title: Differentiation of malignant from benign heart and pericardial lesions using positron emission tomography and computed tomography.
abstract: OBJECTIVE
  To assess the feasibility of (18)F-FDG PET-CT for the differentiation of malignancy from benign lesions of the heart and the pericardium.
  
  
  METHODS
  A total of 23 cases (malignancy:benign = 13:10) with cardiac and pericardial lesions, confirmed by pathology or on clinical grounds, were analyzed in this study. All lesions were evaluated semi-quantitatively using maximum standard uptake values (SUV(max)) and SUV(max) lesion/blood, and the density of the heart and pericardium lesions and the relation with surrounding tissues were evaluated. The differences of SUV(max) and SUV(max) lesion/blood between benign and malignant lesions were analyzed by the Mann-Whitney test. Subsequently, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for CT and PET-CT, respectively.
  
  
  RESULTS
  The maximum SUV showed significant difference between malignancy (avg ± SD 6.5) and benign (avg ± SD 1.5) (Z = -3.601, P < .01), the SUV(max) lesion/blood of malignancy and benign were avg ± SD 3.4 and avg ± SD 0.9, respectively, also with a significant difference (Z = -3.600, P < .01). In this pilot study, the optimal cutoff value to separate benign vs malignant lesions of SUV(max) was 3.5-4.0 and the cutoff for SUV(max) lesion/blood was 1.3-2.0. The sensitivity, specificity, accuracy, PPV, and NPV of CT and PET-CT were 76.9%(10/13), 100.0%(10/10), 87.0%(20/23), 100.0%(10/10), 76.9%(10/13) and 100.0%(13/13), 90.0%(9/10), 95.7%(22/23), 92.9%(13/14), 100.0%(9/9), respectively.
  
  
  CONCLUSIONS
  (18)F-FDG PET-CT appears promising for correctly differentiating benign vs malignant cardiac and pericardial lesions.
authors.affiliation: PET/CT Center, Guangdong Academy of Medical Science & Guangdong General Hospital, 106 Zhong Shan Er Lu, Guangzhou, 510080, Guangdong, People's Republic of China.
authors.forename: Dan
authors.initials: D
authors.lastname: Shao
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Wang
authors.forename: Chang-Hong
authors.initials: CH
authors.lastname: Liang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Gao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005215:Fasting; D005260:Female; D006338:Heart Neoplasms / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009206:Myocardium / Q000473:pathology*; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed