Abstract
Purpose
Our aim was to assess the diagnostic potential of 18F-FDG PET using partial volume correction and dual-time-point imaging in the assessment of solitary pulmonary nodules.
Methods
We included 265 patients in this retrospective study (171 men; 94 women; age range, 41–92 years). All had pulmonary nodules on CT, and diagnosis was confirmed by biopsy or follow-up CT. All underwent whole body FDG PET, 60 min after FDG injection. Of the 265 patients, 255 underwent second FDG PET for chest 100 min after injection. Maximum SUVs for nodules were calculated from both scans. Partial volume correction for first time SUVs was applied, using coefficient factor. Malignancy was defined using the following criteria: (1) Visual assessment; (2) First time SUV ≥ 2.5; (3) Partial volume corrected first time SUV ≥ 2.5; (4) second time SUV ≥ 2.5; (5) Increase in SUV over time; (6) Increase or no change in SUV; (7) First time SUV ≥ 2.5 and/or increase or no change in SUV.
Results
Biopsy and follow-up revealed 72 malignant lung nodules and 193 benign nodules. Sensitivity, specificity and accuracy for the five criteria were as follows: (1) 97, 58 and 68%; (2) 65, 92 and 85%; (3) 84, 91 and 89%; (4) 90, 80 and 83%; (5) 84, 95 and 92%; (6) 92, 92, and 92%; (7) 95, 90 and 91%, respectively.
Conclusion
Dual-time-point 18F-FDG PET has potential impact on improving the diagnostic accuracy for malignant lung nodules. Dual-time-point 18F-FDG PET imaging should be included in the clinical work-up of patients with pulmonary nodule.
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References
Houri NF, Meziane MA, Zerhouni EA, Fishman EK, Siegelman SS. The solitary pulmonary nodule. Chest 1987;91:128–33.
Viggiano RW, Swensen SJ, Rosenow EC III. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med 1992;13:83–95.
Lillington GA. Disease-a-Month 37th ed. St Louis, MO: Mosby-Year Book, 1991. p. 271–318.
Gomstock GW, Vaughan RH, Montgomery G. Outcome of solitary pulmonary nodules discovered in an x-ray screening program. N Engl J Med 1956;254:1018–22.
Gurney JW. Determining the likelihood of malignancy in solitary pulmonary nodules with Baysian analysis. Part I. Theory. Radiology 1993;186:405–13.
Higgins GA, Shields TW, Keehn RJ. The solitary pulmonary nodule. Arch Surg 1975;110:570–5.
Lillington GA, Caskey CI. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med 1993;14:111–9.
Midthun DE, Swensen SJ, Jett JR. Approach to the solitary pulmonary nodule. Mayo Clin Proc 1993;68:378–85.
Steele JD, Kleitsch WP, Dunn JEJ, Buell P. Survival in males with bronchogenic carcinomas resected as asymptomatic solitary pulmonary nodules. Ann Thorac Surg 1996;2:368–76.
Rohren EM, Turkington TG, Coleman RE. Clinical applications of PET in oncology. Radiology 2004;231:305–32.
Kumar R, Bhargava P, Bozkurt MF, Zhuang H, Potenta S, Alavi A. Positron emission tomography imaging in evaluation of cancer patients. Indian J Cancer 2003;40:87–100.
Hustinx R, Smith RJ, Benard F, et al. Dual time point fluorine-18 fluorodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck. Eur J Nucl Med 1999;26:1345–8.
Zhuang H, Pourdehnad M, Lambright ES, et al. Dual time point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med 2001;42:1412–7.
Buck A, Schirrmeister H, Kuhn T, et al. FDG uptake in breast cancer: correlation with biological and clinical prognostic parameters. Eur J Nucl Med Mol Imaging 2002;29:1317–23.
Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual-time-point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med 2002;43:871–5.
Al-Sugair A, Coleman RE. Applications of PET in lung cancer. Semin Nucl Med 1998;28:303–19.
Kubota K, Matsuzawa T, Fujiwara T, et al. Differential diagnosis of lung tumor with positron emission tomography: a prospective study. J Nucl Med 1990;31:1927–32.
Gupta NC, Frank AR, Dewan NA, et al. Solitary pulmonary nodules: detection of malignancy with PET with 2-[F-18]-fluoro-2-deoxy-d-glucose. Radiology 1992;184:441–4.
Patz EF, Lowe VJ, Hoffman JM, et al. Focal pulmonary abnormalities: evaluation with F-18 fluorodeoxyglucose PET scanning. Radiology 1993;188:487–90.
Dewan NA, Gupta NC, Redepenning LS, Phalen JJ, Frick MP. Diagnostic efficacy of FDG-PET imaging in solitary pulmonary nodules: potential role in evaluation and management. Chest 1993;104:997–1002.
Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol 1998;16;1075–84.
Präuer HW, Weber WA, Römer W, Treumann T, Ziegler SI, Schwaiger M. Controlled prospective study of positron emission tomography using the glucose analogue [18F]fluorodeoxyglucose in the evaluation of pulmonary nodules. Br J Surg 1998;85:1506–11.
Kotaro H, Yoshimichi U, Hiroyasu S, et al. Fluorine-18-FDG PET imaging is negative in bronchioalveolar carcinoma. J Nucl Med 1998;39:1016–20.
Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. Visual and semiquantitative analyses for F-18 fluorodeoxyglucose PET scanning in pulmonary nodules 1 cm to 3 cm in size. Ann Thorac Surg 2005;79:984–8.
Hickeson M, Yun M, Matthies A, et al. Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET. Eur J Nucl Med Mol Imaging 2002;29:1639–47.
Weber W, Young C, Abdel-Dayem HM, et al. Assessment of pulmonary lesions with 18F-fluorodeoxyglucose positron imaging using coincidence mode gamma cameras. J Nucl Med 1999;40:574–8.
Bar-Shalom R, Valdivia AY, Blaufox MD. PET imaging in oncology. Semin Nucl Med 2000;30:150–85.
Dewan NA, Shehan CJ, Reeb SD, Gobar LS, Scott WJ, Ryschon K. Likelihood of malignancy in a solitary pulmonary nodule: comparison of Bayesian analysis and results of FDG-PET scan. Chest 1997;112:416–22.
Herder GJ, Golding RP, Hoekstra OS, et al. The performance of 18F-fluorodeoxyglucose positron emission tomography in small solitary pulmonary nodules. Eur J Nucl Med Mol Imaging 2004;31:1231–6.
Hashimoto Y, Tsujikawa T, Kondo C, et al. Accuracy of PET for Diagnosis of Solid Pulmonary Lesions with 18F-FDG Uptake Below the Standardized Uptake Value of 2.5. J Nucl Med 2006;47(3):426–31.
Demura Y, Tsuchida T, Ishizaki T, et al. 18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax. J Nucl Med 2003;44:540–8.
Kumar R, Loving VA, Chauhan A, Zhuang H, Mitchell S, Alavi A. Potential of dual-time-point imaging to improve breast cancer diagnosis with 18F-FDG PET. J Nucl Med 46(11):1819–24.
Lubberink M, Tolmachev V, Widström C, Bruskin A, Lundqvist H, Westlin JE. 110mIn-DTPA-D-Phe1-Octreotide for Imaging of Neuroendocrine tumours with PET.J Nucl Med 2002;43:1391–7.
Hamberg LM, Hunter GJ, Alpert NM, Choi NC, Babich JW, Fischman AJ. The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification? J Nucl Med 1994;35:1308–12.
Nakamoto Y, Higashi T, Sakahara H, et al. Delayed 18F-FDG PET scan for the differentiation between malignant and benign lesions [abstract]. J Nucl Med 1999;40(suppl):247P.
Lodge MA, Lucas JD, Marsden PK, Cronin BF, O’Doherty MJ, Smith MA. A PET study of 18FDG uptake in soft tissue masses. Eur J Nucl Med 1999;26:22–30.
Ponzo F, Zhuang HM, Liu FM, et al. Can the difference of the levels of glucose-6-phosphatase explain the mechanism of FDG-PET dual time point imaging? Eur J Nucl Med 2001;28:OS399.
Knight SB, Delbeke D, Stewart JR, Sandler MP. Evaluation of pulmonary lesions with FDG-PET. Chest 1996;109:982–8.
Kapucu LO, Meltzer CC, Townsend DW, Keenan RJ, Luketich JD. Fluorine-18-fluoro-deoxyglucose uptake in pneumonia. J Nucl Med 1998;39:1267–9.
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Alkhawaldeh, K., Bural, G., Kumar, R. et al. Impact of dual-time-point 18F-FDG PET imaging and partial volume correction in the assessment of solitary pulmonary nodules. Eur J Nucl Med Mol Imaging 35, 246–252 (2008). https://doi.org/10.1007/s00259-007-0584-1
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DOI: https://doi.org/10.1007/s00259-007-0584-1