European Radiology

, Volume 30, Issue 1, pp 442–451 | Cite as

The clinical value of F-18 FDG PET/CT in differentiating malignant from benign lesions in pneumoconiosis patients

  • Eun Kyoung Choi
  • Hye Lim Park
  • Ie Ryung YooEmail author
  • Seung Joon Kim
  • Young Kyoon Kim
Nuclear Medicine



We reviewed PET/CT findings of pneumoconiosis and determined the ability of PET/CT to differentiate lung cancer from progressive massive fibrosis (PMF), and metastatic lymph nodes (LNs) from underlying reactive LN hyperplasia.


This was a retrospective study of patients with pneumoconiosis and suspected lung cancer. Maximum standardized uptake value (SUVmax), long- and short-axis diameters (DL and DS), ratio of DL to DS (DL/S), and Hounsfield unit (HU) from the lung mass and mediastinal LNs were measured. The cutoff values of each parameter were obtained by ROC analysis, and we evaluated the diagnostic sensitivity.


Forty-nine pneumoconiosis patients were included. Eighty-three lung masses were detected, of which 42 were confirmed as lung cancer (23 squamous cell carcinomas, 12 adenocarcinomas, and 7 small cell carcinomas) and 41 were PMF. There were significant differences between lung cancer and PMF in terms of SUVmax, DS, DL/S, and HU (all p < 0.05). The sensitivity, specificity, and accuracy for diagnosis of lung cancer were 81.0%, 73.2%, and 77.1%, respectively, with an SUVmax cutoff value of 7.4; and 92.8%, 87.8%, and 90.4%, respectively, with a HU cutoff value of 45.5. Among the 40 LNs with available pathological results, 7 were metastatic. Metastatic LNs showed higher SUVmax, larger DS, and lower HU than benign lesions (all p < 0.05). The sensitivity, specificity, and accuracy for predicting metastatic LNs by PET/CT were 85.7%, 93.9%, and 92.5%, respectively.


By applying PET and CT parameters in combination, the accuracy for differentiating malignant from benign lesions could be increased. PET/CT can play a central role in the discrimination of lung cancer and PMF.

Key Points

• Lung cancer showed significantly higher SUVmax than PMF.

• Lung cancer showed similar D L but longer D S , resulting in a smaller D L/S than PMF.

• SUVmax demonstrated additive value in differentiating lung cancer from PMF, compared with HU alone.


Pneumoconiosis Lung neoplasms Positron emission tomography–computed tomography Computed tomography, X-ray 



Computed tomography


Long-axis diameter


Ratio of long- to short-axis diameter


Short-axis diameter




Hounsfield unit


Lymph node


Negative predictive value


Positron emission tomography


Progressive massive fibrosis


Positive predictive value


Receiver operating characteristic


Maximum standardized uptake value



The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Ie Ryung Yoo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• retrospective

• observational

• performed at one institution

Supplementary material

330_2019_6342_MOESM1_ESM.docx (29 kb)
ESM 1 (DOCX 28.8 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Eun Kyoung Choi
    • 1
  • Hye Lim Park
    • 2
  • Ie Ryung Yoo
    • 3
    Email author
  • Seung Joon Kim
    • 4
  • Young Kyoon Kim
    • 4
  1. 1.Division of Nuclear Medicine, Department of RadiologyIncheon St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaSeoulSouth Korea
  2. 2.Division of Nuclear Medicine, Department of RadiologyEunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaSeoulSouth Korea
  3. 3.Division of Nuclear Medicine, Department of RadiologySeoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaSeoulSouth Korea
  4. 4.Division of Pulmonology, Department of Internal MedicineSeoul St. Mary’s Hospital, College of Medicine, The Catholic University of KoreaSeoulSouth Korea

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