European Radiology

, Volume 17, Issue 2, pp 467–473 | Cite as

Additional value of integrated PET-CT in the detection and characterization of lung metastases: correlation with CT alone and PET alone

  • W. De Wever
  • L. Meylaerts
  • L. De Ceuninck
  • S. Stroobants
  • J. A. Verschakelen


The purpose was evaluating retrospectively the additional value of integrated positron emission tomography (PET) and computed tomography (CT) in the detection of pulmonary metastases in comparison with CT and PET alone. Fifty-six lung nodules, divided into three groups according their size, detected in 24 consecutive patients with a known primary tumor were retrospectively evaluated with integrated PET-CT, CT and PET. The nature of these nodules was determined by either histopathology or a follow-up of at least 6 months. The CT and PET images of the integrated PET-CT were evaluated separately by a radiologist and a nuclear medicine physician, the integrated PET-CT images were evaluated by a chest radiologist and nuclear medicine physician in consensus. The investigators were asked to search lung nodules and to determine whether these nodules were metastases or not. Sensitivity and accuracy for CT, PET and integrated PET-CT for characterization of all pulmonary nodules were, respectively: 100%, 90%, 100% and 57%, 55%, 55%. There was no significant difference in the characterization of pulmonary nodules between integrated PET-CT and CT alone (P=1.000) and PET alone (P=0.1306). An accurate evaluation is only possible for lesions larger than 1 cm.


Integrated PET-CT Pulmonary metastases Detection Characterization 


  1. 1.
    The International Registry of Lung Metastases (1997) Long-term results of lung metastasectomy: prognostic analyses based on 5,206 cases. J Thorac Cardiovasc Surg 113:37–49CrossRefGoogle Scholar
  2. 2.
    Rusch V (1995) Pulmonary metastasectomy: current indications. Chest 107:322S–332SPubMedGoogle Scholar
  3. 3.
    Diederich S, Semik M, Lentschig MG, Winter F, Scheld HH, Roos N, Bongartz G (1999) Helical CT of pulmonary nodules in patients with extrathoracic malignancy: CT-surgical correlation. AJR Am J Roentgenol 172:353–360PubMedGoogle Scholar
  4. 4.
    Muhm JR, Brown LR, Crowe JK (1977) Detection of pulmonary nodules by computed tomography. AJR Am J Roentgenol 128:267–270PubMedGoogle Scholar
  5. 5.
    Scott WJ, Schwabe JL, Gupta NC et al (1994) Positron emission tomography of lung tumors and mediastinal lymph nodes using [18F] fluorodeoxyglucose. Ann Thorac Surg 58:698–703PubMedCrossRefGoogle Scholar
  6. 6.
    Gambhir SS, Shepherd JE, Shah BD et al (1998) Analytical decision model for the cost-effectiveness management of solitary pulmonary nodules. J Clin Oncol 16:2113–2125PubMedGoogle Scholar
  7. 7.
    Vansteenkiste JF, Stroobants SG (2001) The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology. Eur Respir J 17:808–820CrossRefGoogle Scholar
  8. 8.
    Patz EF, Lowe VJ, Hoffman JM et al (1993) Focal pulmonary abnormalities: evaluation with F-18 fluorodeoxyglucose PET scanning. Radiology 188:487–490PubMedGoogle Scholar
  9. 9.
    Dewan NA, Gupta NC, Redepenning LS et al (1993) Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules. Potential role in evaluation and management. Chest 104:997–1002PubMedGoogle Scholar
  10. 10.
    Higashi K, Ueda Y, Seki H et al (1998) Fluorine-18-FDG PET imaging is negative in bronchioloalveolar carcinoma. J Nucl Med 39:1016–1020PubMedGoogle Scholar
  11. 11.
    Imdahl A, Jenkner S, Brink I, et al (2001) Validation of FDG positron emission tomography for differentiation of unknown pulmonary lesions. Eur J Cardio-Thoracic Surg 20:324–329CrossRefGoogle Scholar
  12. 12.
    Townsend DW, Beyer T, Blodgett TM (2003) PET/CT scanners: a hardware approach to image fusion. Semin Nucl Med 33:193–204PubMedCrossRefGoogle Scholar
  13. 13.
    Diederich S, Hansen J, Wormanns D (2005) Resolving small pulmonary nodules: CT features. Eur Radiol 15:2064–2069PubMedCrossRefGoogle Scholar
  14. 14.
    Ginsberg MS, Griff SK, Go BD, Yoo HH, Schwartz LH, Panicek DM (1999) Pulmonary nodules resected at video-assisted thoracoscopic surgery: etiology in 426 patients. Radiology 213:277–284PubMedGoogle Scholar
  15. 15.
    Chang AE, Schaner EG, Conkle DM, Flye MW, Doppman JL, Rosenberg SA (1979) Evaluation of computed tomography in the detection of pulmonary metastases: a prospective study. Cancer 43:913–916PubMedCrossRefGoogle Scholar
  16. 16.
    Lund G, Heilo A (1982) Computed tomography of pulmonary metastases. Acta Radiol 23:617–620Google Scholar
  17. 17.
    Juergens KU, Weckesser M, Stegger L, Franzius C, Beetz M, Schober O, Heinder W, Wormanns D (2006) Tumor staging using whole-body high-resolution 16-channel PET-CT: does additional low-dose chest CT in inspiration improve the detection of solitary pulmonary nodules? Eur Radiology 16:1131–1137CrossRefGoogle Scholar
  18. 18.
    Goerres GW, Burger C, Kamel E, Seifert B, Kaim AH, Buck A, Buehler TC, von Schulthess GK (2003) Respiration-induced attenuation artifact at PET/CT: technical considerations. Radiology 226:906–910PubMedCrossRefGoogle Scholar
  19. 19.
    Lee J, Aronchick JM, Alavi A (2001) Accuracy of F-18 fluorodeoxyglucose positron emission tomography for the evaluation of malignancy in patients presenting with new lung abnormalities: a retrospective review.Chest 120:1791–1797PubMedCrossRefGoogle Scholar
  20. 20.
    Hubner KF, Buonocore E, Singh SK, et al (1995) Characterization of chest masses by FDG-positron emission tomography. Clin Nucl Med 20:293–298PubMedCrossRefGoogle Scholar
  21. 21.
    Knight SB, Delbeke D, Stewart JR, et al (1996) Evaluation of pulmonary lesions with FDG-PET: comparison of findings in patients with and without a history of prior malignancy. Chest 109:982–988PubMedGoogle Scholar
  22. 22.
    Higashi K, Ueda Y, Seki H, et al (1998) Fluorine-18-FDG PET imaging is negative in bronchoalveolar lung carcinoma. J Nucl Med 39:1016–1020PubMedGoogle Scholar
  23. 23.
    Kim BT, Kim Y, Lee KS, et al (1998) Localized form of bronchoalveolar carcinoma: FDG PET findings. AJR Am J Roentgenol 170:935–939PubMedGoogle Scholar
  24. 24.
    Patz EF, Lowe VJ, Hoffman JM, et al (1993) Focal pulmonary abnormalities: evaluation with F-18 fluorodeoxyglucose PET scanning. Radiology 188:487–490PubMedGoogle Scholar
  25. 25.
    Gupta NC, Frank AR, Dewan NA et al (1992) Solitary pulmonary nodules: detection of malignancy with PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. Radiology 184:441–444PubMedGoogle Scholar
  26. 26.
    Hubner KF, Buonocore E, Gould HR et al (1996) Differentiating benign from malignant lung lesions using “quantitative” parameters of FDG-PET images. Clin Nucl Med 21:941–949PubMedCrossRefGoogle Scholar
  27. 27.
    Fischer BM, Mortensen J, Dirksen A, Eigtved A, Hojgaard L (2004) Positron emission tomography of incidentally detected small pulmonary nodules.Nucl Med Commun 25:3–9PubMedCrossRefGoogle Scholar
  28. 28.
    Kernstine KH, Grannis FW Jr, Rotter AJ (2005) Is there a role for PET in the evaluation of subcentimeter pulmonary nodules? Semin Thorac Cardiovasc Surg Summer; 17:110–114CrossRefGoogle Scholar
  29. 29.
    Reinhardt MJ, Wiethoelter N, Matthies A, Joe AY, Strunk H, Jaeger U, Biersack HJ (2006) PET recognition of pulmonary metastases on PET/CT imaging: impact of attenuation-corrected and non-attenuation-corrected PET images.Eur J Nucl Med Mol Imaging 33:134–139PubMedCrossRefGoogle Scholar
  30. 30.
    Kamel E, Hany TF, Burger C et al (2002) CT vs 68Ge attenuation correction in a combined PET/CT system: evaluation of the effect of lowering the CT tube current. Eur J Nucl Med Mol Imaging 29:346–350PubMedCrossRefGoogle Scholar
  31. 31.
    Hany TF, Steinert HC, Goerres GW, Buck A, von Schulthess GK (2002) PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology 225:575–581PubMedCrossRefGoogle Scholar
  32. 32.
    Wormanns D, Ludwig K, Beyer F, Heindel W, Diederich S (2005) Detection of pulmonary nodules at multirow-detector CT: effectiveness of double reading to improve sensitivity at standard-dose and low-dose chest CT. Eur Radiol 15:14–22PubMedCrossRefGoogle Scholar
  33. 33.
    Antoch G, Freudenberg LS, Beyer T, Bockisch A, Debatin JF (2004) To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med 45 (Suppl 1):56S–65SPubMedGoogle Scholar
  34. 34.
    Yau YY, Chan WS, Tam YM, Vernon P, Wong S, Coel M, Chu SK (2005) Application of intravenous contrast in PET/CT: does it really introduce significant attenuation correction error? J Nucl Med 46:283–291PubMedGoogle Scholar
  35. 35.
    Dizendorf E, Hany TF, Buck A, Von Schulthess GK, Burger C (2003) Cause and magnitude of the error induced by oral CT contrast agent in CT-based attenuation correction of PET emission studies. J Nucl Med 44:732–738PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • W. De Wever
    • 1
  • L. Meylaerts
    • 1
  • L. De Ceuninck
    • 2
  • S. Stroobants
    • 2
  • J. A. Verschakelen
    • 1
  1. 1.Department of RadiologyUniversity Hospitals GasthuisbergLeuvenBelgium
  2. 2.Department of Nuclear MedicineUniversity Hospitals GasthuisbergLeuvenBelgium

Personalised recommendations