title: Differentiation of malignant and benign pulmonary nodules with quantitative first-pass 320-detector row perfusion CT versus FDG PET/CT.
abstract: OBJECTIVE
  To prospectively compare the capability of quantitative first-pass perfusion 320-detector row computed tomography (CT) (ie, area-detector CT) with that of combined positron emission tomography and CT (PET/CT) for differentiation between malignant and benign pulmonary nodules.
  
  
  METHODS
  This prospective study was approved by the institutional review board, and written informed consent was obtained from 50 consecutive patients with 76 pulmonary nodules. All patients underwent dynamic area-detector CT, PET/CT, and microbacterial and/or histopathologic examinations. All pulmonary nodules were divided into three groups: malignant nodules (n = 43), benign nodules with low biologic activity (n = 6), and benign nodules with high biologic activity (n = 27). For each dynamic area-detector CT data set, the perfusion derived by using the maximum slope model (PF(MS)), extraction fraction derived by using the Patlak plot model (EF(PP)), and blood volume derived by using the Patlak plot model (BV(PP)) were calculated. These parameters were statistically compared among the three nodule groups. Receiver operating characteristic (ROC) analyses were used to compare the diagnostic capability of the CT and PET/CT indexes. Finally, the sensitivity, specificity, and accuracy of each index were compared by using the McNemar test.
  
  
  RESULTS
  All indexes in the malignant nodule group were significantly different from those in the low-biologic-activity benign nodule group (P < .05). Areas under the ROC curve for PF(MS) and EF(PP) were significantly larger than those for BV(PP) (P < .05) and maximal standard uptake value (SUV(max)) (P < .05). The specificity and accuracy of PF(MS) and EF(PP) were significantly higher than those of BV(PP) and SUV(max) (P < .05).
  
  
  CONCLUSIONS
  Dynamic first-pass area-detector perfusion CT has the potential to be more specific and accurate than PET/CT for differentiating malignant from benign pulmonary nodules.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100245/-/DC1.
authors.affiliation: Department of Radiology, Division of Thoracic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan. yosirad@med.kobe-u.ac.jp
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Ohno
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Koyama
authors.forename: Keiko
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Onishi
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takenaka
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Fujisawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Konishi
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Maniwa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Tomoo
authors.initials: T
authors.lastname: Ito
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*