European Radiology

, Volume 21, Issue 5, pp 1077–1087 | Cite as

Usefulness of FDG PET/CT in determining benign from malignant endobronchial obstruction

  • Arthur Cho
  • Jin Hur
  • Won Jun Kang
  • Ho Jin Cho
  • Jae-hoon Lee
  • Mijin Yun
  • Jong Doo LeeEmail author
Nuclear Medicine



To evaluate the usefulness of FDG PET/CT to differentiate malignant endobronchial lesions with distal atelectasis from benign bronchial stenosis.


This retrospective study reviewed 84 patients who underwent contrast-enhanced chest CT and then PET/CT and had histological (n = 81) or follow-up imaging (n = 3) confirmation. Two chest radiologists reviewed initial chest CT and determined endobronchial lesions to be malignant or benign. Two nuclear medicine physicians reviewed PET/CT for FDG uptake at the obstruction site and measured SUV. Malignancy was considered when increased FDG uptake was seen in the obstruction site, regardless of FDG within the atelectatic lung.


The sensitivity, specificity and accuracy of chest CT was 95%, 48% and 84%, compared with 95%, 91% and 94% for PET/CT. Benign obstructive lesions showed statistically lower FDG uptake than malignant obstructions (benign SUV 2.5 ± 0.84; malignant SUV 11.8 ± 5.95, p < 0.001). ROC analysis showed an SUV cut-off value of 3.4 with highest sensitivity of 94% and specificity of 91%.


Increased FDG PET/CT uptake at the obstruction site indicates a high probability of malignancy, while benign lesions show low FDG uptake. Careful evaluation of FDG uptake pattern at the obstruction site is helpful in the differentiation between benign and malignant endobronchial lesions.


FDG PET/CT Lung neoplasm Airway obstruction Pulmonary atelectasis 


  1. 1.
    Woodring JH, Reed JC (1996) Types and mechanisms of pulmonary atelectasis. J Thorac Imaging 11:92–108PubMedCrossRefGoogle Scholar
  2. 2.
    Burke M, Fraser R (1988) Obstructive pneumonitis: a pathologic and pathogenetic reappraisal. Radiology 166:699–704PubMedGoogle Scholar
  3. 3.
    Woodring JH (1988) Determining the cause of pulmonary atelectasis: a comparison of plain radiography and CT. AJR Am J Roentgenol 150:757–763PubMedGoogle Scholar
  4. 4.
    Naidich DP, McCauley DI, Khouri NF, Leitman BS, Hulnick DH, Siegelman SS (1983) Computed tomography of lobar collapse: 1. Endobronchial obstruction. J Comput Assist Tomogr 7:745–757PubMedCrossRefGoogle Scholar
  5. 5.
    Molina PL, Hiken JN, Glazer HS (1996) Imaging evaluation of obstructive atelectasis. J Thorac Imaging 11:176–186PubMedGoogle Scholar
  6. 6.
    Wilson RW, Frazier AA (1998) Pathological-radiological correlations: pathological and radiological correlation of endobronchial neoplasms: part II, malignant tumors. Ann Diagn Pathol 2:31–34PubMedCrossRefGoogle Scholar
  7. 7.
    Naidich DP (1990) CT/MR correlation in the evaluation of tracheobronchial neoplasia. Radiol Clin North Am 28:555–571PubMedGoogle Scholar
  8. 8.
    Wilson RW, Kirejczyk W (1997) Pathological and radiological correlation of endobronchial neoplasms: Part I, Benign tumors. Ann Diagn Pathol 1:31–46PubMedCrossRefGoogle Scholar
  9. 9.
    Prince JS, Duhamel DR, Levin DL, Harrell JH, Friedman PJ (2002) Nonneoplastic lesions of the tracheobronchial wall: radiologic findings with bronchoscopic correlation. Radiographics 22 Spec No: S215–30Google Scholar
  10. 10.
    Kim Y, Lee KS, Yoon JH et al (1997) Tuberculosis of the trachea and main bronchi: CT findings in 17 patients. AJR Am J Roentgenol 168:1051–1056PubMedGoogle Scholar
  11. 11.
    Ko JM, Jung JI, Park SH et al (2006) Benign tumors of the tracheobronchial tree: CT-pathologic correlation. AJR Am J Roentgenol 186:1304–1313PubMedCrossRefGoogle Scholar
  12. 12.
    Henschke CI, Davis SD, Auh Y et al (1987) Detection of bronchial abnormalities: comparison of CT and bronchoscopy. J Comput Assist Tomogr 11:432–435PubMedCrossRefGoogle Scholar
  13. 13.
    Mayr B, Ingrisch H, Haussinger K, Huber RM, Sunder-Plassmann L (1989) Tumors of the bronchi: role of evaluation with CT. Radiology 172:647–652PubMedGoogle Scholar
  14. 14.
    Naidich DP, Lee JJ, Garay SM, McCauley DI, Aranda CP, Boyd AD (1987) Comparison of CT and fiberoptic bronchoscopy in the evaluation of bronchial disease. AJR Am J Roentgenol 148:1–7PubMedGoogle Scholar
  15. 15.
    Heitzman ER, Markarian B, Raasch BN, Carsky EW, Lane EJ, Berlow ME (1982) Pathways of tumor spread through the lung: radiologic correlations with anatomy and pathology. Radiology 144:3–14PubMedGoogle Scholar
  16. 16.
    Grenier PA, Beigelman-Aubry C, Brillet PY (2009) Nonneoplastic tracheal and bronchial stenoses. Radiol Clin North Am 47:243–260PubMedCrossRefGoogle Scholar
  17. 17.
    Park CM, Goo JM, Lee HJ, Kim MA, Lee CH, Kang MJ (2009) Tumors in the tracheobronchial tree: CT and FDG PET features. Radiographics 29:55–71PubMedCrossRefGoogle Scholar
  18. 18.
    Emerson GL, Emerson MS, Sherwood CE (1959) The natural history of carcinoma of the lung. J Thorac Surg 37:291–304PubMedGoogle Scholar
  19. 19.
    Gerbaudo VH, Julius B (2007) Anatomo-metabolic characteristics of atelectasis in F-18 FDG-PET/CT imaging. Eur J Radiol 64:401–405PubMedCrossRefGoogle Scholar
  20. 20.
    Kisala JM, Ayala A, Stephan RN, Chaudry IH (1993) A model of pulmonary atelectasis in rats: activation of alveolar macrophage and cytokine release. Am J Physiol 264:R610–614PubMedGoogle Scholar
  21. 21.
    Nestle U, Walter K, Schmidt S et al (1999) 18F-deoxyglucose positron emission tomography (FDG-PET) for the planning of radiotherapy in lung cancer: high impact in patients with atelectasis. Int J Radiat Oncol Biol Phys 44:593–597PubMedCrossRefGoogle Scholar
  22. 22.
    Tateishi U, Hasegawa T, Seki K, Terauchi T, Moriyama N, Arai Y (2006) Disease activity and 18F-FDG uptake in organising pneumonia: semi-quantitative evaluation using computed tomography and positron emission tomography. Eur J Nucl Med Mol Imaging 33:906–912PubMedCrossRefGoogle Scholar
  23. 23.
    Park HJ, Park SH, Im SA, Kim YK, Lee KY (2008) CT differentiation of anthracofibrosis from endobronchial tuberculosis. AJR Am J Roentgenol 191:247–251PubMedCrossRefGoogle Scholar
  24. 24.
    Lee KS, Im JG (1995) CT in adults with tuberculosis of the chest: characteristic findings and role in management. AJR Am J Roentgenol 164:1361–1367PubMedGoogle Scholar
  25. 25.
    Chung HS, Lee JH (2000) Bronchoscopic assessment of the evolution of endobronchial tuberculosis. Chest 117:385–392PubMedCrossRefGoogle Scholar
  26. 26.
    Jeong YJ, Lee KS (2008) Pulmonary tuberculosis: up-to-date imaging and management. AJR Am J Roentgenol 191:834–844PubMedCrossRefGoogle Scholar
  27. 27.
    Ung YC, Maziak DE, Vanderveen JA et al (2007) 18Fluorodeoxyglucose positron emission tomography in the diagnosis and staging of lung cancer: a systematic review. J Natl Cancer Inst 99:1753–1767PubMedCrossRefGoogle Scholar
  28. 28.
    Englmeier KH, Seemann MD (2008) Multimodal virtual bronchoscopy using PET/CT images. Comput Aided Surg 13:106–113PubMedGoogle Scholar
  29. 29.
    Erasmus JJ, McAdams HP, Patz EF Jr, Coleman RE, Ahuja V, Goodman PC (1998) Evaluation of primary pulmonary carcinoid tumors using FDG PET. AJR Am J Roentgenol 170:1369–1373PubMedGoogle Scholar
  30. 30.
    Nakamura R, Ishikawa S, Sakai M, Goto Y, Minami Y (2009) Increased fluorodeoxyglucose-uptake in positron emission tomography with an endobronchial schwannoma occluding the left main stem bronchus. J Thorac Oncol 4:1183–1184PubMedCrossRefGoogle Scholar
  31. 31.
    Pasic A, Brokx HA, Comans EF et al (2005) Detection and staging of preinvasive lesions and occult lung cancer in the central airways with 18F-fluorodeoxyglucose positron emission tomography: a pilot study. Clin Cancer Res 11:6186–6189PubMedCrossRefGoogle Scholar
  32. 32.
    Seemann MD, Schaefer JF, Englmeier KH (2007) Virtual positron emission tomography/computed tomography-bronchoscopy: possibilities, advantages and limitations of clinical application. Eur Radiol 17:709–715PubMedCrossRefGoogle Scholar
  33. 33.
    Tokuyasu H, Harada T, Watanabe E et al (2008) A case of endobronchial actionomycosis evaluated by FDG-PET. Nihon Kokyuki Gakkai Zasshi 46:650–654PubMedGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Arthur Cho
    • 1
  • Jin Hur
    • 2
  • Won Jun Kang
    • 1
  • Ho Jin Cho
    • 1
  • Jae-hoon Lee
    • 1
  • Mijin Yun
    • 1
  • Jong Doo Lee
    • 1
    Email author
  1. 1.Division of Nuclear Medicine, Department of RadiologyYonsei University Health SystemSeoulSouth Korea
  2. 2.Department of RadiologyYonsei University Health SystemSeoulSouth Korea

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