Characterization of 18F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake

Lin, Jie; Ling, Wang; Zheng, Xiujuan; Tang, Kun

doi:10.21037/qims-20-768

Cited by 3 publications

(4 citation statements)

References 30 publications

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“…The FMSD in the proximal region of malignant lesions was significantly higher than that of the distal region, and the FMSD in the proximal region of benign lesions was significantly lower than that of the distal region. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of FMSD were 92.8%, 72.9%, 85.7%, 86.1%, and 89.2% ( 19 ), which is very similar to our research and further supports our conclusion, but diagnostic accuracy of combining PET/CT features with FMSD, and the optimal size of lesion for FMSD application was not discussed in their study. In our study, there were 29 patients whose lesions did not show the heterogeneity of 18 F-FDG uptake.…”

Section: Discussionsupporting

confidence: 87%

“…In the malignant lesions, blood supply from the bronchial artery was more abundant, causing the tumor cells in the proximal growing and metabolizing actively, and 18 F-FDG uptake was increased (21). However, chronic inflammation is more likely to stimulate the blood supply of extrapulmonary systemic circulation arteries, which are mostly located at the distal end of the heart (19). Therefore, the exudation of inflammatory lesions is more frequent at the distal end, leading to the high 18 F-FDG uptake in this location.…”

Section: Figurementioning

confidence: 99%

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18F-FDG distribution pattern improves the diagnostic accuracy of single pulmonary solid nodule

Zhou

Zhang

et al. 2022

Front. Oncol.

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BackgroundThe main purpose is to explore the use of visual assessment of the heterogeneous distribution of 18F-FDG in single pulmonary solid lesions to differentiate the benign from the malignant.MethodsThe 200 cases of pulmonary nodules or masses examined by 18F-FDG PET/CT were retrospectively analyzed. The heterogeneity of 18F-FDG distribution of the lesion was visually and quantitatively evaluated and the higher part of metabolism was observed and measured at the proximal or distal part to determine the lesion nature. The sensitivity, specificity, PPV, NPV, and accuracy of this method were calculated.ResultsTotal 171 pulmonary lesions showed heterogeneity of 18F-FDG uptake, including the 111 malignant and 60 benign. 54/60 (90.00%) benign lesions showed higher 18F-FDG uptake visually at distal part, while 104/111 (93.69%) malignant lesions showed higher 18F-FDG uptake visually at the proximal part. This visual method has good repeatability with a high kappa value (0.821, p<0.001). 52/60 (86.67%) benign lesions showed higher 18F-FDG uptake quantitatively at distal part, while 107/111 (96.40%) malignant lesions showed higher 18F-FDG uptake quantitatively at the proximal part. The sensitivity, specificity, PPV, NPV and accuracy of visual and quantitative methods were 93.69%; 96.40%, 90.0%; 86.67%, 94.55%; 93.04%, 88.52%; 92.86%, 92.40%; 92.98%, respectively (p<0.001). When combining the metabolic value and morphological characteristics of PET/CT with visual18F-FDG heterogeneous features, the accuracy reached to 98.25%. The other 29 lesions (14.5%) with no heterogeneity were smaller (2.17 ± 1.06 vs 3.58 ± 1.48, P<0.001).ConclusionsBenign and malignant lung lesions showed different heterogeneity of 18F-FDG uptake. Lung cancer can be effectively distinguished from infectious or inflammatory lesions by this simple and convenient method.

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Section: Discussionsupporting

confidence: 87%

Section: Figurementioning

confidence: 99%

18F-FDG distribution pattern improves the diagnostic accuracy of single pulmonary solid nodule

Zhou

Zhang

et al. 2022

Front. Oncol.

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“…Our previous study has shown that the metabolic distribution of 2-[ 18 F]FDG in malignant nodules was different from that of benign ones (10). Generally, the 2-[ 18 F] FDG uptake in the proximal region of malignant lesion was higher than that in the distal region, which was also proved by our visual assessment of the spatial distribution of 2-[ 18 F] FDG metabolism (11). Although the visual method can be used as an auxiliary indicator to improve the diagnostic accuracy of pulmonary lesions with high 2-[ 18 F]FDG uptake, the analysis was a subjective empirical judgment method which may lead to subjective bias.…”

Section: Discussionsupporting

confidence: 72%

“…However, the acquisition of RAD requires complex diameter measurement and calculation, which limits its clinical application. Recently, we visually assessed the 2-[ 18 F]FDG spatial distribution in pulmonary lesions (11). Although this simple procedure could improve the diagnostic performance for hypermetabolic pulmonary nodules and masses, the main limitation lied in the subjective bias of observers, and the interobserver agreement needed to be further improved.…”

Section: Introductionmentioning

confidence: 99%

Quantitative assessment of intratumoral 2-[18F]FDG metabolic spatial distribution in hypermetabolic pulmonary lesions in PET/CT

Jiang

Xue

Lin

et al. 2022

Quant Imaging Med Surg

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Background: The purpose of this study was to evaluate the value of quantitative assessment of intratumoral 2-deoxy-2-[ 18 F]fluoro-D-glucose (2-[ 18 F]FDG) metabolic spatial distribution (Q-FMSD) in differentiating pulmonary lesions with high 2-[ 18 F]FDG uptake. Methods:In this retrospective study, a total of 564 patients with pulmonary lesions who underwent 2-[ 18 F] FDG positron emission tomography/computed tomography (PET/CT) examination were analyzed. The maximum standard uptake value (SUVmax) of the proximal (pSUVmax) and distal (dSUVmax) regions of the lesions were measured, respectively. Then, Q-FMSD was obtained by the ratio of pSUVmax to dSUVmax.The diagnostic performance and area under receiver operating characteristic curve (AUC) were compared between Q-FMSD and conventional PET/CT methods for the diagnosis of pulmonary lesions with high 2-[ 18 F]FDG uptake.Results: The malignant tumors presented significantly higher Q-FMSD values than the benign lesions (1.11 vs. 0.94, P<0.001), which indicated that the 2-[ 18 F]FDG uptake in the proximal region was significantly higher than that of distal region in malignant lesions when compared with benign ones. For distinguishing hypermetabolic pulmonary malignant and benign lesions, the sensitivity, specificity and accuracy of Q-FMSD were 96.9%, 83.2% and 92.7%, respectively. Compared with other traditional methods, Q-FMSD presented significantly higher specificity than visual PET/CT (61.8%, P<0.001), retention index (RI) (33.8%, P<0.001) and SUVmax (11.0%, P<0.001). The AUC of Q-FMSD was 0.920, which was obviously larger than that of the SUVmax (0.587, P<0.001), RI (0.701, P<0.001), and visual PET/CT (0.781, P<0.001).Conclusions: Q-FMSD provides a simply and quantitative indicator for differentiating hypermetabolic pulmonary lesions with higher diagnostic performance than conventional PET/CT methods. Therefore, Q-FMSD should be recommended as a new promising marker to improve the diagnostic performance of hypermetabolic pulmonary lesions in clinical practice.

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The application of PET/CT with 18F-FDG in the differential diagnosis of lung solitary lesions

Afonin

Glukhareva

Смоленов

et al. 2022

Issled. prakt. med. (Print)

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Purpose of the study. The study was aimed to investigate the effectiveness of PET / CT with 18 fluoro‑2 deoxy-D-glucose (18F-FDG) in the differential diagnosis of focal lung neoplasms.Materials and methods. Patients (n = 108) with newly diagnosed lung focal lesions were enrolled in the study. All patients underwent PET / CT with 18fluoro‑2deoxy-D-glucose in the "whole body" mode in accordance with the standard protocol. The next step was surgical treatment with morphological verification. According to the results of the morphological conclusion, malignant neoplasm was not diagnosed in 11 (10.2 %) patients, while post-inflammatory changes were detected in 7 patients (SUVmax from 2.3 to 15.15), hamartoma was verified in 3 patients (SUVmax from 1.1 to 4.2) and anthracosis was detected in 1 patient.Results. The median radiopharmaceutical accumulation (SUVmax) was 6.0 (ICR 3.9–8.4, n = 108). In turn, in patients with diagnosed lung cancer this indicator was 7.0 (ICR 5.8–10.9, n = 60), in patients with metastatic lesions 4.3 (ICR 2.5–7.1, n = 37). The threshold for SUVmax was 5.4 for the detection of malignant tumors. PET/CT with 18F-FDG demonstrated high data variability regarding the size of lung focal lesion. An error within 35 % was observed in 76 % of cases, underestimating small lesions (up to 40 mm) but overestimating the major neoplasms. Application of a linear model for adjustment of neoplasm size assessment allows to estimate the actual size of neoplasms with parameters 5.862 + 0,817 × х (х – PET / CT size) in 84.5 % of cases with an error of 50 %. The optimal diagnosing size for metastatic lesions is in the range between 16.4 and 19 mm.Conclusion. Taken together the results of the study show that PET / CT with 18F-FDG gives a relatively accurate estimation of the tumor size. Application of the linear model corrects a radiological size measurements and helps to predict an actual size of a neoplasm in 84.5 % of cases with an error of 50 %. The prospective threshold for SUVmax was at least 5.4 for the detection of malignant neoplasms.

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Characterization of 18F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake

Cited by 3 publications

References 30 publications

18F-FDG distribution pattern improves the diagnostic accuracy of single pulmonary solid nodule

18F-FDG distribution pattern improves the diagnostic accuracy of single pulmonary solid nodule

Quantitative assessment of intratumoral 2-[18F]FDG metabolic spatial distribution in hypermetabolic pulmonary lesions in PET/CT

The application of PET/CT with 18F-FDG in the differential diagnosis of lung solitary lesions

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