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Integrated PET/CT of Pulmonary Neuroendocrine Tumors: Diagnostic and Prognostic Implications

Semin Chong1, Kyung Soo Lee1, Byung-Tae Kim2, Joon Young Choi2, Chin A Yi1, Myung Jin Chung1, Dae-Kun Oh1 and Ji-Young Lee1

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Kangnam-gu, Seoul, South Korea, 135-710.
2 Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.


Figure 1
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  		Fig. 1A —23-year-old man with typical carcinoid with little 18F-FDG uptake (Table 1, patient 1). Transverse unenhanced CT scan (5-mm section thickness, 80 mA) obtained through right middle lung zone shows 32-mm central mass (arrows) occupying right bronchus intermedius. Punctuate calcifications (arrowheads) are evident.

 

Figure 2
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  		Fig. 1B —23-year-old man with typical carcinoid with little 18F-FDG uptake (Table 1, patient 1). and C, FDG PET (B) and integrated PET/CT (C) scans show little FDG uptake (arrows) within tumor (maximum standardized uptake value, 3.2)

 

Figure 3
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  		Fig. 1C —23-year-old man with typical carcinoid with little 18F-FDG uptake (Table 1, patient 1). FDG PET (B) and integrated PET/CT (C) scans show little FDG uptake (arrows) within tumor (maximum standardized uptake value, 3.2)

 

Figure 4
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  		Fig. 2A —42-year-old woman with atypical carcinoid with little 18F-FDG uptake (Table 1, patient 7). Transverse unenhanced CT scan (1-mm section thickness, 180 mA) obtained at level of left inferior pulmonary vein shows 12-mm nodule (arrow) in left lower lobe.

 

Figure 5
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  		Fig. 2B —42-year-old woman with atypical carcinoid with little 18F-FDG uptake (Table 1, patient 7). Transverse contrast-enhanced CT scan (5-mm section thickness, 180 mA) obtained 10-mm superior to A shows enlarged lymph nodes (arrows) in left hilum.

 

Figure 6
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  		Fig. 2C —42-year-old woman with atypical carcinoid with little 18F-FDG uptake (Table 1, patient 7). PET scan obtained at level between A and B shows little FDG uptake within primary tumor (arrow) (maximum standardized uptake value, 1.7) and considerable FDG uptake within left hilar lymph node (arrowhead) (maximum standardized uptake value, 11.2).

 

Figure 7
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  		Fig. 3A —51-year-old man with large cell neuroendocrine carcinoma with high 18F-FDG uptake (Table 1, patient 16). Transverse contrast-enhanced CT scan (5-mm section thickness, 180 mA) obtained at level of distal left main bronchus shows 45-mm mass (arrows) encircling apicoposterior segmental bronchus in left upper lobe.

 

Figure 8
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  		Fig. 3B —51-year-old man with large cell neuroendocrine carcinoma with high 18F-FDG uptake (Table 1, patient 16). Integrated PET/CT scan shows high FDG uptake within tumor (maximum standardized uptake value, 13.4).

 

Figure 9
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  		Fig. 4A —78-year-old man with small cell lung cancer manifesting as solitary pulmonary nodule (Table 2, patient 11). Transverse CT scan (5-mm section thickness, 180 mA) obtained with lung window at level of aortic arch shows 15-mm nodule (arrow) in left upper lobe.

 

Figure 10
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  		Fig. 4B —78-year-old man with small cell lung cancer manifesting as solitary pulmonary nodule (Table 2, patient 11). Integrated PET/CT scan shows high 18F-FDG uptake within tumor (arrow) (maximum standardized uptake value, 8.1).

 

Figure 11
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  		Fig. 5A —49-year-old man with rib metastasis from large cell neuroendocrine carcinoma (Table 1, patient 17). Rib metastasis was detected only with integrated PET/CT. Contrast-enhanced transverse CT scan (5-mm section thickness, 180 mA) obtained with mediastinal window at level of distal bronchus intermedius shows lobulated mass (arrow) in left hilar area with enlarged lymph nodes (arrowhead) in subcarinal area.

 

Figure 12
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  		Fig. 5B —49-year-old man with rib metastasis from large cell neuroendocrine carcinoma (Table 1, patient 17). Rib metastasis was detected only with integrated PET/CT. CT scan obtained at same time as A shows no abnormality in FDG uptake area. Bone scan (not shown) also did not suggest rib metastasis. Thus patient underwent follow-up CT examination without tissue confirmation.

 

Figure 13
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  		Fig. 5C —49-year-old man with rib metastasis from large cell neuroendocrine carcinoma (Table 1, patient 17). Rib metastasis was detected only with integrated PET/CT. Transverse PET scan obtained at same time as A and B shows increased 18F-FDG uptake (arrow) suggestive of rib metastasis in posterior arc of left third rib.

 

Figure 14
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  		Fig. 5D —49-year-old man with rib metastasis from large cell neuroendocrine carcinoma (Table 1, patient 17). Rib metastasis was detected only with integrated PET/CT. Follow-up CT scan obtained at similar level to and 6 months after B and C shows bone destruction and soft-tissue lesion (arrows) at previous FDG uptake area.

 

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