Lesion detectability of a gamma camera based coincidence system with FDG in patients with malignant tumors: A comparison with dedicated positron emission tomography

An improved method for measurement of target-to-background ratio in assessing mediastinal lesions on 18F-FDG coincidence SPECT/CT imaging

OBJECTIVES

Target-to-background ratio (T/B) is a commonly used semiquantitative index in F-FDG dual-head coincidence single-photon emission computed tomography (c-SPECT) imaging. However, because of different methods of measurement, T/B varies. This study used F-FDG c-SPECT/CT imaging of mediastinal lesions to analyze the impact of different backgrounds for determining T/Bs.

METHODS

Thirty-five patients with mediastinal lesions underwent thoracic F-FDG c-SPECT/CT with 1-inch crystals. According to integrated CT, five types of backgrounds were precisely positioned as airway, fat, mediastinal space, vascular blood, and heart areas. Corresponding T/Bs (T/BA, T/BF, T/BM, T/BV, and T/BH) of benign and malignant lesions were calculated. Two-way analysis of variance, receiver-operating characteristic curves, and coefficient of variation were performed for statistical analyses.

RESULTS

Seventeen benign lesions and 23 malignant lesions were identified in patients with histological confirmation. Only T/BA was significantly different from other T/Bs in both the benign and malignant groups; yet, there were no significant differences in the remaining T/Bs (P<0.01). On the basis of receiver-operating characteristic curves, cutoff values, sensitivity, specificity, positive predictive value and negative predictive value, the accuracy of diagnosis followed the order of T/BV>T/BM> T/BA>T/BF>T/BH, and T/BV showed optimal sensitivity (87.0%), specificity (76.5%), and accuracy (82.5%) of diagnosis. Vascular blood and mediastinal space areas, which were in the same homogeneous subset, possessed the significantly lowest coefficient of variation, indicating good homogeneity in the regions.

CONCLUSION

Choosing different backgrounds has a great impact on the diagnostic accuracies of F-FDG c-SPECT/CT imaging of mediastinal lesions. The large blood vessel area is the best background choice for optimization of T/B calculation.

PET scan in clinically suspected paraneoplastic neurological syndromes: a 6-year prospective study in a regional neuroscience unit

BACKGROUND

The role of PET in the diagnosis of paraneoplastic neurological syndromes (PNS) has previously been reported in retrospective studies, from specialized neuro-oncology units, often selecting patients with positive paraneoplastic antibodies.

OBJECTIVES

To prospectively assess the usefulness of PET in detecting malignancy in patients clinically suspected of having PNS.

METHODS

PET was performed in patients suspected of PNS within 4 weeks of the normal CT body scan. All patients were followed up.

RESULTS

Eighty patients suspected of having PNS underwent PET. 18/80 (23%) were abnormal and suspicious of malignancy. The total number of definite and probable PNS with abnormal PET was 11/18 (61%). The total number of definite and probable PNS with a normal PET was 3/62 (5%). Only 50% of patients with biopsy-proven malignancy were positive for paraneoplastic antibodies. The prevalence of abnormal PET in patients presenting with classical PNS was 41% as opposed to 21% in patients with non-classical PNS. The sensitivity and specificity of PET in diagnosing PNS was 75% and 87% respectively.

CONCLUSIONS

PET is a valuable tool in clinically suspected PNS. Its use should not be restricted to specialized neuro-oncology units or in patients with positive paraneoplastic antibodies. Positive yield is the highest amongst patients with classical PNS.