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Dual time point imaging for F18-FDG-PET/CT does not improve the accuracy of nodal staging in non-small cell lung cancer patients

  • Molecular Imaging
  • Published:
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Abstract

Objectives

To analyze the diagnostic performance of dual time point imaging (DTPI) for pre-therapeutic lymph node (LN) staging in non-small cell lung cancer (NSCLC).

Methods

This was a retrospective analysis of 47 patients with NSCLC who had undergone DTPI by PET (early + delayed) using F18-fluorodeoxyglucose (FDG). PET raw data were reconstructed iteratively (point spread function + time-of-flight). LN uptake in PET was assessed visually (four-step score) and semi-quantitatively (SUVmax, SUVmean, ratios LN/primary, LN/liver, and LN/mediastinal blood pool). DTPI analyses included retention indices (RIs), Δ-ratios and changes in visual score. Histology or cytology served as standards of reference. Accuracy was determined based on ROC analyses.

Results

Thirty-six of 155 LNs were malignant. DTPI accuracy was low for all measures (visual assessment, 24.5%; RI SUVmax, 68.4%; RI SUVmean, 65.8%; Δ-ratios, 63.9-76.1%) and significantly inferior to early PET. Accuracies of early (range, 86.5–92.9%) and delayed PET (range, 85.2–92.9%) were comparable. At early PET, accuracy of the visual score (92.9%) was similar or superior to semi-quantitative analyses (range, 86.5–92.3%).

Conclusions

Using a modern PET/CT device and novel image reconstruction, neither additional delayed PET nor DTPI analyses improved the accuracy of PET-based LN staging. Dedicated visual assessment criteria performed very well.

Key Points

• DTPI did not improve accuracy of PET-based LN staging in NSCLC.

• Analyzed SUV ratios were not superior to LN SUVmax or SUVmean.

• A four-step visual score may allow highly accurate, standardized LN assessment.

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Acknowledgments

The scientific guarantor of this publication is Prof. Holger Amthauer. 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. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was obtained (study ID number, RAD271; vote, 44/15). Written informed consent was obtained from all patients in this study. Methodology: retrospective, diagnostic study performed at one institution.

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, Magdeburg, Germany

    Julian M. M. Rogasch, Ingo G. Steffen, Ivayla Apostolova, Ferdinand L. G. A. Steinkrüger, Holger Amthauer & Christian Furth

  2. Department of Cardiology, Angiology and Pneumology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany

    Sandra Riedel & Jens Schreiber

  3. Lung Clinic Lostau gGmbH, Lostau, Germany

    Heinz Wertzel & H. Jost Achenbach

  4. Institute for Pathology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany

    Thomas Kalinski

  5. Institute for Pathology Stendal, Straße der Demokratie 1, Stendal, Germany

    Meinald Schultz

Authors
  1. Julian M. M. Rogasch
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  2. Ingo G. Steffen
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  3. Sandra Riedel
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  4. Ivayla Apostolova
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  6. H. Jost Achenbach
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  7. Ferdinand L. G. A. Steinkrüger
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  9. Meinald Schultz
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  10. Jens Schreiber
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  11. Holger Amthauer
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  12. Christian Furth
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Correspondence to Julian M. M. Rogasch.

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Rogasch, J.M.M., Steffen, I.G., Riedel, S. et al. Dual time point imaging for F18-FDG-PET/CT does not improve the accuracy of nodal staging in non-small cell lung cancer patients. Eur Radiol 26, 2808–2818 (2016). https://doi.org/10.1007/s00330-015-4093-5

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  • DOI: https://doi.org/10.1007/s00330-015-4093-5

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