肺癌是最常被诊断的癌症，也是两性癌症死亡的主要原因。近年来，非小细胞肺癌（NSCLC）患者的诊断和治疗选择取得了重大进展，包括常规使用18F-FDG PET / CT进行分期和反应评估，微创内窥镜活检，靶向放射治疗，微创手术 和分子和免疫治疗。在这篇综述中，对于CT和18F-FDG PET / CT在NSCLC和恶性胸膜间皮瘤（MPM）的分期和反应中的中心角色进行了批判性评估。介绍了NSCLC和MPM的Tumour Node Metastases（TNM-8）分期系统，并对成像的优点和缺陷进行了批判性评估。提供了NSCLC的固体瘤反应评价标准（RECIST 1.1）和MPM的修改后的RECIST标准的概述，以及这些基于解剖的工具的益处和局限性的讨论。将探讨代谢反应评估（未由RECIST 1.1评估）。我们介绍了固体瘤的正电子发射断层扫描反应准则（PERCIST 1.0），包括其优点和挑战。讨论了当解剖和代谢评估标准应用于免疫治疗治疗的NSCLC时的局限性，以及伪进展的重要概念，并参照了免疫治疗固体瘤反应评价标准（iRECIST）。我们对单发肺结节的诊断和随访进行了单独的考虑，参考了英国胸科学会（BTS）指南和弗来施纳（Fleischner）指南，并使用Brock（基于CT）和Herder（添加18F-FDG PET / CT）模型评估恶性潜力。我们谈论了这些模型如何通过多学科团队的决策，包括向不能接受手术的患者转介可疑结节进行非手术管理。我们简要概述了英国，欧洲和北美正在使用的当前肺部筛查系统。评估了MRI在肺癌成像中的新兴作用。讨论了全身MRI在诊断和分期NSCLC中的使用，参考了最近的多中心Streamline L试验。讨论了扩散加权MRI（DW-MRI）在区分肿瘤与放射线治疗引起的肺毒性方面的潜在用途。我们简要概述了正在开发的新型PET-CT示踪剂，用于评估癌症生物学的特定方面，而不仅仅是葡萄糖摄取。最后，我们描述了CT，MRI和18F-FDG PET / CT如何从肺癌的主要诊断工具演变为具有预后和个性化医学的实用性，具有人工智能的代理。

Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer deaths in both sexes combined. Recent years have seen major advances in the diagnostic and treatment options for patients with non-small-cell lung cancer (NSCLC), including the routine use of 18F-FDG PET/CT in staging and response evaluation, minimally-invasive endoscopic biopsy, targeted radiotherapy, minimally invasive surgery, and molecular and immuno-therapies.In this review the central roles of CT and 18F-FDG PET/CT in staging and response in both NSCLC and malignant pleural mesothelioma (MPM) are critically assessed. The Tumour Node Metastases (TNM-8) staging systems for NSCLC and MPM are presented with critical appraisal of the strengths and pitfalls of imaging. Overviews of the Response Evaluation Criteria in Solid Tumours (RECIST 1.1) for NSCLC and the modified RECIST criteria for MPM are provided, together with discussion of the benefits and limitations of these anatomical-based tools. Metabolic response assessment (not evaluated by RECIST 1.1) will be explored. We introduce the Positron Emission Tomography Response Criteria in Solid Tumours (PERCIST 1.0) to include its advantages and challenges. The limitations of both anatomical and metabolic assessment criteria when applied to NSCLC treated with immunotherapy and the important concept of pseudoprogression are addressed with reference to immune RECIST (iRECIST).Separate consideration is given to the diagnosis and follow up of solitary pulmonary nodules with reference to the British Thoracic Society (BTS) guidelines and Fleischner guidelines and use of the Brock (CT- based) and Herder (addition of 18F-FDG PET/CT) models for assessing malignant potential. We discuss how these models inform decisions by the multi disciplinary team, including referral of suspicious nodules for non-surgical management in patients unsuitable for surgery. We briefly outline current lung screening systems being used in the UK, Europe and North America.Emerging roles for MRI in lung cancer imaging are reviewed. The use of whole-body MRI in diagnosing and staging NSCLC is discussed with reference to the recent multicentre Streamline L trial. The potential use of diffusion-weighted MRI (DW-MRI) to distinguish tumour from radiotherapy-induced lung toxicity is discussed. We briefly summarise the new PET-CT radiotracers being developed to evaluate specific aspects of cancer biology, other than glucose uptake. Finally, we describe how CT, MRI and 18F-FDG PET/CT are moving from primarily diagnostic tools for lung cancer towards having utility in prognostication and personalised medicine with the agency of artificial intelligence.