Respiratory-gated imaging in metabolic evaluation of small solitary pulmonary nodules
- 1 July 2015
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Nuclear Medicine Communications
- Vol. 36 (7), 722-727
- https://doi.org/10.1097/mnm.0000000000000311
Abstract
The aim of the study was to evaluate the effect of 2-(F)-fluoro-2-deoxy-D-glucose (F-FDG)-PET/computed tomography (CT) respiratory-gated imaging [four-dimensional (4D)] in the metabolic evaluation of small solitary pulmonary nodules and analyze the cutoff maximum standardized uptake value (SUVmax) of 2.5 in classifying and distinguishing benign/malignant pulmonary pathologies in 4D studies.Thirty-two patients with pulmonary lesions measuring 2 cm or less were included during their scheduled F-FDG PET/CT examinations. The whole-body PET/CT acquisition (3D) was followed by a chest-centered PET/CT (4D) study synchronized with the respiratory cycle. The SUVmax percentage difference (%Diff SUVmax) was calculated. The nodule size, localization, and relationships with histological/cytological findings were studied.Fifteen nodules were 10 mm or smaller and 17 were larger than 10 mm [mean size=12 mm (7-20)]. The mean 3D-SUVmax was 2.5 (0.7-6.1) and the mean 4D-SUVmax 3.2 (0.9-7.2) (P<0.001). The mean %Diff SUVmax was 38% for all patients (7-90), 45% in subcentimetric (7-90%) and 31% (7-75%) in supracentimetric lesions (P=NS). Histology was obtained in 23/32 (72%) cases and the pathologic benign/malignant ratio was 4/19. Malignancies were diagnosed as lung adenocarcinoma, solitary metastases, large cell lung carcinoma, and sarcoma in 13 (41%), 3 (9%), 2 (6%), and 1 (3%) case, respectively. Malignant lesions showed mean 4D-SUVmax of 3.8 (1.2-7.2). The cutoff SUVmax of 2.5 did not classify and distinguish between benign/malignant pulmonary pathologies, neither in 3D nor in 4D studies.Respiratory gating improves the detectability and metabolic evaluation of solitary pulmonary nodules, mostly those that are subcentimetric. However, as expected, the cutoff SUVmax of 2.5 does not distinguish between benign/malignant lesions in either 4D or 3D studies.Keywords
This publication has 19 references indexed in Scilit:
- Molecular Imaging of Pulmonary NodulesAmerican Journal of Roentgenology, 2014
- The effect of breathing irregularities on quantitative accuracy of respiratory gated PET/CTMedical Physics, 2012
- New driver mutations in non-small-cell lung cancerThe Lancet Oncology, 2011
- FDG-PET/CT in Lung Cancer: An UpdateFrontiers of radiation therapy and oncology, 2009
- Identification of residual metabolic-active areas within individual NSCLC tumours using a pre-radiotherapy 18Fluorodeoxyglucose-PET-CT scanRadiotherapy and Oncology, 2009
- Positron Emission Tomography/Computed TomographySeminars in Nuclear Medicine, 2008
- Respiratory Motion in Positron Emission Tomography/Computed Tomography: A ReviewSeminars in Nuclear Medicine, 2008
- Time trends in the maximal uptake of FDG on PET scan during thoracic radiotherapy. A prospective study in locally advanced non-small cell lung cancer (NSCLC) patientsRadiotherapy and Oncology, 2007
- Evaluation of various corrections to the standardized uptake value for diagnosis of pulmonary malignancyNuclear Medicine Communications, 2001
- Approach to the Solitary Pulmonary NoduleMayo Clinic Proceedings, 1993