. Amin R, Charron M, Grinblat L et al (2012) Cystic fibrosis: detecting changes in airway inflammation with FDG PET/CT. Radiology 264:868–875PubMedCrossRefGoogle Scholar
  3. Barrington SF, Maisey MN (1996) Skeletal muscle uptake of fluorine-18-FDG: effect of oral diazepam. J Nucl Med 37:1127–1129PubMedGoogle Scholar
  4. Bleeker-Rovers CP, de Kleijn EM, Corstens FH et al (2004) Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation. Eur J Nucl Med Mol Imaging 31:29–37PubMedCrossRefGoogle Scholar
  5. Bleeker-Rovers CP, Vos FJ, Wanten GJA et al (2005) 18F-FDG PET in detecting metastatic infectious disease. J Nucl Med 46:2014–2019PubMedGoogle Scholar
  6. Blickman JG, Rosen PR, Welch KJ et al (1985) Pectus excavatum in children: pulmonary scintigraphy before and after corrective surgery. Radiology 156:781–782PubMedCrossRefGoogle Scholar
  7. Chen DL, Atkinson JJ, Ferkol TW (2013) FDG PET imaging in cystic fibrosis. Semin Nucl Med 43:412–419PubMedCrossRefGoogle Scholar
  8. Daftary A, Gregory M, Daftary A et al (2005) Chest radiograph as a triage tool in the imaging-based diagnosis of pulmonary embolism. AJR Am J Roentgenol 185:132–134PubMedCrossRefGoogle Scholar
  9. Donnelly LF, Gelfand MJ, Brody AS et al (1997) Comparison between morphologic changes seen on high-resolution CT and regional pulmonary perfusion seen on SPECT in patients with cystic fibrosis. Pediatr Radiol 27:920–925PubMedCrossRefGoogle Scholar
  10. Eyer BA, Goodman LR, Washington L (2005) Clinicians’ response to radiologists’ reports of isolated subsegmental pulmonary embolism or inconclusive interpretation of pulmonary embolism using MDCT. Radiology 184:623–628Google Scholar
  11. Forbes KP, Reid JH, Murchison JT (2001) Do preliminary chest X-ray findings define the optimum role of pulmonary scintigraphy in suspected pulmonary embolism? Clin Radiol 56:397–400PubMedCrossRefGoogle Scholar
  12. Fukuda Y, Momoi N, Mitomo M et al (2010) Increasing the accuracy of lung perfusion scintigraphy in children with bidirectional Glenn circulation. Pediatr Radiol 40:1890–1894PubMedCrossRefGoogle Scholar
  13. Garcia CA, Van Nostrand D, Majd M et al (2004) Benzodiazepine-resistant “brown fat” pattern in positron emission tomography: two case reports of resolution with temperature control. Mol Imag Biol 6:368–372CrossRefGoogle Scholar
  14. Garcia CA, Van Nostrand D, Atkins F et al (2006) Reduction of brown fat 2-deoxy-2-[F-18]fluoro-d-glucose uptake by controlling environmental temperature prior to positron emission tomography scan. Mol Imag Biol 8:24–29CrossRefGoogle Scholar
  15. Gelfand MJ (1978) Shunts of the heart and great vessels. In: Proceedings of the 19th annual meeting and continuing education lectures of the southeastern chapter, society of nuclear medicine, Atlanta, Georgia, pp 9.1–9.23Google Scholar
  16. Gelfand MJ, O’Hara SM, Curtwright LA et al (2005) Premedication to block [(18)F]FDG uptake in the brown adipose tissue of pediatric and adolescent patients. Pediatr Radiol 35:984–990PubMedCrossRefGoogle Scholar
  17. Gelfand MJ, Gruppo RA, Nasser MP (2008) Ventilation-perfusion scintigraphy in children and adolescents is associated with a low rate of indeterminate studies. Clin Nucl Med 33:606–609PubMedCrossRefGoogle Scholar
  18. Glass T, Heyman S, Seliem M et al (1991) Use of Tc-99 m MAA in determining the etiology of increasing cyanosis following SVC-PA anastomosis for the hypoplastic left heart syndrome. Clin Nucl Med 16:410–412PubMedCrossRefGoogle Scholar
  19. Goerres GW, Burger C, Schwitter MR et al (2003) PET/CT of the abdomen: optimizing the patient breathing pattern. Eur Radiol 13:734–739PubMedCrossRefGoogle Scholar
  20. Gungor T, Engel-Bicik I, Eich G et al (2001) Diagnostic and therapeutic impact of whole body positron emission tomography using fluorine-18-fluoro-2-deoxy-d-glucose in children with chronic granulomatous disease. Arch Dis Child 85:341–345PubMedCentralPubMedCrossRefGoogle Scholar
  21. Hany TF, Gharehpapagh E, Kamel EM et al (2002) Brown adipose tissue: a factor to consider in symmetrical tracer uptake in the neck and upper chest region. Eur J Nucl Med Mol Imag 29:1393–1398CrossRefGoogle Scholar
  22. Hayward MJ, Kharasch V, Sheils C et al (2007) Predicting inadequate long-term lung development in children with congenital diaphragmatic hernia: an analysis of longitudinal changes in ventilation and perfusion. J Pediatr Surg 42:112–116PubMedCrossRefGoogle Scholar
  23. Heyman S (1989) The radionuclide salivagram for detecting the pulmonary aspiration of saliva in an infant. Pediatr Radiol 19:208–209PubMedCrossRefGoogle Scholar
  24. Heyman S, Respondek M (1989) Detection of pulmonary aspiration in children by radionuclide “salivagram”. J Nucl Med 30:697–699PubMedGoogle Scholar
  25. Jeandot R, Lambert B, Brendel AJ et al (1989) Lung ventilation and perfusion scintigraphy in the follow up of repaired congenital diaphragmatic hernia. Eur J Nucl Med 15:591–596PubMedCrossRefGoogle Scholar
  26. Jones SE, Wittram C (2005) The indeterminate CT pulmonary angiogram: imaging characteristics and patient clinical outcome. Radiology 237:329–337PubMedCrossRefGoogle Scholar
  27. Klein M, Cohen-Cymberknoh M, Armoni S et al (2009) 18F-fluorodeoxyglucose-PET/CT imaging of lungs in patients with cystic fibrosis. Chest 136:1220–1228PubMedCrossRefGoogle Scholar
  28. Mackie GC, Pohlen JM (2005) Mediastinal histoplasmosis: F-18 FDG PET and CT findings simulating malignant disease. Clin Nucl Med 30:633–635PubMedCrossRefGoogle Scholar
  29. Mascarenhas NB, Lam D, Lynch GR et al (2006) PET imaging of cerebral and pulmonary Nocardia infection. Clin Nucl Med 31:131–133PubMedCrossRefGoogle Scholar
  30. McVeagh P, Howman-Giles R, Kemp A et al (1987) Pulmonary aspiration studied by radionuclide milk scanning and barium swallow roentgenography Am J Dis Child 141:917–921PubMedGoogle Scholar
  31. Miniati M, Sostman HD, Gottschalk A et al (2008) Perfusion lung scintigraphy for the diagnosis of pulmonary embolism: a reappraisal and review of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis methods. Semin Nucl Med 38:450–461PubMedCrossRefGoogle Scholar
  32. Ozsahin H, von Planta M, Muller I et al (1998) Successful treatment of invasive aspergillosis in chronic granulomatous disease by bone marrow transplantation, granulocyte colony-stimulating factor-mobilized granulocytes, and liposomal amphotericin-B. Blood 92:2719–2724PubMedGoogle Scholar
  33. Parker MS, Hui FK, Camacho MA et al (2005) Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol 185:1228–1233PubMedCrossRefGoogle Scholar
  34. Perko R, Messinger Y, Moertel C (2010) Pseudometastasis secondary to histoplasmosis infection: false-positive PET/CT findings. Pediatr Blood Cancer 54:621–623PubMedGoogle Scholar
  35. Sharp SE, Helton KJ, Gelfand MJ, Brody AS (2007) Detection of pulmonary nodules on localization CT scans acquired during PET/CT imaging. Pediatr Radiol 37(1):S60Google Scholar
  36. Soler C, Figueras J, Roca I et al (1997) Pulmonary perfusion scintigraphy in the evaluation of the severity of bronchopulmonary dysplasia. Pediatr Radiol 27:32–35PubMedCrossRefGoogle Scholar
  37. Sostman HD, Miniati M, Gottschalk A et al (2008) Sensitivity and specificity of perfusion scintigraphy combined with chest radiography for acute pulmonary embolism in PIOPED II. J Nucl Med 49:1741–1748PubMedCrossRefGoogle Scholar
  38. Stabin MG, Gelfand MJ (1998) Dosimetry of pediatric nuclear medicine procedures. Q J Nucl Med 12:93–112Google Scholar
  39. Studler U, Gluecker T, Bongartz G et al (2005) Image quality from high-resolution CT of the lung: comparison of axial scans and of sections reconstructed from volumetric data acquired using MDCT. AJR Am J Roentgenol 185:602–607 Google Scholar
  40. Tatsumi M, Engles JM, Ishimori T et al (2004) (18)F-FDG uptake in brown fat can be reduced pharmacologically. J Nucl Med 45:1189–1193PubMedGoogle Scholar
  41. Touya JJ, Corbus HF, Savala KM et al (1986) Single photon emission computed tomography in the diagnosis of pulmonary thromboembolism. Semin Nucl Med 16:306–336PubMedCrossRefGoogle Scholar
  42. Zukotynski KA, Fahey FH, Laffin S et al (2009) Constant ambient temperature of 24 degrees C significantly reduces FDG uptake by brown adipose tissue in children scanned during the winter. Eur J Nucl Med Mol Imag 36:602–606CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Radiology, Cincinnati Children’s Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Medical Imaging, Toronto Nuclear Medical ServicesTorontoCanada

Personalised recommendations