title: Solitary pulmonary nodules: Comparison of dynamic first-pass contrast-enhanced perfusion area-detector CT, dynamic first-pass contrast-enhanced MR imaging, and FDG PET/CT.
abstract: OBJECTIVE
  To prospectively compare the capabilities of dynamic perfusion area-detector computed tomography (CT), dynamic magnetic resonance (MR) imaging, and positron emission tomography (PET) combined with CT (PET/CT) with use of fluorine 18 fluorodeoxyglucose (FDG) for the diagnosis of solitary pulmonary nodules.
  
  
  METHODS
  The institutional review board approved this study, and written informed consent was obtained from each subject. A total of 198 consecutive patients with 218 nodules prospectively underwent dynamic perfusion area-detector CT, dynamic MR imaging, FDG PET/CT, and microbacterial and/or pathologic examinations. Nodules were classified into three groups: malignant nodules (n = 133) and benign nodules with low (n = 53) or high (n = 32) biologic activity. Total perfusion was determined with dual-input maximum slope models at area-detector CT, maximum and slope of enhancement ratio at MR imaging, and maximum standardized uptake value (SUVmax) at PET/CT. Next, all indexes for malignant and benign nodules were compared with the Tukey honest significant difference test. Then, receiver operating characteristic analysis was performed for each index. Finally, sensitivity, specificity, and accuracy were compared with the McNemar test.
  
  
  RESULTS
  All indexes showed significant differences between malignant nodules and benign nodules with low biologic activity (P < .0001). The area under the receiver operating characteristic curve for total perfusion was significantly larger than that for other indexes (.0006 ≤ P ≤ .04). The specificity and accuracy of total perfusion were significantly higher than those of maximum relative enhancement ratio (specificity, P < .0001; accuracy, P < .0001), slope of enhancement ratio (specificity, P < .0001; accuracy, P < .0001), and SUVmax (specificity, P < .0001; accuracy, P < .0001).
  
  
  CONCLUSIONS
  Dynamic perfusion area-detector CT is more specific and accurate than dynamic MR imaging and FDG PET/CT in the diagnosis of solitary pulmonary nodules in routine clinical practice.
authors.affiliation: From the Advanced Biomedical Imaging Research Center (Y.O., M.N., T.Y., S.M.), Division of Functional and Diagnostic Imaging Research, Department of Radiology (Y.O., M.N., T.Y., S.M.), and Division of Radiology, Department of Radiology (H.K., S.S., M.T., K.S.), Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Kobe, Japan; and Toshiba Medical Systems, Otawara, Japan (Y.F.).
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Ohno
authors.forename: Mizuho
authors.initials: M
authors.lastname: Nishio
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Koyama
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Seki
authors.forename: Maho
authors.initials: M
authors.lastname: Tsubakimoto
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Fujisawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Sumiaki
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012039:Regional Blood Flow; D003074:Solitary Pulmonary Nodule / Q000098:blood supply* / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18