[18F]FDG-PET/CT texture analysis in thyroid incidentalomas: preliminary results

Abstract

Backgroundsignificance of incidental thyroid 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake on positron emission tomography/computed tomography (PET/CT) scans remains controversial. We aimed to evaluate the ability of [18F]FDG-PET/CT texture analysis to predict final diagnosis in thyroid incidentaloma.MethodsWe retrospectively evaluated medical records of all patients who performed a [18F]FDG-PET/CT from January 2012 to October 2016. Those patients who presented a thyroid incidentaloma described in the medical records and performed a fine needle aspiration in our institution were considered for the analysis. Cytological and/or histological results were used as reference standard to define the final diagnosis. In case of negative cytology, the nodule was considered benign. In case of non-diagnostic or inconclusive results ultrasound, follow-up and further cytology/histology were used as final diagnosis. For suspected or positive cytological result, histology was used as reference standard. PET images were segmented using a General Electric AW workstation running PET VCAR software (GE Healthcare, Waukesha, WI, USA) settled with a threshold of 40% SUVmax. LifeX software (http://www.lifexsoft.org) was used to perform texture analysis. Statistical analysis was performed with R package (https://www.r-project.org).ResultsWe identified 55 patients with incidental thyroid [18F]FDG uptake. Five patients were excluded from the analysis because a final diagnosis was not available. Thirty-two out of 50 patients had benign nodules while in 18/50 cases a malignancy (primary thyroid cancer = 15, metastases = 3) was diagnosed. Conventional PET parameters and histogram-based features were calculated for all 50 patients, while other matrices-based features were available for 28/50 patients. SUVmax and skewness resulted significantly different in benign and malignant nodules (p = 0.01 and = 0.02, respectively). Using ROC analysis, seven features were identified as potential predictors. Among all the textural features tested, skewness showed the best area under the curve (= 0.66). SUV-based parameters resulted in the highest specificity while MTV, TLG, skewness and kurtosis, as well as correlationGLCM resulted better in sensitivity.Conclusions[18F]FDG-PET/CT texture analysis seems to be a promising approach to stratify the patients with thyroid incidentaloma identified on PET scans, with respect to the risk of the diagnosis of a malignant thyroid nodule and thus, could refine the selection of the patients to be referred for cytology.Electronic supplementary materialThe online version of this article (10.1186/s41824-017-0009-8) contains supplementary material, which is available to authorized users.

A Systematic Review of PET Textural Analysis and Radiomics in Cancer

“…We collected 47 publications on “Other” cancer types. This category included studies on gastrointestinal (11) [ 257 , 258 , 259 , 260 , 261 , 262 , 263 , 264 , 265 , 266 , 267 ], pancreatic (8) [ 268 , 269 , 270 , 271 , 272 , 273 , 274 , 275 ], sarcoma (8) [ 276 , 277 , 278 , 279 , 280 , 281 , 282 , 283 ], neuroendocrine (5) [ 284 , 285 , 286 , 287 , 288 ], prostate (4) [ 289 , 290 , 291 , 292 ], thyroid (3) [ 293 , 294 , 295 ], thymic (2) [ 296 , 297 ], skin (2) [ 298 , 299 ], liver (2) [ 300 , 301 ], and renal carcinomas (1) [ 302 ]. The average number of patients was 84 (median = 70, range, 26–214) and the average number of textural features extracted was 29 (median = 17, ...…”

Differentiating gastric cancer and gastric lymphoma using texture analysis (TA) of positron emission tomography (PET)

“…Another PET TA of 50 patients with thyroid incidentaloma revealed that the skewness of thyroid malignancies was significantly lower than that of benign nodules, while kurtosis was not significantly different between groups. [ 35 ] In contrast, kurtosis and skewness were found to have no significant differences between the baseline and intra-treatment PET images in patients with non-small cell lung cancer. [ 36 ] In PET TA, due to the diversity of the tumor biological characteristics, especially the diversity of cellular FDG uptake, the application value of kurtosis and skewness fluctuates according to the tumor being studied.…”

Support Vector Machine Parameter Optimization for Positron Emission Tomography Images for Estimation of Recurrent Laryngeal Nerve Injury with Thyroid Nodules

“…When SUV max � 4.56 was undertaken as the best critical point for diagnosis, the sensitivity and specificity of SUV max for diagnosing the benign and malignant nodules was 81.33% and 76.18%, respectively. e results of Sollini et al [17] showed that the SUV max critical value for the diagnosis of benign and malignant TN was 5.0, and the corresponding diagnostic sensitivity and specificity was 60% and 91%, respectively. us, the sensitivity of SUV max in the diagnosis of the benign and malignant nodules had been significantly improved, but its specificity was decreased to a certain degree.…”