Texture analysis of FDG PET/CT for differentiating between FDG-avid benign and metastatic adrenal tumors: efficacy of combining SUV and texture parameters
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To retrospectively investigate the SUV-related and texture parameters individually and in combination for differentiating between F-18-fluorodeoxyglucose (FDG)-avid benign and metastatic adrenal tumors with PET/CT.
Thirteen benign adrenal tumors (BATs) and 22 metastatic adrenal tumors (MATs) with a metabolic tumor volume (MTV) > 10.0 cm3 and SUV ≥ 2.5 were included. SUVmax, MTV, total lesion glycolysis, and four textural parameters [entropy, homogeneity, intensity variability (IV), and size-zone variability] were obtained. These parameters were compared between BATs and MATs using Mann–Whitney U test, and the diagnostic performance was evaluated by the area under the curve (AUC) values derived from the receiver operating characteristic analysis. The diagnostic value of combining SUV and texture parameters was examined using a scoring system.
MATs showed significantly higher SUVmax (p = 0.004), entropy (p = 0.013), IV (p = 0.006), and lower homogeneity (p = 0.019) than BATs. The accuracies for diagnosing MATs were 82.9, 82.9, 85.7, and 71.4% for SUVmax, entropy, IV, and homogeneity, respectively. No significant differences in AUC were found among these parameters (p > 0.05 each). When each parameter was scored as 0 (negative for malignancy) and 1 (positive for malignancy) according to each threshold criterion and the four parameter summed scores 0, 1, and 2 were defined as benignity and 3 and 4 as malignancy, the sensitivity and specificity and accuracy to predict MATs were 100% (22/22), 84.6% (11/13), and 94.3% (33/35), respectively, with 0.97 of the AUC.
The combined use of SUVmax and texture parameters has a potential to significantly increase the diagnostic performance to differentiate between large FDG-avid BATs and MATs.
KeywordsAdrenal tumor FDG PET/CT SUVmax Textural analysis
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Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was waived by the institutional review board for this retrospective study.
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