Application of Dynamic ¹⁸F-FDG PET/CT for Distinguishing Intrapulmonary Metastases from Synchronous Multiple Primary Lung Cancer

Abstract

It has been a big challenge to distinguish synchronous multiple primary lung cancer (sMPLC) from primary lung cancer with intrapulmonary metastases (IPM). We aimed to assess the clinical application of dynamic 18F-FDG PET/CT in patients with multiple lung cancer nodules. We enrolled patients with multiple pulmonary nodules who had undergone dynamic 18F-FDG PET/CT and divided them into sMPLC and IPM groups based on comprehensive features. The SUVmax, fitted K i value based on dynamic scanning, and corresponding maximum diameter ( D max ) from the two largest tumors were determined in each patient. We determined the absolute between-tumor difference of SU V max / D max and K i / D max ( Δ SU V max / D max ; Δ K i / D max ) and assessed the between-group differences. Further, the diagnostic accuracy was evaluated by ROC analysis and the correlation between Δ SU V max / D max and Δ K i / D max from all groups was determined. There was no significant difference for Δ SU V max / D max between the IPM and sMPLC groups, while the IPM group had a significantly higher Δ K i / D max than the sMPLC group. The AUC of Δ K i / D max for differentiating sMPLC from IPM was 0.80 (cut-off value of K i = 0.0059 , sensitivity 79%, specificity 75%, p < 0.001 ). There was a good correlation (Pearson r = 0.91 , 95% CI: 0.79-0.96, p < 0.0001 ) between Δ SU V max / D max and Δ K i / D max in the IPM group but not in the sMPLC group (Pearson r = 0.45 , p > 0.05 ). Dynamic 18F-FDG PET/CT could be a useful tool for distinguishing sMPLC from IPM. K i calculation based on Patlak graphic analysis could be more sensitive than SUVmax in discriminating IPM from sMPLC in patients with multiple lung cancer nodules.

Four-dimensional quantitative analysis using FDG-PET in clinical oncology

“…Some of these preliminary studies did not show significant differences in the contrast between malignant and benign lesions. However, Ki, a marker of FDG metabolism, seems to be more suitable for predicting tumor cellular function and aggressiveness than SUV, a static FDG uptake marker in lung and breast cancer [97][98][99][100][101][102][103][104][105]. As many PET centers have had the chance to apply their up-to-date technology for parametric FDG analysis, these preliminary results will be confirmed in many oncology areas.…”

The imaging quantification of multiple organs by dynamic 18F-FDG PET/CT in discharged COVID-19 patients: A prospective pilot study

“…Patients were asked to fast for a minimum of six hours prior to PET/CT scans. PET/CT imaging was conducted via a 112-ring digital light guide PET/CT (uMI780, United Imaging, China) according to published guidelines for PET/CT imaging 12 . Helical CT was implemented from the head to proximal thigh prior to PET procurement based on the standardized protocol.…”

Diagnostic Value of Dynamic 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (18F-FDG PET-CT) in Cervical Lymph Node Metastasis of Nasopharyngeal Cancer

“…Specifically, VOI was drawn on the aortic arch of each patient, and then input functions derived from arterial images were extracted from all dynamic PET sequences. Then, by applying the OLS linear regression method to the following Patlak equation, the tracer uptake rate K i at the voxel level could be calculated [18][19][20][21]. The specific block diagram was shown in Figure 1, and its equation was as follows: K i -Mean was defined as the average K i value at which the tracer was uptaken, and K i -Max was the K i value at which the uptake rate reached the highest value.…”