Pulmonary alveolar microlithiasis: imaging characteristics of planar and SPECT/CT bone scan versus 18F-FDG and 18F-sodium fluoride PET/CT scanning

Jpn J Radiol. 2013 Nov;31(11):766-9. doi: 10.1007/s11604-013-0250-4. Epub 2013 Oct 2.


Pulmonary alveolar microlithiasis (PAM) is a very rare disease in which multiple microscopic calcium phosphate microliths are deposited within the alveoli of both lungs. A lung biopsy is considered to be definitive for final diagnosis; however, non-invasive imaging modalities such as chest X-ray, HRCT scan and (99m)Tc-MDP bone scan suggest the diagnosis in the vast majority of patients. Although (18)F-FDG PET/CT has been tried to characterize the disease, (18)F-sodium fluoride PET/CT as a 'proof-of-principle' was tried for the first time in a known case of PAM in order to characterize the lung lesions. Interestingly, we noted that (18)F-sodium fluoride PET/CT is a superior modality in characterization and assessment of the extent of disease in PAM compared to all other non-invasive imaging modalities. Thus, we recommend that (18)F-sodium fluoride PET/CT should be the investigation of choice in PAM.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Calcinosis / diagnosis*
  • Calcinosis / diagnostic imaging
  • Fluorine Radioisotopes*
  • Fluorodeoxyglucose F18*
  • Genetic Diseases, Inborn / diagnosis*
  • Genetic Diseases, Inborn / diagnostic imaging
  • Humans
  • Lung Diseases / diagnosis*
  • Lung Diseases / diagnostic imaging
  • Male
  • Middle Aged
  • Positron-Emission Tomography* / methods
  • Predictive Value of Tests
  • Radiopharmaceuticals*
  • Rare Diseases
  • Sensitivity and Specificity
  • Sodium Fluoride*
  • Tomography, Emission-Computed, Single-Photon* / methods
  • Tomography, X-Ray Computed* / methods


  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Sodium Fluoride

Supplementary concepts

  • Pulmonary Alveolar Microlithiasis