In a retrospective cohort of patients with chronic cough referred to specialty care with normal chest radiographs, Turner et al [16] showed successful clinical management of 266 patients with minimal investigation and empiric treatment, requiring chest CT in 1 patient to diagnose bronchiectasis, 1 patient with pulmonary fibrosis, and 2 patients with malignancy. Future studies may be needed to better validate CT findings with clinical features in order to determine causation/association in the context of chronic cough. Lung patterns of disease and obvious abnormalities identified on CT will still be of clinical value, and an expected number of CT Chronic Cough abnormalities may be noncontributory to management. The role of chest CT in the initial evaluation of chronic cough remains indeterminate. The evidence suggests that wide application in all patients presenting with chronic cough may be of low clinical yield. Appropriate selection would likely improve the specificity of findings. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET in the initial evaluation of chronic cough. FDG-PET/CT is not listed as an imaging option in the most recent ACCP guidelines on chronic cough [1]. FDG-PET utilizes a radiolabeled glucose analog to evaluate for upregulated metabolism in areas of infection, inflammation, and neoplasm [43]. MRI Chest There is no relevant literature to support the use of thoracic MRI in the initial evaluation of chronic cough. MRI of the chest is not included in the clinical algorithms recommended by various pulmonary and thoracic societies [1,10,15,29]. Thoracic MRI (nonbreast, noncardiac, nonmusculoskeletal) is currently utilized for the evaluation of indeterminate findings on other imaging modalities, most commonly mediastinal and thymic [44], less often utilized for vascular, airway, and pulmonary parenchymal abnormalities.
Chronic Cough. In a retrospective cohort of patients with chronic cough referred to specialty care with normal chest radiographs, Turner et al [16] showed successful clinical management of 266 patients with minimal investigation and empiric treatment, requiring chest CT in 1 patient to diagnose bronchiectasis, 1 patient with pulmonary fibrosis, and 2 patients with malignancy. Future studies may be needed to better validate CT findings with clinical features in order to determine causation/association in the context of chronic cough. Lung patterns of disease and obvious abnormalities identified on CT will still be of clinical value, and an expected number of CT Chronic Cough abnormalities may be noncontributory to management. The role of chest CT in the initial evaluation of chronic cough remains indeterminate. The evidence suggests that wide application in all patients presenting with chronic cough may be of low clinical yield. Appropriate selection would likely improve the specificity of findings. FDG-PET/CT Skull Base to Mid-Thigh There is no relevant literature to support the use of fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG)-PET in the initial evaluation of chronic cough. FDG-PET/CT is not listed as an imaging option in the most recent ACCP guidelines on chronic cough [1]. FDG-PET utilizes a radiolabeled glucose analog to evaluate for upregulated metabolism in areas of infection, inflammation, and neoplasm [43]. MRI Chest There is no relevant literature to support the use of thoracic MRI in the initial evaluation of chronic cough. MRI of the chest is not included in the clinical algorithms recommended by various pulmonary and thoracic societies [1,10,15,29]. Thoracic MRI (nonbreast, noncardiac, nonmusculoskeletal) is currently utilized for the evaluation of indeterminate findings on other imaging modalities, most commonly mediastinal and thymic [44], less often utilized for vascular, airway, and pulmonary parenchymal abnormalities.