Virtual positron emission tomography/computed tomography-bronchoscopy: possibilities, advantages and limitations of clinical application

Abstract

The aim of this study was to demonstrate the possibilities, advantages and limitations of virtual bronchoscopy using data sets from positron emission tomography (PET) and computed tomography (CT). Twelve consecutive patients with lung cancer underwent PET/CT. PET was performed with F-18-labelled 2-[fluorine-18]-fluoro-2-deoxy-D: -glucose ((18)F-FDG). The tracheobronchial system was segmented with a volume-growing algorithm, using the CT data sets, and visualized with a shaded-surface rendering method. The primary tumours and the lymph node metastases were segmented for virtual CT-bronchoscopy using the CT data set and for virtual PET/CT-bronchoscopy using the PET/CT data set. Virtual CT-bronchoscopy using the low-dose or diagnostic CT facilitates the detection of anatomical/morphological structure changes of the tracheobronchial system. Virtual PET/CT-bronchoscopy was superior to virtual CT-bronchoscopy in the detection of lymph node metastases (P=0.001), because it uses the CT information and the molecular/metabolic information from PET. Virtual PET/CT-bronchoscopy with a transparent colour-coded shaded-surface rendering model is expected to improve the diagnostic accuracy of identification and characterization of malignancies, assessment of tumour staging, differentiation of viable tumour tissue from atelectases and scars, verification of infections, evaluation of therapeutic response and detection of an early stage of recurrence that is not detectable or is misjudged in comparison with virtual CT-bronchoscopy.

Usefulness of FDG PET/CT in determining benign from malignant endobronchial obstruction

“…However, most of these studies have focused on solitary pulmonary nodules (SPN) or evaluated the FDG uptake of the malignant lesion itself only. Although there have been a few studies on the FDG uptake in evaluation of central airway lesions [28][29][30][31][32][33], to our knowledge, there have been no reports evaluating the FDG uptake pattern at the obstruction site in patients with endobronchial lesions with distal atelectasis.…”

Update on Multidetector Computed Tomography Imaging of the Airways

“…This promising technique has been shown in preliminary studies to improve the spatial localization of lesions and to aid preprocedural planning by highlighting specific lymph nodes to be biopsied, targeting the biopsy to metabolically active sites within a lesion, and helping to determine the route and method of the biopsy. 36,37 In addition, in a recent phantom model study by Yerushalmi et al, 38 virtual PET-CT bronchoscopy enabled visualization of flat endoluminal lesions that were undetectable with virtual bronchoscopy alone. Although virtual PET-CT bronchoscopy, when compared with virtual bronchoscopy, is expected to improve the diagnostic accuracy of endobronchial lesions and aid in defining submucosal and peribronchial tumor extension, further investigation is needed to validate these predictions.…”

Simulations of Virtual PET/CT 3-D Bronchoscopy Imaging Using a Physical Porcine Lung–Heart Phantom

“…However, to our knowledge, no previous research has systematically examined the factors affecting these results [7,8]. A thorough understanding of the quantitative limitations of this modality is an important prerequisite for ultimately determining its clinical value.…”