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The feasibility of 11C-methionine-PET in diagnosis of solitary lung nodules/masses when compared with 18F-FDG-PET

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Abstract

Objective

To differentiate between benign and malignant lesions of the lung, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has limitations such as a lower specificity in cases of non-specific inflammation. The positive predictive value is unsatisfactory in countries where inflammatory lung disorders are prevalent. We present the preliminary results of the usefulness of combining 11C-methionine-PET and 18F-FDG-PET in this context.

Methods

Fifteen patients with indeterminate solitary pulmonary nodules/masses (10 men, 5 women; average age 64.7 ± 14.0 years, ranging from 25 to 87 years) were studied using 11C-methionine- and 18F-FDG-PET. Interpretations were primarily made on visual analysis with five-point scale and a consensus of two nuclear medicine physicians, using standardized uptake value as an accessory reference. Foci of abnormal radiotracer uptake were subsequently correlated with clinical follow-up, imaging modalities such as chest radiography, chest computed tomography (CT), serial PET studies, and pathology results from bronchoscopic biopsy and/or surgical specimen.

Results

Diagnoses were established in 14 patients. The 11C-methionine-PET and 18F-FDG-PET studies were both true positive in two cases of adenocarcinoma and true negative in two cases of clinical benign nodules. In one case of lymphoid hyperplasia both 11C-methionine-PET and 18F-FDG-PET showed false-positive findings. Discordant results were obtained in nine cases. In spite of the false-positive results of 18F-FDG-PET, 11C-methionine-PET was true negative in four cases with chronic inflammatory nodules and three cases of pulmonary tuberculosis. Furthermore, 11C-methionine-PET was true positive in one case of lung metastasis of thyroid cancer, and in another with recurrence of gastric cancer, respectively, for which 18F-FDG-PET imaging was false negative.

Conclusions

Our experience indicates that 11C-methionine-PET seems more specific and sensitive when compared with 18F-FDG-PET for the purpose of differentiating benign and malignant thoracic nodules/masses. The possibility of an FDG-avid lesion being malignant is decreased if it shows a negative result by 11C-methionine-PET.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital, 707, Sec. 3, Chung Yang Rd., Hualien, 970, Taiwan, China

    Hung-Jen Hsieh

  2. Department of Internal Medicine, Taipei County Hospital, Taipei, Taiwan, China

    Sheng-Hsiang Lin

  3. Department of Nuclear Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, China

    Ko-Han Lin, Chien-Ying Lee, Cheng-Pei Chang & Shyh-Jen Wang

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  1. Hung-Jen Hsieh
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  2. Sheng-Hsiang Lin
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Correspondence to Hung-Jen Hsieh.

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Hsieh, HJ., Lin, SH., Lin, KH. et al. The feasibility of 11C-methionine-PET in diagnosis of solitary lung nodules/masses when compared with 18F-FDG-PET. Ann Nucl Med 22, 533–538 (2008). https://doi.org/10.1007/s12149-007-0142-8

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  • DOI: https://doi.org/10.1007/s12149-007-0142-8

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