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Accuracy of early and delayed FDG PET-CT and of contrast-enhanced CT in the evaluation of lung nodules: a preliminary study on 30 patients

Accuratezza della FDG PET-TC in fase precoce e in fase tardiva e della TC con mezzo di contrasto nella valutazione dei noduli polmonari: uno studio preliminare su 30 pazienti

  • Chest Radiology/Radiologia Toracica
  • Published:
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Abstract

Purpose

The aim of our prospective study was to compare the diagnostic accuracy of early, delayed and dual-time-point positron emission tomography (PET) acquisition with contrast enhanced computed tomography (CT) within a PET-CT examination in the evaluation of pulmonary solitary nodules (SPNs).

Materials and methods

Thirty patients were enrolled in the study. All the patients underwent a dual-time-point PET-CT examination. Whole-body PET images were acquired at 50 min after fluorine18-fluorodeoxyglucose (18F-FDG) administration (early), followed by a chest acquisition (delayed). Lung nodules with maximum standardised uptake value SUVmax ≥2.5 were considered malignant. SUVmax was calculated on early and delayed images; SUV increasing ≥10% (Δ SUVmax) was considered suggestive of malignancy. Absence of significant lung nodule enhancement (<15 Δ HU) at CT was considered strongly predictive of benignity. For the CT morphological assessment, the irregularity of the shape of each lesion was rated. PET-CT results were related to histological assays and clinical records. Diagnostic accuracy was assessed by area under the receiveroperarting characteristic (ROC) curves analysis.

Results

Early and delayed SUVmax of malignant nodules were significantly higher than those of benign disease. Early SUVmax sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 77%, 91%, 79.5% and 66.7%; delayed SUVmax corresponding values were 77%, 66%, 74% and 66%; dual-time-point SUVmax values were 83%, 67%, 75% and 74%; ΔHU values were 94%, 34%, 67%, 96%; CT morphologic evaluation values were 61%, 46%, 60%, 47%. Area under the curve (AUC) for early SUVmax was 0.79, for delayed SUVmax 0.80, for dual-time-point SUVmax 0.85, for ΔHU 0.63 and for CT morphologic assessment 0.58.

Conclusions

In our small series of patients, early and delayed SUVmax showed comparable accuracies, whereas morphological and contrast enhanced CT evaluations showed the lowest accuracies. Dual-time-point SUVmax showed the largest AUC. However, dual-time-point SUVmax was most sensitive, whereas single-time-point SUVmax was most specific.

Riassunto

Obiettivo

Scopo del nostro studio è stato quello di comparare l’accuratezza diagnostica dell’acquisizione PET in fase precoce, in fase tardiva e dual-time associata all’esecuzione di TC con mezzo di contrasto in un’unica sessione nella valutazione del nodulo polmonare solitario (SPN).

Materiali e metodi

Presso il nostro Dipartimento sono stati sottoposti a valutazione PET-TC dual-time con mezzo di contrasto 30 pazienti con nodulo polmonare solitario. Le immagini PET total-body sono state acquisite 50 minuti dopo la somministrazione di 18F-FDG (fase precoce) seguite da un’acquisizione del torace (fase tardiva). I noduli polmonari con SUVmax≥2,5 sono stati considerati maligni. È stato calcolato il valore di SUVmax sulle immagini precoci e tardive: l’incremento (Δ SUVmax) del SUVmax tra fase precoce e fase tardiva ≥10% è stato considerato suggestivo di malignita; in valutazione TC invece è stata considerato suggestivo di benignità l’assenza di un significativo incremento di densità (<15 HU) tra l’acquisizione basale e quella post-contrastografica. Le caratteristiche morfologiche dei noduli alla TC sono state analizzate quantificando l’irregolarità della forma della lesione in una scala da 1 a 4. I risultati della PET-TC sono stati correlati ai dati clinici e a campioni istologici. L’accuratezza diagnostica è stata misurata mediante curva ROC.

Risultati

Il valore di SUVmax in fase precoce e tardiva nei noduli maligni è risultato significativamente più elevato di quello riscontrato per i noduli benigni. La sensibilità, la specificità, il VPP e il VPN del SUVmax ottenuto in fase precoce sono state del 77%, 91%, 79,5% e 66,7% rispettivamente; in fase tardiva abbiamo ottenuto valori di 83%, 67%, 75% e 74% rispettivamente. La differenza del valore in HU (ΔHU) tra acquisizione TC basale e quella post-contrastografica ha mostrato valori di sensibilità del 94%, di specificità del 34%, VPP del 67% e VPN del 96%. La valutazione TC morfologica ha riportato valori di sensibilita, specificita, di VPP e di VPN di 61%, 46%, 60%, 47%. La curva AUC del valore di SUVmax in fase precoce è stata di 0,79, in fase tardiva è stata di 0,80, riguardo all’acquisizione dual-time (Δ SUVmax) di 0,85 e riguardo al ΔHU di 0,63 e per quanto riguarda la valutazione morfologica di 0,58.

Conclusioni

Nel nostro piccolo gruppo di pazienti il valore di SUVmax sia in fase precoce che tardiva ha mostrato accuratezza sovrapponibile, le valutazioni TC morfologica e contrastografica hanno mostrato l’accuratezza piu bassa. Il valore di SUVmax calcolato in dual-time (Δ SUVmax) ha mostrato l’accuratezza diagnostica maggiore. Tuttavia il valore di SUVmax in dual-time pur mostrandosi piu sensibile rispetto al valore di SUVmax ottenuto con singola acquisizione, è risultato meno specifico.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, Molecular Imaging Interventional Radiology and Radiotherapy, University Hospital “Tor Vergata”, Rome, Italy

    O. Schillaci, L. Travascio, F. Bolacchi, F. Calabria, C. Bruni, C. Cicciò, M. Guazzaroni, A. Orlacchio & G. Simonetti

  2. Viale G. Mazzini 121, 00195, Rome, Italy

    O. Schillaci

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  1. O. Schillaci
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  2. L. Travascio
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Schillaci, O., Travascio, L., Bolacchi, F. et al. Accuracy of early and delayed FDG PET-CT and of contrast-enhanced CT in the evaluation of lung nodules: a preliminary study on 30 patients. Radiol med 114, 890–906 (2009). https://doi.org/10.1007/s11547-009-0400-z

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  • DOI: https://doi.org/10.1007/s11547-009-0400-z

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