Differentiating benign from malignant lung lesions using "quantitative" parameters of FDG PET images.
Fluorine-18 labeled deoxyglucose positron-emission tomography (FDG-PET) applications in oncology include the differential diagnosis of chest masses and single pulmonary nodules. However, FDG is not tumor-specific; rather, it also accumulates in inflammatory processes. This study was performed to identify image parameters that would improve the specificity of PET.


METHODS
Twenty-six patients who had benign and malignant lung lesions were examined retrospectively. Positron-emission tomography data were acquired in dynamic scanning mode after intravenous bolus of 250-402 MBq of FDG. Standardized uptake values (SUVs) were calculated and Patlak analyses were performed in selected regions of interest in the PET images. Positron-emission tomography results were related to histological diagnosis (N = 49) or clinical follow-up (N = 3).


RESULTS
The specificity and sensitivity of the original PET scan reports, which was based on visual image interpretation and loosely applied SUVs, was 100% and 73%, respectively. Using the SUVs with a cut-off value of 3.8 and Kpat value with a cut-off at 0.025 min-1 improved the specificity to 81% and 85%.


CONCLUSIONS
FDG-PET image interpretation can be facilitated by using SUV information or the accumulation rate of the radiotracer (Patlak). With additional validation, this method could have a significant cost-effective impact on the medical/surgical management of chest masses.
Hübner
K F
KF
Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee.
Buonocore
E
E
Gould
H R
HR
Thie
J
J
Smith
G T
GT
Stephens
S
S
Dickey
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003362:Cost-Benefit Analysis; D003847:Deoxyglucose / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D003937:Diagnosis, Differential; D005260:Female; D005462:Fluorine Radioisotopes / Q000008:administration & dosage / Q000493:pharmacokinetics; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007275:Injections, Intravenous; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D014055:Tomography, Emission-Computed / Q000191:economics; D014057:Tomography, X-Ray Computed
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D003847:Deoxyglucose