title: Positron emission tomography in the evaluation of pulmonary nodules among patients living in a coccidioidal endemic region.
abstract: BACKGROUND
  Within a coccidioidal endemic region, pulmonary nodules due to coccidioidomycosis are common. Uptake of (18)fluorodeoxyglucose ((18)FDG) by positron emission tomography with computed axial tomography (PET/CT) has been used to assess whether pulmonary nodules are malignant but inflammatory lesions can be positive. The purpose of this study was to compare by PET/CT the (18)FDG uptake in pulmonary nodules likely due to coccidioidomycosis to that of nodules shown to be malignant among patients living in a coccidioidal endemic region.
  
  
  METHODS
  We retrospectively reviewed patients who underwent a PET/CT at the Southern Arizona Veterans Affairs Health Care System between January 2008 and March 2012 who were subsequently found on biopsy to have pulmonary nodules that were coccidioidal or granulomatous or were due to malignancy.
  
  
  RESULTS
  Among 245 diagnostic biopsies where the subject had a previous PET/CT, 15 (6.1 %) were either coccidioidal (n = 12) or granulomatous without an identified organism (n = 3). The median maximum standard unit of uptake (SUV(max)) on PET/CT of coccidioidal or granulomatous lesions was 2.0 compared to 9.8 for malignant lesions (P < 0.001). The maximum diameter of the coccidioidal or granulomatous nodules was 2.1 cm compared to 3.0 cm for the malignant lesions (P = 0.009). On multivariable analysis, an elevated SUV(max) was the only distinguishing feature between the malignant and the granulomatous lesions (OR 1.28, 95 % CI 1.05-1.55; P = 0.013).
  
  
  CONCLUSIONS
  Coccidioidal pulmonary nodules take up significantly less (18)FDG than those due to malignancies, but there is considerable overlap between granulomatous and malignant lesions at lower SUV(max).
authors.affiliation: Pulmonary and Critical Care Division, University of Arizona, Tucson, AZ, USA.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Reyes
authors.forename: Oluwole O
authors.initials: OO
authors.lastname: Onadeko
authors.forename: Maria Del Carmen
authors.initials: Mdel C
authors.lastname: Luraschi-Monjagatta
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Knox
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Rennels
authors.forename: Travis Kent
authors.initials: TK
authors.lastname: Walsh
authors.forename: Neil M
authors.initials: NM
authors.lastname: Ampel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001130:Arizona / Q000453:epidemiology; D001706:Biopsy; D016009:Chi-Square Distribution; D003047:Coccidioidomycosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D003937:Diagnosis, Differential; D019353:Endemic Diseases; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000382:microbiology; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015999:Multivariate Analysis; D016017:Odds Ratio; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18