18F-Fluorodeoxyglucose-PET/CT Imaging of Lungs in Patients With Cystic Fibrosis

Background: Airway inflammation plays a critical role in the progression of cystic fibrosis (CF) lung disease, and in the destruction of airways and lung parenchyma. Current methods to assess CF lung disease (BAL, spirometry, and high-resolution CT scanning), do not always accurately reflect actual disease states. Fluorodeoxyglucose (FDG)-PET scanning has been used previously to image infection and inflammation. In this study, we assessed the use of F-18-FDG PET/CT scanning to evaluate and monitor lung inflammation and/or infection in patients with CF. Methods: PET/CT scans were performed in 20 patients with CF (age range, 14 to 54 years); 7 of 20 patients underwent repeat PET/CT scans during and after acute exacerbations. The results were compared with clinical information and with images from eight control subjects with no known lung disease. Results: Foci of enhanced activity were observed on FDG-PET scans of patients with CF but not those of control subjects. Higher focal activity (standardized uptake value, > 3.0) was seen during disease exacerbation and infection. Coregistered CT scan images assisted in the localization of PET foci and showed corresponding CT scan findings, with many additional findings on CT scans that were not seen on PET scans. Foci seen on high-intensity PET scans during exacerbations disappeared after antibiotic therapy and the resolution of exacerbation, while corresponding CT scan findings remained unchanged. Conclusions: PET/CT imaging demonstrated the presence of foci of enhanced uptake that may reflect active focal infectious or inflammatory processes in the lungs. These foci can be cleared with antibiotic therapy. Further studies are needed to validate these results and to determine whether FDG-PET/CT scanning can predict the nature/severity of disease in patients with CF. (CHEST 2009; 136:1220-1228)