Interstitial Lung Disease Research.

Interstitial Lung Disease is a general category that includes many different lung conditions characterised by the progressive destruction of the interstitium, a part of the lungs' anatomic structure. In its most severe type, the disease (IPF- Idiopathic Pulmonary Fibrosis) has a mean survival of 3 years after diagnosis.
Although HRCT is essential for diagnosis and quantitative CT has been increasingly tested with promising results, both techniques only provide a picture of the morphological abnormalities in the lungs, without taking in consideration the inflammatory status of the lung which in principle is the dominant element of the disease.

At the INM we are running a research project since 2008 aiming to correlate the severity of disease- associated with active inflammation and destruction of the lung, with increased FDG metabolic activity of lung cells, reflecting the degree of inflammation. Despite the precise cellular mechanisms underlying the observed FDG-PET signal in ILD are as yet unknown, there is evidence that metabolically active cells, taking up increased amounts of glucose, are present in the lungs of ILD patients. Our ongoing study has demonstrated the utility of FDG-PET with respect to the understanding of pathogenesis and prognosis of disease and it may suggest that PET is detecting disease signal before anatomical changes on HRCT are revealed and as such PET may be detecting early or mild disease. Furthermore a recent prospective clinical trial on IPF patients completed  at our centre revealed an important prognostic role of FDG/PET to track progression of disease and on this regard, this new methodology may provide a useful imaging biomarker making it a very promising technique for use in clinical studies.

Our centre has several collaborations within the campus and externally with industries, including GSK, Mayo Clinic and Imbio, with the latter for the development of a platform for CT quantification of ILD.
To date and to the best of our knowledge we are the first in world to combine a protocol of HRCT and FDG PET in a single exam and to apply a computed algorithm for the CT quantification of the disease.

Dr Francesco Fraioli