Positron emission tomography studies of human airways using an inhaled beta-adrenoceptor antagonist, S-11C-CGP 12388

OBJECTIVES: Positron emission tomography (PET) scanning may provide information on changes in the density and affinity of airway beta-adrenoceptors in lung diseases. However, the injection of a radiolabeled beta-blocker results in a pulmonary PET signal that reflects the binding of the ligand in the alveoli and not in the airways. Better discrimination between alveolar and airway beta-adrenoceptors may be possible with an inhaled radioligand. DESIGN: A nebulizer was used to administer the antagonist S-11C-CGP12388 in aerosol form. Eight volunteers inhaled the tracer twice, at baseline and after pretreatment with a beta-adrenergic drug. In both PET scan studies, a dynamic scan of the lungs was followed by a whole-body scan to assess the inhaled dose. Pulmonary uptake was quantified using a region-of-interest-based analysis. SETTING: University hospital. PARTICIPANTS: Healthy volunteers. INTERVENTIONS: Pretreatment consisted either of inhaled salbutamol (400 microg, 20 min before the scan), or orally administered pindolol (3 x 5 mg during a period of 16 h before PET scanning). RESULTS: Drug pretreatment did not affect pulmonary deposition of the radioligand. The agonist salbutamol accelerated the monoexponential washout of 11C not only in the peripheral lung (mainly alveoli), but also in the central lung (mainly airways) and in the main bronchi. An even larger increase of the washout rate was induced by the antagonist pindolol. CONCLUSION: The similar effects of pindolol and salbutamol on tracer kinetics suggest that accelerated washout is due to the blockade of beta-adrenoceptors. Thus, the interaction of drugs with airway beta-adrenoceptors can be visualized using PET scanning and an inhaled radioligand.     

The impact of positron emission tomography on clinical decision making in a university-based multidisciplinary lung cancer practice

INTRODUCTION: Positron emission tomography (PET) scanning has gained increasing application as a diagnostic and staging tool in the evaluation of lung cancer. Although PET scanning has been demonstrated to be a cost-effective adjunct to lung cancer diagnosis, its global impact on clinical decision making has not been assessed. STUDY OBJECTIVES: To evaluate the impact of the systematic use of PET scanning on clinical decision making. DESIGN: Retrospective study. SETTING: A university-based multidisciplinary lung cancer practice. PATIENTS: All patients undergoing diagnostic or staging PET scans from December 31, 2000, to December 31, 2002. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: One hundred ninety-eight patients underwent PET for diagnosis (161 patients) or staging (37 patients). PET scan results and clinical outcomes were retrospectively reviewed to determine the frequency with which PET scan findings (1) upstaged patients, (2) downstaged patients, (3) changed the diagnostic workup, (4) altered therapy, (5) resulted in a significant additional diagnosis, and (6) triggered evaluations that ultimately proved fruitless. PET upstaged 32 of 198 patients (16.2%) and downstaged 12 patients (6.1%), facilitating curative resection in 4 patients. Overall, PET scan findings changed the stage in 44 patients (22.2%). PET scan findings changed diagnostic management in 105 of 198 patients (53%), among whom biopsy was deferred in 65 patients (61.9%) and was triggered or guided in 40 patients (38.1%). PET scan findings altered treatment decisions in 38 patients (19.2%), leading to neoadjuvant therapy in 6 patients and resection in 5 patients, and forestalling noncurative thoracotomy in 6 patients. PET scan findings prompted or redirected chemotherapy or radiotherapy in the remainder of the patients. Overall, PET scan findings changed management in 143 patients (72.2%). PET scan findings triggered additional diagnostic testing in 32 patients (16.2%), resulting in no new diagnosis in 16 patients (50%) and a critical change in management in 7 patients (21.9%). PET scan findings were solely responsible for a significant non-lung cancer diagnosis in eight patients (4%). CONCLUSIONS: Systematically applied PET scanning has a significant impact on patient management, altering diagnostic or therapeutic interventions in 72.2% of patients, changing staging in 22.2% of patients, and identifying serious unsuspected diagnoses in 4.0% of patients, with potentially life-saving consequences in 2.0%.Key Words: diagnosis; lung neoplasms; positron emission tomography.     

正电子发射体层成像在肺癌诊治中的作用

目的探讨正电子发射体层成像（PET）在肺癌诊治中的作用。方法收集1998年9月1日至2000年3月1日期间就诊的肺癌或拟诊为肺癌的患者,均行PET及胸腹部CT、骨显像检查。结果共收集88例患者,其中肺癌患者68例(77.3%),良性疾病者20例(22.7%)。CT与PET共发现125个肺内病灶,其中恶性病灶80个（64.0%）,良性病灶45个（36.0%）,恶性病灶的标准摄取比（SUR）值明显高于良性病灶。PET诊断肺癌的敏感性、特异性与病灶是否经过放化疗无关,但与病灶大小相关。对肺内病灶PET所见及SUR值诊断的特异性及准确性均高于CT,其中PET诊断的敏感性、特异性和准确性分别为95.0%、95.6%及95.2%;SUR值诊断分别为65.0%、91.1%及74.4%。SUR值诊断直径≥1.5cm的肺内病灶的准确性高于直径＜1.5cm的病灶。在诊断肺癌肺门淋巴结、纵隔淋巴结、远处淋巴结转移中,PET敏感性及准确性均显著高于CT。SUR值与细胞分化程度无关;小细胞肺癌经过放化疗后SUR值显著下降。结论PET在判断肺内病灶的良恶性程度上有优势,且能准确判断肺癌淋巴结转移情况。对直径<1.5cm的病灶及放化疗后的病灶,PET诊断的准确性高。     

Routine Echocardiographic Views Miss Significant Pleural Effusions

Objectives: To determine the benefit of adding chest scanning to the routine echocardiographic examination to diagnose pleural effusions. Background: Pleural effusions are common in several cardiac disorders, yet routine echocardiography is insensitive in delineating pleural fluid. Methods: Bilateral chest scanning was performed in addition to the routine echo examination in 100 consecutive inpatients referred for echocardiography with recent chest X rays (CXRs). Detection and quantification of pleural effusion by sonographic chest scanning was compared blindly with CXRs. Identification of pleural fluid was analyzed for correlation with clinical diagnosis of congestive heart failure (CHF) and elevated pulmonary artery pressures if found by echo-Doppler examination. Results: Agreement on presence or absence of pleural effusion occurred in 88 of 100 patients—in 5 patients bilateral chest scanning detected pleural effusion with negative CXRs; in 7 patients CXRs suggested pleural effusion with negative bilateral chest scanning (all 7 patients had minor blunting of the costophrenic angle). Routine echo views only detected 22 of 51 patients (43%) with pleural effusion detected by bilateral chest scanning. In 45 patients with CHF, 29 (64%) had pleural effusion by bilateral chest scanning (25 bilateral, 1 left, 3 right) vs 12 (27%) by routine echo (only left pleural effusion seen). Ejection fraction and estimated pulmonary artery pressure did not differ between CHF patients with and without pleural effusion. Conclusions: Routine echocardiographic views underestimate the presence of pleural effusion in patients referred for study. Bilateral chest scanning is equal to CXRs for pleural effusion detection and provides clinically useful information which may be of particular benefit to patients with CHF.     

Clinical role of F-18 fluorodeoxyglucose positron emission tomography imaging in patients with lung cancer and suspected malignant pleural effusion

STUDY OBJECTIVES: The goals of this study were to determine the sensitivity, specificity, and predictive accuracy of F-18 fluorodeoxyglucose positron emission tomography (PET-FDG) imaging in detecting metastatic disease involvement of pleura and/or presence of malignant pleural effusion in patients with proven lung cancer. We wanted to compare efficacy of PET-FDG imaging to CT scanning in differentiating benign pleural effusion from malignant effusion and/or pleural involvement in patients with lung cancer. METHODS: We studied 35 patients with biopsy-proven lung cancer and abnormal findings on CT scanning for presence of pleural effusion (n = 34) and/or pleural thickening or nodular involvement (n = 4). The results of positron emission tomography and CT scanning were compared to pleural cytology (n = 31), histologic findings of pleural biopsy (n = 3), and/or clinical follow-up (n = 3) for at least 1 year for presence or absence of malignant pleural effusion. RESULTS: PET-FDG imaging correctly detected the presence of malignant pleural effusion and malignant pleural involvement in 16 of 18 patients and excluded malignant effusion or pleural metastatic involvement in 16 of 17 patients (sensitivity, specificity, and accuracy of 88.8%, 94.1%, and 91.4% respectively). CONCLUSION: PET-FDG imaging is a highly accurate and reliable noninvasive test to differentiate malignant from benign pleural effusion and/or pleural involvement in patients with lung cancer and findings of suspected malignant pleural effusion on CT scanning.     

An immunoglobulin G4-related disease mimicking postoperative lung cancer recurrence

Abstract

A postoperative lung cancer patient presented with lymphadenopathy, pleural thickening, and 18F-fluorodeoxyglucose (FDG) uptake on a positron emission tomography–computed tomography (PET–CT) scan. Lung cancer recurrence was initially suspected, but bilateral submandibular masses with 18F-FDG uptake indicated the possibility of a systemic disease, such as Mikulicz’s disease. High serum immunoglobulin G4 (IgG4) and IgG4-positive plasma cell infiltration in the submandibular glands led to the diagnosis of IgG4-related disease. After systemic steroid therapy, 18F-FDG uptake decreased in both the submandibular glands and the suspected recurrent lesions.     

Evaluation of Tl-20 lung uptake and impairment of pulmonary perfusion on scintigraphies in pulmonary tuberculosis

Tl-201 lung uptake in 74 patients (85 lesions) and pulmonary perfusion in 105 patients were studied to evaluate clinical usefulness of Tl-201 lung uptake and perfusion lung scintigraphy in pulmonary tuberculosis, using a scintillation camera with a mini-computer system. As indices of Tl-201 lung uptake, lung (lesion) to upper mediastinum uptake ratio (L/M) and visual grading were used. L/M in pulmonary tuberculosis was 1.96 +/- 0.66, which was significantly larger than 1.04 +/- 0.24 in healthy controls and lower than that in heart diseases with left heart failure and idiopathic interstitial pneumonia, and showed no significant differences with that in acute pneumonia, pyothorax, primary lung cancer and malignant mediastinal tumor. L/M in pulmonary tuberculosis did not correlate with CRP, erythrocyte sedimentation rate, Gaffky number of sputum and body temperature. It correlated with the type of pulmonary tuberculosis according to the Gakken Classification reflecting the disease activity. It was larger in the exudative type, caseo-infiltrative one, disseminated one, one with cavity in infiltrative lesion than the fibro-caseous one. On perfusion lung scintigram, impairment of pulmonary perfusion larger than area of the entire unilateral lung was observed in 68 cases (64.8%). Area of hypoperfused lung field, which correlated with % vital capacity (r = 0.60, p = 0.0002) and PaO2 (r = 0.39, p = 0.0024), was significantly larger in patients with silicosis and those with bilateral pleural involvements such as pleural callosity than in those with type III according to the Gakkai Classification. Most of the patients showed decreased pulmonary perfusion and Tl-201 accumulation of which grade reflects the disease activity in active tuberculous lesion. Patients with miliary tuberculosis and those with silicotuberculosis showed diffuse Tl-201, accumulation in the both lungs. Tl-201 lung scintigraphy seems to be useful for visualizing active tuberculous lesions, particularly the ones that could not be detected by the chest radiograph in patients with destroyed lung and with pleural callosity. Joint use of Tl-201 and perfusion lung scintigraphies provides useful informations about the pathophysiology and disease process in pulmonary tuberculosis.     

Staging by positron emission tomography predicts survival in patients with non-small cell lung cancer

BACKGROUND: Positron emission tomography (PET) scanning is used increasingly to detect and stage lung cancer, but the test performance characteristics and relationship of PET to patient outcomes remain undefined. OBJECTIVE: To determine the test performance characteristics and relationship of PET scanning stage to patient outcomes relative to the 1997 International System for the Staging of Lung Cancer. DESIGN: Survival analysis using pathologic staging as the criterion standard for comparison of survival as predicted by staging by PET and CT. SETTING: University-based hospital. PATIENTS: All consecutive patients undergoing PET scanning for the evaluation of possible non-small cell lung cancer (NSCLC) during a 5-year period. Main outcome measures: Long-term survival of patients with NSCLC after staging by PET. RESULTS: One hundred fifty-two thoracic PET scans were obtained for the staging of possible NSCLC during a 5-year period. One hundred twenty-three patients (81%) demonstrated increased (18)F-fluorodeoxyglucose uptake. The overall sensitivity and specificity of PET for detecting malignancy were 95% and 67%, respectively, compared with 100% and 27% for chest CT. PET and CT had similar accuracy for staging the overall extent of disease (91% and 89%, respectively). PET stage correlated highly with survival using either nodal location or overall stage (p = 0.003, p = 0.002), as did pathologic staging (p = 0.0001, p = 0.0001). CT scan results did not accurately predict survival (p = 0.608, p = 0.338). CONCLUSION: PET scanning is a highly sensitive technologic advance in detecting and staging of thoracic malignancy and may more accurately predict the likelihood of long-term survival in patients with NSCLC than chest CT does.     

Marginal zone B-cell lymphoma of bronchus-associated lymphoid tissue: imaging findings in 21 patients

BACKGROUND: Few articles have been published on imaging findings of marginal zone B-cell lymphoma of bronchus-associated lymphoid tissue (BALT) of the lung. We present CT scan and 18F-fluorodeoxyglucose (FDG) PET scan findings of the disease. METHODS: From March 1995 to February 2007, 21 pretreatment patients (male patients, 9; female patients, 12; age range, 35 to 76 years; mean [+/- SD] age, 54 +/- 10.4 years) were seen who had pathologic diagnoses of marginal zone B-cell lymphoma of BALT. After CT scans were reviewed searching for specific patterns and distribution of parenchymal lung lesions, patients were classified as having the following four different patterns: (1) single nodular or consolidative; (2) multiple nodular or areas of consolidation; (3) bronchiectasis and bronchiolitis; and (4) diffuse interstitial lung disease (DILD) patterns. In six patients, in whom PET/CT scanning was performed, the pattern and the extent of maximum standardized uptake values (mSUVs) of FDG uptake were described. RESULTS: A single nodular or consolidative pattern was observed in 7 of 21 (33%) patients, multiple nodular or areas of consolidation were observed in 9 patients (43%), bronchiectasis and bronchiolitis were observed in 3 patients (14%), and DILD was observed in 2 patients (10%). On PET scans (n = 6), lesions showed heterogeneous FDG uptake in five patients and homogeneous uptake in one patient, with mSUVs ranging from 2.2 to 6.3 (mean mSUV, 4.2 +/- 1.48). CONCLUSIONS: Marginal zone B-cell lymphomas of BALT manifest diverse patterns of lung abnormality on CT scans, but single or multiple nodules or areas of consolidation are the main patterns that occur in a majority (76%) of patients. Most lesions show heterogeneous but identifiable FDG uptake on PET scans.     

A case of post-traumatic bilateral eosinophilic pleural effusion]

A 58-year-old man was admitted to our hospital with chest pain caused by chest trauma. After admission, his chest pain decreased and he was discharged. Later, he was admitted again with a high fever and dyspnea. Laboratory findings on second admission showed a leukocyte count of 7,900/microliter (9% eosinophils) and a C-reactive protein of 17.0 mg/dl. Chest radiography and chest CT scanning on second admission showed moderate bilateral pleural effusion. Close examination showed an increase of eosinophils in the pleural effusion (14% of total cell counts on the right and 27% of total cell counts on the left) that was exudate. Post-traumatic bilateral eosinophilic pleural effusion was diagnosed. The patient was treated with antibiotic therapy and his condition improved. A chest CT scan afterwards showed improvement of the bilateral pleural effusion. The eosinophil count in the peripheral blood was 1% at chest trauma, 15% in the hospital to the max and decreased to 3% with the decrease of pleural effusion. Post-traumatic eosinophilic pleural effusion may be accompanied with inflammatory findings, and the mechanism is guessed by immunological reaction.     

Increased lung uptake of thallium-201 during exercise myocardial imaging: Clinical,hemodynamic and angiographic implications in patients with coronary artery disease

To determine the clinical significance of increased thallium-201 activity in the lung immediately after exercise stress, the thallium-201 scans in 227 patients undergoing cardiac catheterization were reviewed. Thallium lung activity on the Initial anterior view images were graded qualitatively as follows: 0 (none) in 175 patients (77 percent); 1+ (moderate—increased activity in the lungs but less intense than that in left ventricular myocardium) in 37 patients (16 percent); and 2+ (severe—activity equal to or greater in intensity than left ventricular myocardlal activity) in 15 patients (7 percent). Increased (1+ or 2+) lung activity was related to (1) a greater number of myocardial segmental thallium defects (probability [p] < 0.05); and (2) increased severity and extent of coronary artery disease (p < 0.05). In addition, 2+ lung thallium activity was associated with: (1) a greater prevalence of prior myocardial infarctions (p < 0.01); and (2) a lower angiographic ejection fraction at rest (p < 0.05). To determine the hemodynamic changes associated with increased lung uptake of thallium-201, supine stress thallium imaging was performed during cardiac catheterization in 12 additional patients. Of these, the five patients with increased lung activity on thallium scanning had a mean pulmonary capillary wedge pressure that increased with exercise from 12 ± 1 (mean ± 1 standard deviation) to 24 ± 3 mm Hg (p < 0.05); cardiac index did not increase with stress. In contrast, seven patients without increased lung thallium activity demonstrated an increase in mean cardiac index (p < 0.05) without an associated rise in pulmonary capillary wedge pressure (at rest = 10 ± 3 mm Hg; during stress = 12 ± 2 mm Hg). In conclusion, increased pulmonary uptake during exercise thallium-201 imaging suggests the development of exercise-induced left ventricular dysfunction. Evaluation of lung activity should be added to the routine interpretation of exercise thallium-201 myocardial imaging studies.     

18F-FDG PET in the management of patients with anaplastic thyroid carcinoma

BACKGROUND: Anaplastic thyroid carcinoma (ATC) is one of the most aggressive solid tumors in humans. The use of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) in ATC has not been studied, and only a few case reports have been published. The objective of this study was to investigate the potential contribution of 18F-FDG PET to the clinical management of patients with ATC. METHODS: All patients with ATC studied with 18F-FDG PET from August 2001 through March 2007 were included. The PET results were correlated with computed tomography, ultrasound, magnetic resonance imaging, bone scan, histology, and clinical follow-up. The FDG uptake was semiquantified as maximum standard uptake value. Any change in the treatment plan as a direct result of the PET findings as documented in the clinical notes was recorded. RESULTS: Sixteen patients were included. True-positive PET findings were seen for all primary tumors, in all nine patients with lymph node metastases, in five out of eight patients with lung metastases, and in two patients with distant metastases other than lung metastases. In 8 of the 16 patients, the medical records reported a direct impact of the PET findings on the clinical management. CONCLUSIONS: ATC demonstrates intense uptake on 18F-FDG PET images. In 8 of the 16 patients (50%), the medical records reported a direct impact of the PET findings on the management of the patient. PET may improve disease detection and have an impact on the management of patients with ATC relative to other imaging modalities.     

FDG-PET in bleomycin-induced pneumonitis following ABVD chemotherapy for Hodgkin's disease--a useful tool for monitoring pulmonary toxicity and disease activity

Bleomycin-related pneumonitis (BIP) has recently emerged as one of the main causes of death in Hodgkin's disease treated with standard chemotherapy ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine). We used 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) scanning in a patient with Hodgkin's disease who developed bleomycin lung toxicity following the 4(th) cycle of chemotherapy. The PET scan done two month after the acute presentation with BIP showed uptake of FDG in the lungs. Following treatment with corticosteroids, the FDG avidity in the lungs disappeared. Corticosteroids were tapered off subsequently, without recurrence of the respiratory symptoms. Conventional CT scanning was not able to distinguish between residual changes and active inflammation. Thus PET represents a useful diagnostic tool and, independently of CT, indicates the resolution of disease activity, even in the presence of residual pulmonary scarring.     

以肺为首发部位的NK/T细胞淋巴瘤二例并文献复习

目的 分析2例首发于肺部的NK/T细胞淋巴瘤的临床、影像学及病理特征.方法 回顾性分析南京大学医学院附属鼓楼医院呼吸科收治的2例以肺部为首发部位的NK/T细胞淋巴瘤患者的临床、影像学及病理资料,并复习相关文献.结果 2例均为年轻女性患者,首发病灶部位均为肺部,通过CT引导下经皮肺穿刺活检病理证实为NK/T细胞淋巴瘤.2例患者有类似的临床表现,包括发热、干咳、呼吸困难,呈进行性进展并发呼吸衰竭.2例患者胸部CT表现为双肺多发实变影,部分病灶显示有空气支气管征和晕环征,伴有胸腔积液.2例患者的血浆EB病毒DNA检测结果分别为3.65×105拷贝/ml、1000拷贝/ml.由于病情进展迅速,2例患者的生存期仅分别为44 d和66 d.结论 肺部可以是NK/T细胞淋巴瘤首发侵袭部位,预后凶险.     

正电子发射体层成像在肺癌诊断和分期中的价值

目的了解正电子发射体层成像(PET)在肺癌诊断和分期中的价值。方法收集1998年9月至2003年4月间行PET和CT检查,且诊断明确的肺部疾病患者的临床资料,对PET和CT检查结果与病理检查结果进行对比分析。结果在此期间共收集104例患者,其中肺癌64例(60%),肺部良性疾病40例(40%)。肺癌患者PET的标准摄取比值(SUV值)中位值为4.5(1.2～11.7),明显高于良性患者的1.0(0～7.7);且肺癌患者的SUV值与肺癌组织学类型、分化程度、临床分期和病灶大小均无关(P>0.05)。PET诊断肺癌的敏感性、特异性和准确性分别为88%、85%和87%;CT的敏感性、特异性和准确性分别为73%、28%、57%,PET的特异性和准确性显著高于CT(P<0.05)。对于胸腔淋巴结转移诊断的敏感性、特异性和准确性CT:N1期分别为33%、73%、59%,N2期分别为80%、79%、79%,N3期特异性及准确性均为97%;PET:N1期分别为33%、82%、65%,N2期分别为60%、83%、85%,N3期特异性及准确性均为85%;两者差异无统计学意义(P>0.05)。结论PET在鉴别肺内病灶良恶性质上有优势,对胸腔内淋巴结转移的诊断要结合CT结果综合判断。     

The future in diagnosis and staging of lung cancer: positron emission tomography

Since its introduction in 1974, positron emission tomography (PET) has gained widespread use, especially in diagnosis and staging of lung cancer. In this respect, (18)F-fluorodeoxyglucose (FDG) is by far the most used PET tracer exploiting the increased glucose uptake and metabolism in malignant cells. A large number of studies have suggested that addition of FDG-PET to conventional workup can improve diagnosis and staging in patients with non-small cell lung cancer (NSCLC). In meta-analysis, the sensitivity and specificity of PET in diagnosing single pulmonary nodules and masses is found to be 96 and 78%, respectively. In mediastinal staging, the sensitivity and specificity of PET is estimated to be 83 and 92%. In order to achieve high diagnostic values from PET, it is necessary to pay attention to a number of pitfalls, e.g., the uptake of FDG by inflammatory cells causing false-positive results, as well as size and histology of the tumour in order to avoid false-negative results. In 2001, the first integrated PET/computed tomography (CT) was installed, and since then, the use of this modality has expanded steadily, thereby decreasing examination time and overcoming the lack of anatomical details on PET. Recently, PET and PET/CT have become increasingly integrated in therapy planning and evaluation: response evaluation during and after chemotherapy, restaging after neoadjuvant therapy, planning of radiotherapy and detection of recurrent disease are all examples of emerging indications for PET and PET/CT in managing patients with lung cancer.     

Whole-body gallium 67 scans. Role in diagnosis of sarcoidosis

Early studies of 67gallium (67Ga) scanning in sarcoidosis focused on the lungs as a measure of disease activity, likelihood of progression, and the advisability of corticosteroid therapy. The predictive value of pulmonary uptake proved to be limited, but there has been renewed interest in 67Ga scanning as a diagnostic aid with special attention to characteristic extrapulmonary uptake patterns. Review of whole-body 67Ga scans in 172 patients with sarcoidosis, 21 with lymphoma, and 51 with other disorders demonstrated distinctive cranial, mediastinal, and hilar uptake patterns in sarcoidosis patients. Bilateral hilar uptake occurred in 81 sarcoidosis patients (47%) but in no lymphoma cases. Increased lacrimal and/or salivary gland uptake was observed in 47.5% but lacked specificity. Uptake in peripheral lymph nodes was infrequent in sarcoidosis (5%) but common in lymphoma (57%). 67Ga scans are especially valuable in patients with uveitis and liver granulomas whose chest radiographs are normal or equivocal. 67Ga scans, unnecessary in typical cases of sarcoidosis, have an important diagnostic role by reducing the need for invasive biopsy procedures in asymptomatic patients.     

How useful is positron emission tomography for lymphnode staging in non-small-cell lung cancer?

The introduction of positron emission tomography (PET) raises the question of the new method's capabilities in the staging of mediastinal lymphnodes, since PET differentiates between metabolically active and inactive tissues. 80 patients with histologically confirmed non-small-cell lung cancer (NSCLC) underwent PET scanning with 18-F-marked fluorodeoxyglucose (FDG). Extensive dissection of mediastinal lymphnodes (18-28 lymphnodes recovered) was performed in 78 cases. Metastasis to mediastinal lymphnodes were observed in 25 patients (N2: 22; N3: 3). Results: Primary Tumor: FDG-PET showed significant enhancement of the primary tumor in 78 of 80 patients (sensitivity: 97%). Lymphnode Involvement: FDG-PET was positive in 23 of 25 patients with surgically confirmed lymphnode involvement (sensitivity: 92%). After a median follow up interval of 18 months, 11 patients with false positive lymphnode uptake were still alive; 10 of them showed no tumor recurrency. On the basis of these findings, enlarged mediastinal lymphnodes visualized at CT, but negative at FDG-PET are free of metastatic involvement with a sensitivity of 92%. FDG uptake of mediastinal lymphnodes at PET, however, should not be interpreted as proof of malignancy.     

Organising pneumonia caused by transtuzumab (Herceptin) therapy for breast cancer.

The case of a 49-yr-old female, who developed fever, effort dyspnoea and cough, with patchy migratory bilateral pulmonary infiltrates 6 weeks after starting transtuzumab therapy, following breast-conserving surgery with adjuvant chemoradiotherapy and hormone therapy for breast carcinoma, is reported here. Chest radiograph and thin section computed tomography demonstrated alveolar opacities with air bronchogram in both lungs. A lung biopsy was performed in a nonirradiated area of the contralateral lung and revealed a typical histological pattern of organising pneumonia (previously known as bronchiolitis obliterans organising pneumonia). Transtuzumab therapy was discontinued and subsequent gradual clinical and radiological improvement was observed. After 3 months, complete resolution of symptoms and radiographical abnormalities were noted. This is the first case report that suggests that transtuzumab therapy might induce the development of lung infiltrates with the histological appearance of organising pneumonia.     

Postpneumonic pleural suppuration in children

Postpneumonic pleural suppuration is a common condition seen in paediatric practice in Nigeria. One hundred and twenty cases seen at the University of Nigeria Teaching Hospital, Enugu, over a 4-year period were reviewed. The patients were aged between 1 1/2 months and 16 years. History of antecedent measles was elicited in 27 of the children, and 70% of the patients presented to the hospital later than 7 days after the onset of symptoms of pleura suppuration. From the pleural aspirates of 106 cases (88.3%) Staphylococcus aureus was cultured in 31.2%, but there were no organisms cultured in 39.4%. Twenty-nine children were treated by chemotherapy only; 11 of them (37.9%) died. Sixty-eight cases had tube drainage of the pleural collections, with 6 deaths (8.8%). Twenty-three patients had thoracotomy, evacuation of the suppurative lesion and decortication of the lung, with no mortality. There was overall hospital mortality of 14.2%, the highest mortality being in children who had associated measles, gastroenteritis, anaemia or malnutrition. Early surgical drainage by tube thoracostomy or by thoracotomy and decortication in addition to appropriate and adequate antibiotic therapy is the treatment of choice.