Apport de l'imagerie médicale fonctionnelle dans le diagnostic du nodule pulmonaire

The introduction into clinic of positron emission tomography (PET) with 18F-Flurorodesoxyglucose (FDG) and of hybrid cameras combining PET and computed tomography (PET/CT) has radically changed the management of solitary pulmonary nodules (SPN). Three meta-analyses have shown a high diagnostic accuracy of FDG PET for the diagnosis of cancer in SPN. Small pulmonary nodules (less than 5mm), respiratory movements and histology with low cell density and/or low metabolic activity are the most common cases of false negative FDG PET/CT. The majority of false positive cases are related to benign tumours, granulomatosis and infectious diseases.Likelihood ratio's (LR) of FDG PET/CT for overall prevalence of malignancy in SPN were published and are higher for malignancy diagnosis with PET scan in comparison with most clinical and radiological variables. Today, the Bayesian approach for SPN differential diagnosis must include information from FDG PET/CT.The increasing use of new radiotracers, such as octreotide derivates labeled with 68Gallium (68Ga) for diagnosis and staging of carcinoid tumours and the development of other radiotracers, will lead to an improvement in the management of solitary pulmonary nodules.SCOPUS: ar.j