title: Dual time point imaging for F18-FDG-PET/CT does not improve the accuracy of nodal staging in non-small cell lung cancer patients.
abstract: OBJECTIVE
  To analyze the diagnostic performance of dual time point imaging (DTPI) for pre-therapeutic lymph node (LN) staging in non-small cell lung cancer (NSCLC).
  
  
  METHODS
  This was a retrospective analysis of 47 patients with NSCLC who had undergone DTPI by PET (early + delayed) using F18-fluorodeoxyglucose (FDG). PET raw data were reconstructed iteratively (point spread function + time-of-flight). LN uptake in PET was assessed visually (four-step score) and semi-quantitatively (SUVmax, SUVmean, ratios LN/primary, LN/liver, and LN/mediastinal blood pool). DTPI analyses included retention indices (RIs), Δ-ratios and changes in visual score. Histology or cytology served as standards of reference. Accuracy was determined based on ROC analyses.
  
  
  RESULTS
  Thirty-six of 155 LNs were malignant. DTPI accuracy was low for all measures (visual assessment, 24.5%; RI SUVmax, 68.4%; RI SUVmean, 65.8%; Δ-ratios, 63.9-76.1%) and significantly inferior to early PET. Accuracies of early (range, 86.5-92.9%) and delayed PET (range, 85.2-92.9%) were comparable. At early PET, accuracy of the visual score (92.9%) was similar or superior to semi-quantitative analyses (range, 86.5-92.3%).
  
  
  CONCLUSIONS
  Using a modern PET/CT device and novel image reconstruction, neither additional delayed PET nor DTPI analyses improved the accuracy of PET-based LN staging. Dedicated visual assessment criteria performed very well.
  
  
  CONCLUSIONS
  • DTPI did not improve accuracy of PET-based LN staging in NSCLC. • Analyzed SUV ratios were not superior to LN SUVmax or SUVmean. • A four-step visual score may allow highly accurate, standardized LN assessment.
authors.affiliation: Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, Magdeburg, Germany. julian.rogasch@gmx.de.
authors.forename: Julian M M
authors.initials: JM
authors.lastname: Rogasch
authors.affiliation: Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, Magdeburg, Germany.
authors.forename: Ingo G
authors.initials: IG
authors.lastname: Steffen
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Riedel
authors.affiliation: Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, Magdeburg, Germany.
authors.forename: Ivayla
authors.initials: I
authors.lastname: Apostolova
authors.affiliation: Lung Clinic Lostau gGmbH, Lostau, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Wertzel
authors.affiliation: Lung Clinic Lostau gGmbH, Lostau, Germany.
authors.forename: H Jost
authors.initials: HJ
authors.lastname: Achenbach
authors.affiliation: Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, Magdeburg, Germany.
authors.forename: Ferdinand L G A
authors.initials: FL
authors.lastname: Steinkrüger
authors.affiliation: Institute for Pathology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kalinski
authors.affiliation: Institute for Pathology Stendal, Straße der Demokratie 1, Stendal, Germany.
authors.forename: Meinald
authors.initials: M
authors.lastname: Schultz
authors.affiliation: Department of Cardiology, Angiology and Pneumology, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Schreiber
authors.affiliation: Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, Magdeburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Amthauer
authors.affiliation: Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Otto-von-Guericke University Magdeburg, Leipziger Straße 44, Magdeburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Furth
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D012372:ROC Curve; D019275:Radiopharmaceuticals / Q000494:pharmacology; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Dual time point imaging; FDG-PET/CT; NSCLC; SUV; Thoracic lymph node staging