Purpose of Review The main goal of the article is to familiarize the reader with commonly and uncommonly used nuclear medicine procedures that can significantly contribute to improved patient care. nuclear medicine are discussed Efavirenz with emphasis on molecular imaging and implementation of new targeted tracers used in diagnostics and therapeutics (theranostics). Summary Nuclear medicine and molecular imaging provide many unique and novel options for the diagnosis and treatment of pulmonary diseases. This article reviews current applications for nuclear medicine and molecular imaging and selected future applications for radiopharmaceuticals and targeted molecular imaging techniques. pneumonia (PJP) and essentially any pulmonary disease [22]. 67Ga can be used for evaluation and follow-up of lymphocytic or granulomatous inflammatory processes, such as sarcoidosis or tuberculosis [23, 24]. It is sensitive for drug-induced pulmonary toxicity (e.g., bleomycin and amiodarone) [25]. It is preferred over WBC scan in a leukopenic patient. For diagnosing discitis/osteomyelitis, it is preferred over labeled leukocytes. 67Ga scan is negative in adenocarcinoma, squamous cell carcinoma, histiocytosis, and Kaposi sarcoma (which is Efavirenz Rabbit polyclonal to KIAA0494 positive on a thallium scan), but positive in lymphoma. Diffuse 67Ga uptake in lungs is nonspecific, which can be seen in various infectious and inflammatory conditions. Due to long testing time, high frequency of false positive results, relatively high radiation dose, and availability of other modalities (PET/CT), the role of 67Ga scintigraphy in clinical practice has been reduced [9, 18]. Labeled Leukocytes in Pulmonary Infections Leukocytes can be labeled with 111indium-oxine (111In) or 99mTc-hexamethylpropyleneamine oxime (HMPAO), depending on specific clinical question and anatomic location. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) guidelines state that WBC imaging can be used for detection of suspected sites of acute inflammation/infection in the febrile patient, patients with granulocytosis, and/or positive blood cultures [26, 27]. Per European Association of Nuclear Medicine (EANM) guidelines [28], labeled WBC Efavirenz scintigraphy may be used to detect, localize, and determine the degree of the process in occult lung illness disorders, as well as fever of unfamiliar source (FUO), endocarditis, postoperative abscesses, infected central venous catheters, or additional vascular devices. Disadvantages of scintigraphy with radiolabeled WBC are the requirement of blood handling for radiopharmaceutical preparation, the longer duration of the procedure compared with 18F-2-deoxyglucose (FDG) PET/CT, and lower spatial resolution. Labeled leukocyte with SPECT/CT imaging is a sensitive test for detecting lung infection, it can be especially beneficial in immunocompromised individuals, and a study by Like et al. showed that absence of focal pulmonary activity experienced a 99% bad predictive value for excluding pulmonary illness [29]. However, this test is not specific due to possibility of damaged leukocytes build up (sequestration) in the lungs, especially on early images. Prolonged diffuse uptake in the lung on delayed images may show infection or swelling and is more often seen in heart or renal failure. This may obscure focal lung infections [27]. Atypical lung infections and opportunistic illness, like 2-S-(4-isothiocyanatobenzyl)-1,4,7-triazacyclononane-1,4,7-triacetic acid Additional Indications for PET/CT in Swelling and Illness Fungal and parasitic infectionsdisease activity monitoring, e.g., candidiasis, aspergillosis, [41], and echinococcosis [42, 43] AIDS-associated opportunistic infections Assessment of metabolic activity in tuberculosis lesions Cystic fibrosisdisease activity, response to therapy Acute lung injury or acute respiratory distress syndrome [44] PET/CT in Systemic Inflammatory Diseases Over recent years, there has been growth in PET utilization in systemic infections and swelling for analysis, assessment of disease activity, and therapy monitoring [45, 46]. FDG PET/CT can Efavirenz be used for analysis and follow-up in multiple inflammatory conditions including rheumatoid arthritis (RA) [47], polymyalgia rheumatica [48], IgG4-relate disease, large vessel vasculitis [49], and granulomatosis with polyangiitis, adult-onset Still disease [50, 51], spondyloarthritis, chronic osteomyelitis, and multicentric reticulohistiocytosis [52]. Improved FDG uptake in the tracheobronchial Efavirenz tree is definitely a reliable sign of cartilage involvement in relapsing polychondritis [53]. FDG PET/CT can be used for early analysis of RPC and follow-up [54, 55]. New specific PET tracers are becoming developed, for example, 51-integrin PET appears to be a encouraging tool for early analysis of RA and therapy monitoring [56]. Future Directions.