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Liu X, Zou Q, Sun Y, Liu H, Cailiang G. Role of multiple dual-phase 18F-FDG PET/CT metabolic parameters in differentiating adenocarcinomas from squamous cell carcinomas of the lung. Heliyon 2023; 9:e20180. [PMID: 37767476 PMCID: PMC10520777 DOI: 10.1016/j.heliyon.2023.e20180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Purpose To evaluate the ability of multiple dual-phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) metabolic parameters to distinguish the histological subtypes of non-small cell lung cancer (NSCLC). Methods Data from 127 patients with non-small cell lung cancer who underwent preoperative dual-phase 18F-FDG PET/CT scanning at the PET-CT center of our hospital from December 2020 to October 2021 were collected, and the metabolic parameters of their primary lesions were measured and analyzed retrospectively. Intraclass correlation coefficients (ICC) were calculated for consistency between readers. Metabolic parameters in the early (SUVpeak, SUVmean, SUVmin, SUVmax, MTV, and TLG) and delayed phases (dpSUVpeak, dpSUVmean, dpSUVmin, dpSUVmax, dpMTV, and dpTLG) were calculated. We drew receiver operating characteristic (ROC) curves to compare the differences in different metabolic parameters between the adenocarcinoma (AC) and squamous cell carcinoma (SCC) groups and evaluated the ability of different metabolic parameters to distinguish AC from SCC. Results Inter-reader agreement, as assessed by the intraclass correlation coefficient (ICC), was good (ICC = 0.71, 95% CI:0.60-0.79). The mean MTV, SUVmax, TLG, SUVpeak, SUVmean, dpSUVmax, dpTLG, dpSUVpeak, dpSUVmean, and dpSUVmin of the tumors were significantly higher in SCC lesions than in AC lesions (P = 0.049, < 0.001, 0.016, < 0.001, 0.001, < 0.001, 0.018, < 0.001, 0.001, and 0.001, respectively). The diagnostic efficacy of the metabolic parameters in 18F-FDG PET/CT for differentiating adenocarcinoma from squamous cell carcinoma ranged from high to low as follows: SUVpeak (AUC = 0.727), SUVmax (AUC = 0.708), dpSUVmax (AUC = 0.699), dpSUVpeak (AUC = 0.698), TLG (AUC = 0.695), and dpTLG (AUC = 0.692), SUVmean (AUC = 0.690), dpSUVmean (AUC = 0.687), dpSUVmin (AUC = 0.680), SUVmin (AUC = 0.676), and MTV (AUC = 0.657). Conclusions Squamous cell carcinoma of the lung had higher mean MTV, SUVmax, TLG, SUVpeak, SUVmean, SUVmin, dpSUVpeak, dpSUVmean, dpSUVmin, dpSUVmax, and dpTLG than AC, which can be helpful tools in differentiating between the two. The metabolic parameters of the delayed phase (2 h after injection) 18F-FDG PET/CT did not improve the diagnostic efficacy in distinguishing lung AC from SCC. Conventional dual-phase 18F-FDG PET/CT is not recommended.
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Affiliation(s)
| | | | - Yu Sun
- Department of Nuclear Medicine, Chongqing University Three Gorges Hospital, Wanzhou, 404100, Chongqing, China
| | - Huiting Liu
- Department of Nuclear Medicine, Chongqing University Three Gorges Hospital, Wanzhou, 404100, Chongqing, China
| | - Gao Cailiang
- Department of Nuclear Medicine, Chongqing University Three Gorges Hospital, Wanzhou, 404100, Chongqing, China
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Yoldaş B, Gürsoy S, Budak E, Gülmez B, Ceylan KC, Çırak AK, Susam S, Güldaval F, Gayaf M, Şanlı B, Yazgan S, Sevinç S. FDG PET/CT signs of proven pulmonary hydatid cyst: is there any clue? Jpn J Radiol 2022; 40:1194-1200. [PMID: 35727457 DOI: 10.1007/s11604-022-01296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/17/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Pulmonary hydatid cyst (PHC) can imitate many diseases. Sometimes, positron emission tomography/computed tomography (PET/CT) is performed in terms of malignancy exclusion for complicated cysts. Although some specific findings (doughnut sign) have been identified in hydatid cyst of the liver, there is no specific sign described for PHC. The aim of this study is to investigate the presence of a common finding in PHC patients scanned with PET/CT inadvertently. MATERIALS AND METHODS From January 2015 to 2020, patients proven to have PHC were analyzed retrospectively. From all the patients, only 17, having a previous PET/CT, were included the study. Lesions were evaluated in three groups according to FDG uptake: A, negative; B, focal; C, doughnut sign. RESULTS The total number of patients was 17. Nine of the patients were male and the median age was 41.94 + 14.68 (16-65) years. SUV max of the lesions ranged from 0.5 to 15.8 (mean ± SE: 4.68). According to the FDG uptake of the lesions, five were in Group A, two in Group B, and the remaining ten (58.8%) in Group C with doughnut sign. To correlate the CT findings with PET/CT findings, doughnut sign, which is a typical finding of hydatid cysts of liver, is seen in only four patients in Group 1-classified cysts which are non-complicated. But in Group 2 (n = 3) and 3(n = 4), the finding of doughnut sign is three in both groups. CONCLUSIONS PET/CT is not a recommended imaging technique for PHC, but in cases where a definitive diagnosis is difficult, interpreting PET/CT findings is significant. This study demonstrates that previously described doughnut sign for liver hydatid cysts is also common for perforated pulmonary cysts. According to our knowledge, this is the first largest series of determining PET/CT findings of PHC. Further larger series will contribute to the literature.
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Affiliation(s)
- Banu Yoldaş
- Department of Thoracic Surgery, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Izmir, Turkey.
| | - Soner Gürsoy
- Department of Thoracic Surgery, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Izmir, Turkey
| | - Emine Budak
- Department of Nuclear Medicine, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Izmir, Turkey
| | - Barış Gülmez
- Department of Thoracic Surgery, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Izmir, Turkey
| | - Kenan C Ceylan
- Department of Thoracic Surgery, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Izmir, Turkey
| | - Ali K Çırak
- Department of Pulmonology, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Izmir, Turkey
| | - Seher Susam
- Department of Radiology, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Izmir, Turkey
| | - Filiz Güldaval
- Department of Pulmonology, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Izmir, Turkey
| | - Mine Gayaf
- Department of Pulmonology, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Izmir, Turkey
| | | | - Serkan Yazgan
- Department of Thoracic Surgery, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Izmir, Turkey
| | - Serpil Sevinç
- Department of Thoracic Surgery, Izmir Dr. Suat Seren Chest Diseases and Surgery Education and Research Hospital, Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, Izmir, Turkey
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Grisanti F, Zulueta J, Rosales JJ, Morales MI, Sancho L, Lozano MD, Mesa-Guzman M, Garcia-Velloso MJ. Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. Rev Esp Med Nucl Imagen Mol 2021. [DOI: 10.1016/j.remnie.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Grisanti F, Zulueta J, Rosales JJ, Morales MI, Sancho L, Lozano MD, Mesa-Guzmán M, García-Velloso MJ. Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. Rev Esp Med Nucl Imagen Mol 2021; 40:155-160. [PMID: 33781718 DOI: 10.1016/j.remn.2020.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/21/2020] [Accepted: 03/17/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine the accuracy of visual analysis and the retention index (RI) with dual-time point 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules (IPN) with low FDG uptake. MATERIALS AND METHODS A retrospective analysis was performed on 43 patients (28 men, 64 ± 11 years old, range 36-83 years) referred for IPN characterization with 18F-FDG-PET/CT and maximum standard uptake value ≤ 2.5 at 60 minutes post-injection (SUVmax1). Nodules were analyzed by size, visual score for FDG uptake on standard (OSEM 2,8) and high definition (HD) reconstructions, SUVmax1, SUVmax at 180 minutes post-injection (SUVmax2), and RI was calculated. The definitive diagnosis was based on histopathological confirmation (n = 28) or ≥ 2 years of follow-up. RESULTS Twenty-four (56%) nodules were malignant. RI ≥ 10% on standard reconstruction detected 18 nodules that would have been considered negative using the standard SUVmax ≥ 2.5 criterion for malignancy. RI ≥ 10% had a sensitivity, specificity, PPV, NPV and accuracy of 75, 73.7, 78.3, 70, and 74.4%, respectively, while for FDG uptake > liver on HD these were 79.1, 63.2, 73.1, 70.6, and 72.1%, respectively. SUVmax1 ≥ 2, SUVmax2 > 2.5 and FDG uptake > liver on standard reconstruction had a PPV of 100%. FDG uptake > mediastinum on HD had a NPV of 100%. CONCLUSIONS RI ≥ 10% was the most accurate criterion for malignancy, followed by FDG uptake > liver on HD reconstruction. On standard reconstruction, SUVmax1 ≥2 was highly predictive of malignancy, as well as SUVmax2 > 2.5 and FDG uptake > liver. FDG uptake < mediastinum on HD was highly predictive of benign nodules.
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Affiliation(s)
- F Grisanti
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España.
| | - J Zulueta
- Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, España
| | - J J Rosales
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
| | - M I Morales
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
| | - L Sancho
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Madrid, España
| | - M D Lozano
- Departamento de Patología, Clínica Universidad de Navarra, Pamplona, España
| | - M Mesa-Guzmán
- Departamento de Cirugía Torácica, Clínica Universidad de Navarra, Pamplona, España
| | - M J García-Velloso
- Departamento de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España
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2-[ 18F]FDG PET/CT radiomics in lung cancer: An overview of the technical aspect and its emerging role in management of the disease. Methods 2020; 188:84-97. [PMID: 32497604 DOI: 10.1016/j.ymeth.2020.05.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/22/2020] [Accepted: 05/27/2020] [Indexed: 12/15/2022] Open
Abstract
Lung cancer is the most common cancer, worldwide, and a major health issue with a remarkable mortality rate. 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (2-[18F]FDG PET/CT) plays an indispensable role in the management of lung cancer patients. Long-established quantitative parameters such as size, density, and metabolic activity have been and are being employed in the current practice to enhance interpretation and improve diagnostic and prognostic value. The introduction of radiomics analysis revolutionized the quantitative evaluation of medical imaging, revealing data within images beyond visual interpretation. The "big data" are extracted from high-quality images and are converted into information that correlates to relevant genetic, pathologic, clinical, or prognostic features. Technically advanced, diverse methods have been implemented in different studies. The standardization of image acquisition, segmentation and features analysis is still a debated issue. Importantly, a body of features has been extracted and employed for diagnosis, staging, risk stratification, prognostication, and therapeutic response. 2-[18F]FDG PET/CT-derived features show promising value in non-invasively diagnosing the malignant nature of pulmonary nodules, differentiating lung cancer subtypes, and predicting response to different therapies as well as survival. In this review article, we aimed to provide an overview of the technical aspects used in radiomics analysis in non-small cell lung cancer (NSCLC) and elucidate the role of 2-[18F]FDG PET/CT-derived radiomics in the diagnosis, prognostication, and therapeutic response.
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Diagnostic Performance of PET or PET/CT with Different Radiotracers in Patients with Suspicious Lung Cancer or Pleural Tumours according to Published Meta-Analyses. CONTRAST MEDIA & MOLECULAR IMAGING 2020; 2020:5282698. [PMID: 32405280 PMCID: PMC7196984 DOI: 10.1155/2020/5282698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023]
Abstract
Purpose Several meta-analyses have reported data about the diagnostic performance of positron emission tomography or positron emission tomography/computed tomography (PET or PET/CT) with different radiotracers in patients with suspicious lung cancer (LC) or pleural tumours (PT). This review article aims at providing an overview on the recent evidence-based data in this setting. Methods A comprehensive literature search of meta-analyses published in PubMed/MEDLINE and Cochrane Library database from January 2010 through March 2020 about the diagnostic performance of PET or PET/CT with different radiotracers in patients with suspicious LC or PT was performed. This combination of keywords was used: (A) “PET” OR “positron emission tomography” AND (B) “lung” OR “pulmonary” OR “pleur∗” AND (C) meta-analysis. Only meta-analyses on PET or PET/CT in patients with suspicious LC or PT were selected. Results We have summarized the diagnostic performance of PET or PET/CT with fluorine-18 fluorodeoxyglucose (18F-FDG) and other radiotracers taking into account 17 meta-analyses. Evidence-based data demonstrated a good diagnostic performance of 18F-FDG PET or PET/CT for the characterization of solitary pulmonary nodules (SPNs) or pleural lesions with overall higher sensitivity than specificity. Evidence-based data do not support the routine use of dual time point (DTP) 18F-FDG PET/CT or fluorine-18 fluorothymidine (18F-FLT) PET/CT in the differential diagnosis of SPNs. Even if 18F-FDG PET/CT has high sensitivity and specificity as a selective screening modality for LC, its role in this setting remains unknown. Conclusions Evidence-based data about the diagnostic performance of PET/CT with different radiotracers for suspicious LC or PT are increasing, with good diagnostic performance of 18F-FDG PET/CT. More prospective multicenter studies and cost-effectiveness analyses are warranted.
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SEMİRGİN SU, BIÇAKÇI N. Soliter Pulmoner Nodüllerin Değerlendirilmesi: Malign Lezyonların Ayırıcı Tanısında F-18 FDG PET/BT’ Nin Tanısal Değeri. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.706135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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PET in Lung Cancer and Mediastinal Malignancies. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Lovinfosse P, Rousseau C, Pierga JY, Bouchet F, Cochet A, Alberini JL, Girault S, Vera P, Olivier P, Uwer L, Cachin F, Scarwell B, Lemonnier J, Fourme E, Mesleard C, Martin AL, Lacœuille F, Couturier OF. Dual time point [ 18F]FLT-PET for differentiating proliferating tissues vs non-proliferating tissues. EJNMMI Res 2019; 9:109. [PMID: 31832803 PMCID: PMC6908533 DOI: 10.1186/s13550-019-0579-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose For differentiating tumor from inflammation and normal tissues, fluorodeoxyglucose ([18F]FDG) dual time point PET could be helpful. Albeit [18F]FLT is more specific for tumors than [18F]FDG; we explored the role of dual time point [18F]FLT-PET for discriminating benign from malignant tissues. Methods Before any treatment, 85 womens with de novo unifocal breast cancer underwent three PET acquisitions at 33.94 ± 8.01 min (PET30), 61.45 ± 8.30 min (PET60), and 81.06 ± 12.12 min (PET80) after [18F]FLT injection. Semiquantitative analyses of [18F]FLT uptake (SUV) were carried out on tumors, liver, bone marrow (4th thoracic vertebra (T4) and humeral head), descending thoracic aorta, muscle (deltoid), and contralateral normal breast. Repeated measures ANOVA tests and Tukey’s posttests were used to compare SUVmax of each site at the three time points. Results There was a significant increase in SUVmax over time for breast lesions (5.58 ± 3.80; 5.97 ± 4.56; 6.19 ± 4.42; p < 0.0001) (m ± SD for PET30, PET60, and PET80, respectively), and bone marrow (for T4, 8.21 ± 3.17, 9.64 ± 3.66, 10.85 ± 3.63, p < 0.0001; for humeral head, 3.36 ± 1.79, 3.87 ± 1.89, 4.39 ± 2.00, p < 0.0001). A significant decrease in SUVmax over time was observed for liver (6.79 ± 2.03; 6.24 ± 1.99; 5.57 ± 1.74; p < 0.0001), muscle (0.95 ± 0.28; 0.93 ± 0.29; 0.86 ± 0.20; p < 0.027), and aorta (1.18 ± 0.34; 1.01 ± 0.32; 0.97 ± 0.30; p < 0.0001). No significant difference was observed for SUVmax in contralateral breast (0.8364 ± 0.40; 0.78 ± 0.38; 0.80 ± 0.35). Conclusion [18F]FLT-SUVmax increased between 30 and 80 min only in proliferating tissues. This could be helpful for discriminating between residual tumor and scar tissue.
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Affiliation(s)
- Pierre Lovinfosse
- Nuclear Medicine Department and Inserm UMR_S 1066 MINT, University of Angers, Angers, France
| | - Caroline Rousseau
- Nuclear Medicine Department, West Cancer Institut (ICO), René Gauducheau Centre, Saint Herblain, France
| | | | - Francis Bouchet
- Nuclear Medicine Department and Inserm UMR_S 1066 MINT, University of Angers, Angers, France
| | - Alexandre Cochet
- Nuclear Medicine Department, Georges-François Leclerc Centre, Dijon, France
| | | | - Sylvie Girault
- Nuclear Medicine Department, West Cancer Institut (ICO), Paul Papin Centre, Angers, France
| | - Pierre Vera
- Nuclear Medicine Department, Henri Becquerel Centre, Rouen, France
| | - Pierre Olivier
- Nuclear Medicine Department, University of Nancy, Nancy, France
| | - Lionel Uwer
- Nuclear Medicine Department, Institut de cancerologie de lorraine, Vandoeuvre-les-, Nancy, France
| | - Florent Cachin
- Nuclear Medicine Department, Jean Perrin Center, Clermont Ferrand, France
| | - Benoit Scarwell
- Nuclear Medicine Department, Centre Hospitalier de la Cote Basque, Bayonne, France
| | | | | | | | | | - Franck Lacœuille
- Nuclear Medicine Department and Inserm UMR_S 1066 MINT, University of Angers, Angers, France
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Nakajo M, Jinguji M, Aoki M, Tani A, Sato M, Yoshiura T. The clinical value of texture analysis of dual-time-point 18F-FDG-PET/CT imaging to differentiate between 18F-FDG-avid benign and malignant pulmonary lesions. Eur Radiol 2019; 30:1759-1769. [DOI: 10.1007/s00330-019-06463-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/01/2019] [Accepted: 09/18/2019] [Indexed: 12/16/2022]
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Abstract
Soft tissue sarcomas (STSs) account for less than 1% of adult solid tumors and about 7% of pediatric malignancies, causing 2% of cancer-related deaths. With the advent of PET-computed tomography (CT), the value of (18) fluorine-2-fluoro-2-deoxy-d-glucose (FDG) PET imaging to improve the management of STSs has been explored. FDG PET imaging has been found useful in restaging and treatment response assessment. This article reviews current knowledge and application of FDG PET-CT in initial diagnosis, staging, restaging, treatment response monitoring, and prognosis, with a brief overview of the most common histologic subtypes of STS.
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Purandare NC, Pramesh CS, Agarwal JP, Agrawal A, Shah S, Prabhash K, Karimundackal G, Jiwnani S, Tandon S, Rangarajan V. Solitary pulmonary nodule evaluation in regions endemic for infectious diseases: Do regional variations impact the effectiveness of fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Cancer 2018; 54:271-275. [PMID: 29199704 DOI: 10.4103/0019-509x.219563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a preferred imaging modality for the evaluation of solitary pulmonary nodule (SPN), particularly in the developed world. Since FDG can concentrate in infective/inflammatory lesions, the diagnostic utility of FDG-PET can be questioned, particularly in regions endemic for infectious decisions. AIM To evaluate the accuracy of FDG-PET/CT in evaluation of SPNs in a population endemic for infectious disease and to assess if regional variations have an impact on its effectiveness. MATERIALS AND METHODS All patients who underwent an FDG/PET-CT with a clinico-radiological diagnosis of SPN categorized as indeterminate were included. Based on a maximum standardized uptake values (SUVmax) cut-off of 2.5, lesions were classified as benign (<2.5) or malignant (>2.5) and compared with gold standard histopathology. The diagnostic accuracy of PET-CT to detect malignancy was calculated. On the basis of final histopathology, lesions were grouped as (a) malignant nodules (b) infective/granulomatous nodules with a specific diagnosis and (c) nonspecific inflammatory nodules. The SUVmaxbetween these groups was compared using nonparametric statistical tests. RESULTS A total of 191 patients (129 males, 62 females) with a median age of 64 years (range: 36-83) were included. Totally, 144 nodules (75.3%) were malignant and 47 were benign (24.7%). Adenocarcinoma (n = 84) was the most common malignancy. Tuberculosis (n = 16) and nonspecific infections (n = 24) were the two most common benign pathologies. There was a significant overlap in the metabolic uptake of malignant (median SUVmax-11.2, range: 3.3-34.6) and tuberculous nodules (median SUVmax-10.3, range: 2.7-22.5) with no statistically difference between their SUVmaxvalues (P = 0.43). The false-positive rate was 65.2% and the false-negative rate was 5.5%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT for detecting malignancy were 94.4%, 34.7%, 81.9%, 66.6%, and 79.5%, respectively. CONCLUSIONS Though FDG-PET scans show a very high sensitivity for malignant nodules, it has a high false-positive rate and reduced specificity when characterizing SPNs in an infectious endemic region. Physicians must be aware of this limitation in the workup of lung nodules, and regional variations must be considered before further management decisions are taken.
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Affiliation(s)
- N C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - A Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Tandon
- Department of Chest Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
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Divisi D, Barone M, Bertolaccini L, Zaccagna G, Gabriele F, Crisci R. Diagnostic performance of fluorine-18 fluorodeoxyglucose positron emission tomography in the management of solitary pulmonary nodule: a meta-analysis. J Thorac Dis 2018; 10:S779-S789. [PMID: 29780624 DOI: 10.21037/jtd.2017.12.126] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background In the setting of solitary pulmonary nodules (SPNs), fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) is considered a useful non-invasive diagnostic tool though false positive (FP) and false negative (FN) results affects accuracy due to different conditions, such as inflammatory diseases or low-uptake neoplasms. Aim of this study is to evaluate overall diagnostic performance of 18F-FDG-PET/CT for malignant pulmonary nodules. Methods A computerized research, including published articles from 2012 and 2017, was carried out. 18F-FDG-PET/CT overall sensitivity (Se), specificity (Spe), positive likelihood ratio (PLR), negative likelihood ratio (NLR), positive predictive value (PPV), negative predictive value (NPV), diagnostic index and odds ratio were pooled. No selection-bias were found according to asymmetry test. Results A total of twelve studies were included in the meta-analysis. The pooled Se, Spe, PLR, NLR, PPV, NPV and accuracy index (AI) with relative 95% confidence intervals (CI) were 0.819 (95% CI: 0.794-0.843), 0.624 (95% CI: 0.582-0.665), 2.190 (95% CI: 1.950-2.440), 0.290 (95% CI: 0.250-0.330), 0.802 (95% CI: 0.783-0.819), 0.652 (95% CI: 0.618-0.684) and 0.649 (95% CI: 0.625-0.673), respectively. The diagnostic odds ratio (DOR) was 7.049 with a relative 95% CI between 5.550 and 8.944. Conclusions The results suggest 18F-FDG-PET/CT has good diagnostic accuracy in SPNs evaluation; but, it should not be considered as a discriminatory test rather than a method to be included in a clinical and diagnostic pathway.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| | - Mirko Barone
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| | | | - Gino Zaccagna
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| | - Francesca Gabriele
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital, Teramo Italy
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Parghane RV, Basu S. Dual-time point 18F-FDG-PET and PET/CT for Differentiating Benign From Malignant Musculoskeletal Lesions: Opportunities and Limitations. Semin Nucl Med 2017; 47:373-391. [PMID: 28583277 DOI: 10.1053/j.semnuclmed.2017.02.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this review, we summarize the false-positive and false-negative results of standard 18F-FDG-PET/CT in characterizing musculoskeletal lesions and discussed the added value and limitations of dual-time point imaging (DTPI) and delayed imaging in differentiating malignant from benign musculoskeletal lesions, based on review of the peer-reviewed literature. The quantitative and semiquantitative parameters adopted for DTPI are standardized uptake value (mainly maximum standardized uptake value [SUVmax]) and retention index (RI), calculated as RI (%) = 100% × (SUV [maxD-Delayed] - SUV [maxE-Early])/SUV [maxE-Early], although the criteria and cutoff for diagnosing malignancy in studies have varied considerably. Also, there has been considerable heterogeneity in protocol (time point of delayed imaging), interpretation, and results in dual-time point (DTP) 18F-FDG-PET for differentiating malignant from benign musculoskeletal lesions in various research studies. The specificity of DTPI is a function of many factors such as the nature of the musculoskeletal lesion or malignancy in question, the prevalence of false-positive etiologies in the patient population, and the cutoff values (either SUVmax or RI) employed to define a malignancy. Despite the apparent conflicting reports on the performance, there have been certain common points of agreement regarding DTPI: (1) DTP PET increases the sensitivity of 18F-FDG-PET/CT due to continued clearance of background activity and increasing 18F-FDG accumulation in malignant lesions, when the same diagnostic criteria (as in the initial standard single-time point imaging) are used. Increased sensitivity for lesion detection can be viewed as a strong point of DTP and delayed-time point imaging. (2) The causes for false positives (such as active infectious or inflammatory lesions and locally aggressive benign tumors) and false negatives (eg, low-grade sarcomas) are the major hurdles accounting for reduced diagnostic value of the technique, with overlap of 18F-FDG uptake patterns between benign and malignant musculoskeletal lesions on DTPI. (3) DTPI, however, could still be potentially useful in increasing the confidence of interpretation such as differentiating malignancy from sites of inactive or chronic inflammation, post-treatment viable residue vs necrosis, and certain other benign lesions. (4) Consideration of diagnostic CT component of PET/CT and the patient's clinical picture can lead to increase in specificity of interpretation in a given case scenario. Further systematic research, adoption of uniform protocol, and interpretation criterion could evolve the specific indications and interpretation criteria of DTPI for improved diagnostic accuracy in musculoskeletal lesions and its clinical applications.
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Affiliation(s)
- Rahul V Parghane
- Bhabha Atomic Research Centre (BARC), Tata Memorial Hospital Annexe, Radiation Medicine Centre, Bombay, India
| | - Sandip Basu
- Bhabha Atomic Research Centre (BARC), Tata Memorial Hospital Annexe, Radiation Medicine Centre, Bombay, India.
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Sheikhbahaei S, Mena E, Yanamadala A, Reddy S, Solnes LB, Wachsmann J, Subramaniam RM. The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer. AJR Am J Roentgenol 2017; 208:420-433. [PMID: 27726427 DOI: 10.2214/ajr.16.16532] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to summarize the evidence regarding the role of FDG PET/CT in treatment response assessment and surveillance of lung cancer and to provide suggested best practices. CONCLUSION FDG PET/CT is a valuable imaging tool for assessing treatment response for patients with lung cancer, though evidence for its comparative effectiveness with chest CT is still evolving. FDG PET/CT is most useful when there is clinical suspicion or other evidence for disease recurrence or metastases. The sequencing, cost analysis, and comparative effectiveness of FDG PET/CT and conventional imaging modalities in the follow-up setting need to be investigated.
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Affiliation(s)
- Sara Sheikhbahaei
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Esther Mena
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Anusha Yanamadala
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Siddaling Reddy
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Lilja B Solnes
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Jason Wachsmann
- 2 Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Rathan M Subramaniam
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
- 2 Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
- 3 Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX
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Ziai P, Hayeri MR, Salei A, Salavati A, Houshmand S, Alavi A, Teytelboym OM. Role of Optimal Quantification of FDG PET Imaging in the Clinical Practice of Radiology. Radiographics 2017; 36:481-96. [PMID: 26963458 DOI: 10.1148/rg.2016150102] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The combination of fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) for dual-modality imaging (PET/CT) plays a key role in the diagnosis and staging of FDG-avid malignancies. FDG uptake by the tumor cells offers an opportunity to detect cancer in organs that appear normal at anatomic imaging and to differentiate viable tumor from posttreatment effects. Quantification of FDG uptake has multiple clinical applications, including cancer diagnosis and staging. Dedicated FDG PET/CT-based visual and quantitative criteria have been developed to evaluate treatment response. Furthermore, the level of tumor FDG uptake reflects the biologic aggressiveness of the tumor, predicting the risk of metastasis and recurrence. FDG uptake can be measured with qualitative, semiquantitative, and quantitative methods. Qualitative or visual assessment of PET/CT images is the most common clinical approach for describing the level of FDG uptake. Standardized uptake value (SUV) is the most commonly used semiquantitative tool for measuring FDG uptake. SUV can be measured as maximum, mean, or peak SUV and may be normalized by using whole or lean body weight. SUV measurements provide the basis for quantitative response criteria; however, SUVs have not been widely adopted as diagnostic thresholds for discriminating malignant and benign lesions. Volumetric FDG uptake measurements such as metabolic tumor volume and total lesion glycolysis have shown substantial promise in providing accurate tumor assessment. SUV measurement and other quantification techniques can be affected by many technical, physical, and biologic factors. Familiarity with FDG uptake quantification approaches and their pitfalls is essential for clinical practice and research.
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Affiliation(s)
- Pouya Ziai
- From the Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 (P.Z., M.R.H., A. Salei, O.M.T.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A. Salavati, S.H., A.A.)
| | - Mohammad Reza Hayeri
- From the Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 (P.Z., M.R.H., A. Salei, O.M.T.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A. Salavati, S.H., A.A.)
| | - Aliaksei Salei
- From the Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 (P.Z., M.R.H., A. Salei, O.M.T.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A. Salavati, S.H., A.A.)
| | - Ali Salavati
- From the Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 (P.Z., M.R.H., A. Salei, O.M.T.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A. Salavati, S.H., A.A.)
| | - Sina Houshmand
- From the Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 (P.Z., M.R.H., A. Salei, O.M.T.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A. Salavati, S.H., A.A.)
| | - Abass Alavi
- From the Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 (P.Z., M.R.H., A. Salei, O.M.T.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A. Salavati, S.H., A.A.)
| | - Oleg M Teytelboym
- From the Department of Radiology, Mercy Catholic Medical Center, 1500 Lansdowne Ave, Darby, PA 19023 (P.Z., M.R.H., A. Salei, O.M.T.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (A. Salavati, S.H., A.A.)
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Chen S, Li X, Chen M, Yin Y, Li N, Li Y. Limited diagnostic value of Dual-Time-Point 18 F-FDG PET/CT imaging for classifying solitary pulmonary nodules in granuloma-endemic regions both at visual and quantitative analyses. Eur J Radiol 2016; 85:1744-1749. [DOI: 10.1016/j.ejrad.2016.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
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Kitajima K, Doi H, Kanda T, Yamane T, Tsujikawa T, Kaida H, Tamaki Y, Kuribayashi K. Present and future roles of FDG-PET/CT imaging in the management of lung cancer. Jpn J Radiol 2016; 34:387-99. [PMID: 27121156 DOI: 10.1007/s11604-016-0546-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022]
Abstract
Integrated positron emission tomography/computed tomography (PET/CT) using 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) has emerged as a powerful tool for combined metabolic and anatomic evaluation in clinical oncologic imaging. This review discusses the utility of (18)F-FDG PET/CT as a tool for managing patients with lung cancer. We discuss different patient management stages, including diagnosis, initial staging, therapy planning, early treatment response assessment, re-staging, and prognosis.
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Affiliation(s)
- Kazuhiro Kitajima
- Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomonori Kanda
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Tomohiko Yamane
- Department of Nuclear Medicine, Saitama International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tetsuya Tsujikawa
- Department of Biomedical Imaging Research Center, Fukui University, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Hayato Kaida
- Department of Radiology, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yukihisa Tamaki
- Department of Radiation Oncology, Shimane University School of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Kozo Kuribayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Radiotherapy volume delineation using dynamic [ 18F]-FDG PET/CT imaging in patients with oropharyngeal cancer: a pilot study. Int J Comput Assist Radiol Surg 2016; 11:2059-2069. [PMID: 26811083 DOI: 10.1007/s11548-016-1351-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Delineation of gross tumour volume in 3D is a critical step in the radiotherapy (RT) treatment planning for oropharyngeal cancer (OPC). Static [18F]-FDG PET/CT imaging has been suggested as a method to improve the reproducibility of tumour delineation, but it suffers from low specificity. We undertook this pilot study in which dynamic features in time-activity curves (TACs) of [18F]-FDG PET/CT images were applied to help the discrimination of tumour from inflammation and adjacent normal tissue. METHODS Five patients with OPC underwent dynamic [18F]-FDG PET/CT imaging in treatment position. Voxel-by-voxel analysis was performed to evaluate seven dynamic features developed with the knowledge of differences in glucose metabolism in different tissue types and visual inspection of TACs. The Gaussian mixture model and K-means algorithms were used to evaluate the performance of the dynamic features in discriminating tumour voxels compared to the performance of standardized uptake values obtained from static imaging. RESULTS Some dynamic features showed a trend towards discrimination of different metabolic areas but lack of consistency means that clinical application is not recommended based on these results alone. CONCLUSIONS Impact of inflammatory tissue remains a problem for volume delineation in RT of OPC, but a simple dynamic imaging protocol proved practicable and enabled simple data analysis techniques that show promise for complementing the information in static uptake values.
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García Vicente AM, Pérez-García VM, Soriano Castrejón Á. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography characterization of solitary pulmonary nodules: can we do better? J Thorac Dis 2015; 7:E215-8. [PMID: 26380781 DOI: 10.3978/j.issn.2072-1439.2015.08.24] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/19/2015] [Indexed: 11/14/2022]
Affiliation(s)
- Ana María García Vicente
- 1 Nuclear Medicine Department, University General Hospital, Ciudad Real, Spain ; 2 Laboratory of Mathematical Oncology, Institute for Applied Mathematics in Science and Engineering, Castilla-La Mancha University, Ciudad Real, Spain
| | - Víctor M Pérez-García
- 1 Nuclear Medicine Department, University General Hospital, Ciudad Real, Spain ; 2 Laboratory of Mathematical Oncology, Institute for Applied Mathematics in Science and Engineering, Castilla-La Mancha University, Ciudad Real, Spain
| | - Ángel Soriano Castrejón
- 1 Nuclear Medicine Department, University General Hospital, Ciudad Real, Spain ; 2 Laboratory of Mathematical Oncology, Institute for Applied Mathematics in Science and Engineering, Castilla-La Mancha University, Ciudad Real, Spain
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21
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Houshmand S, Salavati A, Segtnan EA, Grupe P, Høilund-Carlsen PF, Alavi A. Dual-time-point Imaging and Delayed-time-point Fluorodeoxyglucose-PET/Computed Tomography Imaging in Various Clinical Settings. PET Clin 2015; 11:65-84. [PMID: 26590445 DOI: 10.1016/j.cpet.2015.07.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The techniques of dual-time-point imaging (DTPI) and delayed-time-point imaging, which are mostly being used for distinction between inflammatory and malignant diseases, has increased the specificity of fluorodeoxyglucose (FDG)-PET for diagnosis and prognosis of certain diseases. A gradually increasing trend of FDG uptake over time has been shown in malignant cells, and a decreasing or constant trend has been shown in inflammatory/infectious processes. Tumor heterogeneity can be assessed by using early and delayed imaging because differences between primary versus metastatic sites become more detectable compared with single time points. This article discusses the applications of DTPI and delayed-time-point imaging.
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Affiliation(s)
- Sina Houshmand
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Ali Salavati
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Radiology, University of Minnesota, 420 Delaware Street Southeast, Minneapolis, MN 55455, USA
| | - Eivind Antonsen Segtnan
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, Odense C 5000, Denmark
| | - Peter Grupe
- Department of Nuclear Medicine, Odense University Hospital, Sdr. Boulevard 29, Odense C 5000, Denmark
| | | | - Abass Alavi
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Daouk J, Bailly P, Kamimura M, Sacksick D, Jounieaux V, Meyer ME. Positron emission tomography-based evidence of low-amplitude respiratory motion in patients with chronic obstructive pulmonary disease. Ann Nucl Med 2015; 29:319-24. [DOI: 10.1007/s12149-014-0945-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
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23
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Norman G, Fayter D, Lewis-Light K, Chisholm J, McHugh K, Levine D, Jenney M, Mandeville H, Gatz S, Phillips B. An emerging evidence base for PET-CT in the management of childhood rhabdomyosarcoma: systematic review. BMJ Open 2015; 5:e006030. [PMID: 25573522 PMCID: PMC4289735 DOI: 10.1136/bmjopen-2014-006030] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 10/30/2014] [Accepted: 11/06/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Rhabdomyosarcoma (RMS) management depends on risk stratification at diagnosis and treatment response. Assessment methods include CT, MRI, bone scintigraphy, histological analysis and bone marrow biopsy. Advanced functional imaging (FI) has potential to improve staging accuracy and management strategies. METHODS AND ANALYSIS We conducted a systematic review (PROSPERO 2013:CRD42013006128) of diagnostic accuracy and clinical effectiveness of FI in histologically proven paediatric RMS. PRISMA guidance was followed. We searched 10 databases to November 2013. Studies with ≥10 patients with RMS which compared positron emission tomography (PET), PET-CT or diffusion-weighted imaging (DWI) MRI to conventional imaging at any treatment stage were included. Study quality was assessed. Limited, heterogeneous effectiveness data required narrative synthesis, illustrated by plotting sensitivity and specificity in receiver operating curve (ROC) space. RESULTS Eight studies (six PET-CT, two PET) with 272 RMS patients in total were included. No DWI-MRI studies met inclusion criteria. Pooled estimates were not calculated due to sparseness of data. Limited evidence indicated initial PET-CT results were predictive of survival. PET-CT changed management of 7/40 patients. Nodal involvement PET-CT: sensitivity ranged from 80% to 100%; specificity from 89% to 100%. Distant metastatic involvement: PET-CT sensitivity ranged from 95% to 100%; specificity from 80% to100%. Data on metastases in different sites were sparse. Limited data were found on outcome prediction by PET-CT response. DISSEMINATION AND ETHICS PET/PET-CT may increase initial staging accuracy in paediatric RMS, specifically in the detection of nodal involvement and distant metastatic spread. There is a need to further assess PET-CT for this population, ideally in a representative, unbiased and transparently selected cohort of patients.
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Affiliation(s)
- Gill Norman
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Debra Fayter
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | - Kate Lewis-Light
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
| | | | | | | | | | | | | | - Bob Phillips
- Centre for Reviews and Dissemination, University of York, York, North Yorkshire, UK
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Houshmand S, Salavati A, Basu S, Khiewvan B, Alavi A. The role of dual and multiple time point imaging of FDG uptake in both normal and disease states. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-014-0075-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Wang YXJ, Gong JS, Suzuki K, Morcos SK. Evidence based imaging strategies for solitary pulmonary nodule. J Thorac Dis 2014; 6:872-87. [PMID: 25093083 DOI: 10.3978/j.issn.2072-1439.2014.07.26] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/29/2014] [Indexed: 12/21/2022]
Abstract
Solitary pulmonary nodule (SPN) is defined as a rounded opacity ≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients' age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.
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Affiliation(s)
- Yi-Xiang J Wang
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Jing-Shan Gong
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Kenji Suzuki
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
| | - Sameh K Morcos
- 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK
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Murrmann GB, van Vollenhoven FHM, Moodley L. Approach to a solid solitary pulmonary nodule in two different settings-"Common is common, rare is rare". J Thorac Dis 2014; 6:237-48. [PMID: 24624288 DOI: 10.3978/j.issn.2072-1439.2013.11.13] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/20/2013] [Indexed: 12/19/2022]
Abstract
A new solid solitary pulmonary nodule (SPN) is a common feature in the daily practice of physicians, pulmonologists and thoracic surgeons. The etiology and consequently the diagnostic approach is very different in various parts of the world. Identification of malignant nodules is the universal goal to proceed to a potential curable therapy. In countries with a low incidence of inflammatory disease and a high incidence of lung cancer the diagnostic work up includes a positron emission tomography (PET) scan or PET-computer tomography (CT) as a main pillar. In countries with a high incidence of inflammatory and infectious disease and a low incidence in lung cancer this diagnostic work up needs to be adapted. In these settings a PET scan has a limited role and tissue diagnosis, whether with a trans-thoracic, trans-bronchial biopsy or a video-assisted wedge resection is the most targeted approach to determine or exclude malignancy. The evaluation of a solid SPN in the two different situations is outlined in our algorithm. Recommendations stress the value of clinical judgement in different settings, determination of probabilities of malignancy, cost-effective use of diagnostic tools and evaluation of various management alternatives according to the risk profile and the patients preferences.
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Affiliation(s)
- Gabriele B Murrmann
- 1 Department of Surgery, 2 Department of Pulmonology, Medisch Centrum Leeuwarden, The Netherlands ; 3 Department of Cardio-Thoracic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Femke H M van Vollenhoven
- 1 Department of Surgery, 2 Department of Pulmonology, Medisch Centrum Leeuwarden, The Netherlands ; 3 Department of Cardio-Thoracic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - Loven Moodley
- 1 Department of Surgery, 2 Department of Pulmonology, Medisch Centrum Leeuwarden, The Netherlands ; 3 Department of Cardio-Thoracic Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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Sim YT, Poon FW. Imaging of solitary pulmonary nodule-a clinical review. Quant Imaging Med Surg 2014; 3:316-26. [PMID: 24404446 DOI: 10.3978/j.issn.2223-4292.2013.12.08] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/18/2013] [Indexed: 12/11/2022]
Abstract
Current widespread use of cross-sectional imaging has led to exponential rise in detection of solitary pulmonary nodules (SPNs). Whilst large numbers of these are benign 'incidentalomas', lung cancers presenting as SPNs are often early disease, which have good prognosis. Therefore, there is rising demand and expectation for more accurate, non-invasive, diagnostic tests to characterize SPNs, aiming to avoid missed or delayed diagnosis of lung cancer. There are wide differential diagnoses of benign and malignant lesions that manifest as SPNs. On conventional imaging, the morphological features supporting benignity include stable small nodule size, smooth demarcated margins, and calcifications. Lack of significant contrast enhancement is also more suggestive of benign nodules. With improved understanding of tumor biology, for instance neo-vascularization and increased vascular permeability, imaging techniques such as dynamic contrast-enhanced computed tomography (CT) provide details on contrast uptake and wash-out kinetics, which is more closely reflecting the physiological and pathological phenomena. Positron emission tomography (PET) using 18fluorine-fluoro-deoxyglucose ((18)F-FDG) is a well-established functional imaging technique, for which one of the most common indications is differentiating between benign and malignant SPNs. Combined PET-CT integrates the anatomical, morphological and metabolic aspects in a single examination, improving overall diagnostic accuracy. Semi-quantitative analysis in FDG-PET imaging is based on measurement of maximum standardized uptake values (SUVmax). SUVmax analysis may become more useful as an assessment of tumor biology in future risk stratification models for cancers. Dual-time point FDG-PET imaging, dual-energy CT, perfusion CT, magnetic resonance (MR) imaging using dynamic contrast enhancement or diffusion-weighted imaging (DWI) techniques, are among the growing armamentarium for diagnostic imaging of SPNs. Provided there is no unacceptably high procedural or operative risk, tissue diagnosis by resection or percutaneous biopsy of SPN should be advocated in those patients identified as at moderate or high risk of malignancy, based on clinical stratification.
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Affiliation(s)
- Yee Ting Sim
- Radiology Department, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
| | - Fat Wui Poon
- West of Scotland PET Centre, Beatson Oncology Centre, Gartnavel General Hospital, Glasgow G12 0YN, UK
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Sahiner I, Vural GU. Positron emission tomography/computerized tomography in lung cancer. Quant Imaging Med Surg 2014; 4:195-206. [PMID: 24914421 DOI: 10.3978/j.issn.2223-4292.2014.03.05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/14/2014] [Indexed: 12/25/2022]
Abstract
Positron emission tomography (PET) using 2-(18F)-flouro-2-deoxy-D-glucose (FDG) has emerged as a useful tool in the clinical work-up of lung cancer. This review article provides an overview of applications of PET in diagnosis, staging, treatment response evaluation, radiotherapy planning, recurrence assessment and prognostication of lung cancer.
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Affiliation(s)
- Ilgin Sahiner
- Ankara Oncology Research and Training Hospital, Turkey
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Lee S, Park T, Park S, Pahk K, Rhee S, Cho J, Jeong E, Kim S, Choe JG. The Clinical Role of Dual-Time-Point (18)F-FDG PET/CT in Differential Diagnosis of the Thyroid Incidentaloma. Nucl Med Mol Imaging 2013; 48:121-9. [PMID: 24900152 PMCID: PMC4028480 DOI: 10.1007/s13139-013-0247-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/10/2013] [Accepted: 10/21/2013] [Indexed: 11/26/2022] Open
Abstract
Thyroid incidentalomas are common findings during imaging studies including 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for cancer evaluation. Although the overall incidence of incidental thyroid uptake detected on PET imaging is low, clinical attention should be warranted owing to the high incidence of harboring primary thyroid malignancy. We retrospectively reviewed 2,368 dual-time-point 18F-FDG PET/CT cases that were undertaken for cancer evaluation from November 2007 to February 2009, to determine the clinical impact of dual-time-point imaging in the differential diagnosis of thyroid incidentalomas. Focal thyroid uptake was identified in 64 PET cases and final diagnosis was clarified with cytology/histology in a total of 27 patients with 18F-FDG-avid incidental thyroid lesion. The maximum standardized uptake value (SUVmax) of the initial image (SUV1) and SUVmax of the delayed image (SUV2) were determined, and the retention index (RI) was calculated by dividing the difference between SUV2 and SUV1 by SUV1 (i.e., RI = [SUV2 - SUV1]/SUV1 × 100). These indices were compared between patient groups that were proven to have pathologically benign or malignant thyroid lesions. There was no statistically significant difference in SUV1 between benign and malignant lesions. SUV2 and RI of the malignant lesions were significantly higher than the benign lesions. The areas under the ROC curves showed that SUV2 and RI have the ability to discriminate between benign and malignant thyroid lesions. The predictability of dual-time-point PET parameters for thyroid malignancy was assessed by ROC curve analyses. When SUV2 of 3.9 was used as cut-off threshold, malignancy on the pathology could be predicted with a sensitivity of 87.5 % and specificity of 75 %. A thyroid lesion that shows RI greater than 12.5 % could be expected to be malignant (sensitivity 88.9 %, specificity 66.3 %). All malignant lesions showed an increase in SUVmax on the delayed images compared with the initial images. But in the group of benign lesions, 37.5 % (6/16) showed a decrease or no change in SUVmax. Dual-time-point 18F-FDG PET/CT, obtaining additional images 2 h after injection, seems to be a complementary method for the differentiation between malignancy and benignity of incidental thyroid lesions.
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Affiliation(s)
- Sinae Lee
- />Departments of Nuclear Medicine, Korea University Guro Hospital, # 80, Guro-dong, Guro-gu Seoul, 152-703 Korea
| | - Taegyu Park
- />Departments of Nuclear Medicine, Korea University Guro Hospital, # 80, Guro-dong, Guro-gu Seoul, 152-703 Korea
| | - Soyeon Park
- />Departments of Nuclear Medicine, Korea University Guro Hospital, # 80, Guro-dong, Guro-gu Seoul, 152-703 Korea
| | - Kisoo Pahk
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seunghong Rhee
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Jaehyuk Cho
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Eugene Jeong
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Sungeun Kim
- />Departments of Nuclear Medicine, Korea University Guro Hospital, # 80, Guro-dong, Guro-gu Seoul, 152-703 Korea
| | - Jae Gol Choe
- />Departments of Nuclear Medicine, Korea University Anam Hospital, Seoul, Korea
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PET-CT evaluation of solitary pulmonary nodules: correlation with maximum standardized uptake value and pathology. Lung 2013; 191:625-32. [PMID: 24013495 DOI: 10.1007/s00408-013-9500-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/05/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE 18-fluorine fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) has an established role for the characterization of solitary pulmonary nodules (SPN). Visual assessment of nodule morphology, together with maximum standardized uptake value (SUVmax), is used to estimate likelihood of malignancy. We correlated SUVmax value with pathology of SPN and assessed diagnostic accuracy in differentiating malignant from benign nodule, using 2.5 as threshold SUVmax. METHODS Retrospective review of PET-CT scans for SPN characterization between April 2008 and June 2011 was performed. Only cases with pathological verification were included. RESULTS A total of 641 PET-CTs were performed for SPN characterization and staging; 186 patients (77 males, 109 females) with pathological confirmation were included, and 158 (85 %) nodules were malignant: adenocarcinomas (n = 66), squamous cell carcinomas (n = 40), and metastases (n = 20) were the commonest. 28 lesions (15 %) were benign, including granuloma/chronic inflammation (n = 8), infection (n = 7), and hamartomas (n = 5). Using cutoff SUVmax of 2.5, the accuracy of PET-CT in diagnosing malignant SPN is 81.2 %, with sensitivity 86.7 %, specificity 50 %, PPV 90.7 %, and NPV 40 %. The likelihood of malignancy increases with SUVmax. Nevertheless, even with SUVmax <2.5, there is a 62 % chance that a nodule is malignant. CONCLUSIONS Although PET-CT is useful in diagnostic workup of SPN, it cannot replace "gold standard" tissue diagnosis.
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Jeffers CD, Pandey T, Jambhekar K, Meek M. Effective Use of Low-Dose Computed Tomography Lung Cancer Screening. Curr Probl Diagn Radiol 2013; 42:220-30. [DOI: 10.1067/j.cpradiol.2013.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Zhang L, Wang Y, Lei J, Tian J, Zhai Y. Dual time point 18FDG-PET/CT versus single time point 18FDG-PET/CT for the differential diagnosis of pulmonary nodules: a meta-analysis. Acta Radiol 2013; 54:770-7. [PMID: 23528566 DOI: 10.1177/0284185113481594] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Lung cancer is one of the most common cancer types in the world. An accurate diagnosis of lung cancer is crucial for early treatment and management. PURPOSE To perform a comprehensive meta-analysis to evaluate the diagnostic performance of dual time point 18F-fluorodexyglucose position emission tomography/computed tomography (FDG-PET/CT) and single time point 18FDG-PET/CT in the diagnosis of pulmonary nodules. MATERIAL AND METHODS PubMed (1966-2011.11), EMBASE (1974-2011.11), Web of Science (1972-2011.11), Cochrane Library (-2011.11), and four Chinese databases - CBM (1978-2011.11), CNKI (1994-2011.11), VIP (1989-2011.11), and Wanfang Database (1994-2011.11) - were searched. Summary sensitivity, summary specificity, summary diagnostic odds ratios (DOR), and summary positive likelihood ratios (LR+) and negative likelihood ratios (LR-) were obtained using Meta-Disc software. Summary receiver-operating characteristic (SROC) curves were used to evaluate the diagnostic performance of dual time point 18FDG-PET/CT and single time point 18FDG-PET/CT. RESULTS The inclusion criteria were fulfilled by eight articles, with a total of 415 patients and 430 pulmonary nodules. Compared with the gold standard (pathology or clinical follow-up), the summary sensitivity of dual time point 18FDG-PET/CT was 79% (95%CI, 74.0-84.0%), and its summary specificity was 73% (95%CI, 65.0-79.0%); the summary LR+ was 2.61 (95%CI, 1.96-3.47), and the summary LR- was 0.29 (95%CI, 0.21-0.41); the summary DOR was 10.25 (95%CI, 5.79-18.14), and the area under the SROC curve (AUC) was 0.8244. The summary sensitivity for single time point 18FDG-PET/CT was 77% (95%CI, 71.9-82.3%), and its summary specificity was 59% (95%CI, 50.6-66.2%); the summary LR+ was 1.97 (95%CI, 1.32-2.93), and the summary LR- was 0.37 (95%CI, 0.29-0.49); the summary DOR was 6.39 (95%CI, 3.39-12.05), and the AUC was 0.8220. CONCLUSION The results indicate that dual time point 18FDG-PET/CT and single time point 18FDG-PET/CT have similar accuracy in the differential diagnosis of pulmonary nodules. Dual time point 18FDG-PET/CT appears to be more specific than single time point 18FDG-PET/CT.
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Affiliation(s)
- Li Zhang
- The First Clinical Medical School of Lanzhou University
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University
| | - Yinzhong Wang
- The First Clinical Medical School of Lanzhou University
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University
| | - Junqiang Lei
- The First Clinical Medical School of Lanzhou University
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University
- The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jinhui Tian
- The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yanan Zhai
- The First Clinical Medical School of Lanzhou University
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Khan AN, Al-Jahdali H. Value of delayed 18F-FDG PET in the diagnosis of solitary pulmonary nodule. J Thorac Dis 2013; 5:373-4. [PMID: 23825780 DOI: 10.3978/j.issn.2072-1439.2013.06.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 06/05/2013] [Indexed: 11/14/2022]
Abstract
Performing dual point 18F-FDG PET scans of solitary pulmonary nodules at an initial SUV (max) <2.5 is a useful technique. However, prolonging second image acquisition from 120 to 180 min does not appear to improve accuracy. Dual time 18F-FDG PET is not useful in differentiating benign and malignant pulmonary nodules with an initial mean SUV ≤2.5 in parts of the world where granulomatous disease is prevalent. Prolonged imaging on PET scanners is expensive particularly where availability if these scanners is limited. Further prospective research is required to define the potential benefits of dual time point 18F-FDG PET imaging, before recommending routine use of the technique.
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Affiliation(s)
- Ali Nawaz Khan
- Pulmonary Division, Department of Medicine, King Saud University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Sebro R, Aparici CM, Hernandez-Pampaloni M. FDG PET/CT evaluation of pathologically proven pulmonary lesions in an area of high endemic granulomatous disease. Ann Nucl Med 2013; 27:400-5. [PMID: 23400394 PMCID: PMC3642363 DOI: 10.1007/s12149-013-0695-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/23/2013] [Indexed: 12/21/2022]
Abstract
Purpose The goal of this study is to assess how reliable the threshold maximum standardized uptake value (maxSUV) of 2.5 on positron emission tomography–computed tomography (PET/CT) is for evaluation of solitary pulmonary lesions in an area of endemic granulomatous disease and to consider other imaging findings that may increase the accuracy of PET/CT. Materials and methods The staging PET/CT of 72 subjects with solitary pulmonary lesions (nodules (less than 3 cm) or masses (greater than 3 cm)) were retrospectively reviewed. Pathology proven diagnosis from tissue samples was used as the gold standard. Logistic regression was used to assess whether the subject’s age, maxSUV, size of lesion, presence of emphysema, or evidence of granulomatous disease was predictive of malignancy. Results Malignant lesions were identified in 84.7 % (61/72) of the 72 subjects. A threshold maxSUV of 2.5 had a sensitivity of 95.1 % (58/61), specificity of 45.5 % (5/11), positive predictive value of 90.6 % (58/64), negative predictive value of 62.5 % (5/8) and an accuracy of 87.5 % (63/72). The false negative rate was 4.9 %, and the false positive rate was 54.5 %. All 3 false negatives were less than or equal to 1.0 cm; however, false positives ranged from 1.1 to 5.6 cm. The false negatives had a mean (SD) maxSUV of 2.0 (0.4), whereas the false positives had a mean (SD) maxSUV of 5.6 (3.0). Emphysema was associated with 1.1 higher odds of malignancy, and evidence of granulomatous disease was associated with 0.34 lower odds of benign disease, however, neither was statistically significant (p = 0.92 and p = 0.31, respectively). Higher maxSUV was significantly associated with increased risk of malignancy (p = 8.3 × 10−3). Older age and larger size of lesion were borderline associated with increased risk of malignancy (p = 0.05 and p = 0.07, respectively). Conclusion In an area of high endemic granulomatous disease, the PET/CT threshold maxSUV of 2.5 retains a high sensitivity (95.1 %) and positive predictive value (90.6 %) for differentiating benign from malignant pulmonary lesions; however, the specificity (45.5) and negative predictive value (62.5) decrease due to increased false positives. The presence of emphysema and absence of evidence of granulomatous disease increases the probability that a pulmonary lesion is malignant; however, these were not statistically significant.
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Affiliation(s)
- Ronnie Sebro
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143, USA.
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Potential value of dual-time-point ¹⁸F-FDG PET compared with initial single-time-point imaging in differentiating malignant from benign pulmonary nodules: a systematic review and meta-analysis. Nucl Med Commun 2013; 33:1011-8. [PMID: 22825038 DOI: 10.1097/mnm.0b013e32835710d6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We performed a meta-analysis to assess the potential value of dual-time-point (DTP) imaging as compared with initial single-time-point (STP) scanning with 18F-fluorodeoxyglucose (18F-FDG) PET in differentiating malignant from benign single pulmonary nodules. Data on the performance of DTP 18F-FDG PET imaging in assessing lung nodules were extracted from articles of prospective or retrospective original research published between January 2001 and April 2010. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used to assess the quality of study methodology. Heterogeneity in the results of the studies was assessed, and summary receiver operating characteristic (SROC) curves were constructed. Eleven studies comprising a total of 788 patients who underwent initial scanning, 778 of whom also underwent DTP imaging, were included in the final analysis. The quality of study methodology was judged to be moderate. Substantial heterogeneity in the results of the studies, with inconsistency (I2) index values above 85%, reflected important differences in study methods and populations, including varying lesion sizes, 18F-FDG avidity, uptake interval for delayed imaging, and threshold for positive result on DTP imaging. SROC curve analysis revealed a statistically nonsignificant trend toward higher sensitivity with DTP imaging, at moderate levels of specificity, when compared with initial STP scanning. The area under the curve (SE) values for DTP and initial STP imaging were 0.839 (0.079) and 0.757 (0.074), respectively. Although the results of our analysis do not support the routine use of DTP imaging with 18F-FDG PET in the differential diagnosis of pulmonary nodules, this technique may provide additional information in selected cases with equivocal results from initial scanning. Further prospective research is required to better define the potential benefits of DTP 18F-FDG PET imaging.
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Takeda A, Kunieda E, Fujii H, Yokosuka N, Aoki Y, Oooka Y, Oku Y, Ohashi T, Sanuki N, Mizuno T, Ozawa Y. Evaluation for local failure by 18F-FDG PET/CT in comparison with CT findings after stereotactic body radiotherapy (SBRT) for localized non-small-cell lung cancer. Lung Cancer 2012; 79:248-53. [PMID: 23246123 DOI: 10.1016/j.lungcan.2012.11.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/31/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) is the standard care for medically inoperable early non-small-cell lung cancer (NSCLC). However, it can be difficult to differentiate local recurrence from non-recurrence radiation-induced lung opacity. We retrospectively assessed (18)F-FDG PET/CT to detect local recurrence after SBRT for NSCLC. METHODS Between 2005 and 2011, 273 NSCLCs in 257 patients were treated with SBRT. Prescribed doses were 50Gy and 40Gy per 5 fractions for peripheral and central lesions, respectively. Tri-monthly follow-up CT scans were acquired. (18)F-FDG PET/CT scans were scheduled for screening at one year after SBRT or when recurrence was highly suspected. The dual-time-point maximum standardized uptake values (SUVmaxs) and their retention indexes (RIs) were obtained. RESULTS A total of 214 (18)F-FDG PET/CT scans were obtained for 164 localized NSCLC tumors in 154 patients. The median follow-up period was 24.9 months (range: 6.3-72.1). Among these, 21 scans of 17 tumors were diagnosed as local recurrence. The median SUVmaxs on early and late images of recurrence and their RI were 5.0 (range: 3.2-10.7), 6.3 (range: 4.2-13.4), and 0.20 (range; 0-0.41), respectively. These were significantly higher than the respective values of non-recurrence images of 1.8 (range: 0.5-4.6), 1.7 (range: 0.5-6.1), and 0.00 (range: -0.37-0.41) (all p<0.05). For SUVmaxs on early and late images, optimal thresholds were identified as 3.2 and 4.2. Using each threshold, the sensitivity and specificity were 100% and 96-98%, respectively. CT findings were classified into ground-glass opacity (N=9), scar or fibrotic change (N=96), consolidation with air-bronchogram (N=34), consolidation only (N=22), and nodule (N=17); the respective numbers of recurrence were 0, 0, 1, 3, and 17. CONCLUSION SUVmaxs of (18)F-FDG PET/CT could detect local recurrence after SBRT for localized NSCLC. In contrast, CT scan results had a limited ability to diagnose local recurrence.
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Schillaci O. Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity. Semin Nucl Med 2012; 42:267-80. [DOI: 10.1053/j.semnuclmed.2012.02.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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