title: Solitary pulmonary nodules differentiated by dynamic F-18 FDG PET in a region with high prevalence of granulomatous disease.
abstract: This study determined whether dynamic F-18 FDG PET imaging could differentiate benign from malignant solitary pulmonary nodules (SPNs). Histopathologically confirmed SPNs (10-35 mm), 24 malignant and 10 benign, from 34 patients were studied through both dynamic and static F-18 FDG PET imaging of all patients. Volumes of interest (VOIs) were placed over the pulmonary nodules using a 50% maximum pixel value threshold. The arterial input function was estimated from a left ventricle-defined VOI. Based on Patlak analysis, we calculated the net FDG phosphorylation rate (K(i)) and glucose metabolic rate (MRGlu) of each nodule. The slope values of the time-activity curves (TACs) of the nodules were also determined. Based on the static PET images, maximum and mean standardized uptake values (SUV(max) and SUV(mean), respectively) were calculated. Benign and malignant SPNs had significantly different values for SUV(max), SUV(mean), K(i), MRGlu, and TAC slope, with area under the receiver operating characteristic curves distinguishing benign from malignant nodules. McNemar's test of marginal homogeneity found all the predictors helpful to detect malignant nodules (all, p > 0.05), and combining K(i) and MRGlu, which were generated by dynamic study, yielded a higher specificity of 90%, and a sensitivity of 79%. Among the 10 benign nodules, static SUV imaging correctly classified seven, while dynamic F-18 PET imaging correctly classified nine. Dynamic F-18 FDG PET imaging is valuable in differentiating benign from malignant SPNs, particularly for granulomatous disease.
authors.affiliation: Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.
authors.forename: Yu-Erh
authors.initials: YE
authors.lastname: Huang
authors.forename: Hung-I
authors.initials: HI
authors.lastname: Lu
authors.forename: Feng-Yuan
authors.initials: FY
authors.lastname: Liu
authors.forename: Yu-Jie
authors.initials: YJ
authors.lastname: Huang
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lin
authors.forename: Chih-Feng
authors.initials: CF
authors.lastname: Chen
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006099:Granuloma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18