Dual-Time Point FDG PET Imaging in the Evaluation of Pulmonary Nodules With Minimally Increased Metabolic Activity

Xi, Yan; Bhutani, Chirdeep; Dhurairaj, Thiruvenkatasamy; Yu, Jinpu; Dadparvar, Simin; Reddy, Swapna; Kumar, Rakesh; Yang, Hua; Alavi, Abass; Zhuang, Hongming

doi:10.1097/01.rlu.0000252457.54929.b7

Cited by 110 publications

(52 citation statements)

References 24 publications

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“…These findings are similar to those previously reported by Xiu et al, 33 whose second image acquisition occurred earlier, on average 114 minutes after tracer injection, and despite a different prevalence of granulomatous disease between the 2 study populations. In fact, sensitivity, specificity, and accuracy resulted 44%, 87%, and 72% when using the criterion of delayed SUV Ն2.5, and 81%, 87%, and 85% when applying a RI of Ͼ10%, respectively.…”

Section: Lung Cancersupporting

confidence: 82%

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Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Schillaci

2012

Seminars in Nuclear Medicine

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Positron emission tomography (PET) and positron emission tomography/computed tomography imaging with fluorodeoxyglucose (FDG) are widely used as a powerful evaluation modality in oncological nuclear medicine not only for detecting tumors but also for staging and for therapy monitoring. Nevertheless, there are numerous causes of FDG uptake in benign processes seen on PET images. In fact, the degree of FDG uptake is related to the cellular metabolic rate and the number of glucose transporters. FDG accumulation in tumors is due, in part, to an increased number of glucose transporters in malignant cells. However, FDG is not specific for neoplasms: a similar situation exists in inflammation; activated inflammatory cells demonstrate increased expression of glucose transporters. Therefore, there is growing interest in improving the specificity of FDG-PET in patients with cancer. Preliminary studies showed that in several neoplasms, the uptake of FDG continues to increase for hours after radiopharmaceutical injection, and this difference in the time course of FDG uptake could be useful to improve the accuracy of PET to distinguish benign lesions from malignant ones. Also in experimental cultures, dual-point acquisition (early at 40-60 minutes postinjection and delayed at 90-270 minutes) demonstrated that it is able to differentiate inflammatory from neoplastic tissue. In general, inflammatory tissue is expected to reduce FDG uptake as the time goes by, whereas the uptake in the neoplastic lesions is supposed to be increasing. There is evidence in the recent literature of the clinical usefulness of dual-time-point FDG-PET imaging in a wide variety of malignancies, including those of head and neck, lung, breast, gallbladder, cervix, liver, and in brain tumors. A lesion is likely to be malignant if the standard uptake value increases over time, whereas it is likely to be benign if the standard uptake value is stable or decreases. It is worth noting that in many of these studies, dual-time-point PET improved not only the specificity but also the sensitivity in assessing breast, pulmonary, liver, and other tumors because of increased lesion-to-background ratio, as a consequence of FDG washout from the surrounding normal tissues and increasing neoplastic uptake. Semin Nucl Med 42:267-280

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Section: Lung Cancersupporting

confidence: 82%

“…35 Ten publications 28,29,31,33,34,[36][37][38][39][40] fulfilled all of the inclusion criteria, with a total of 816 patients and 890 pulmonary nodules. Multiple different thresholds were used to define a pulmonary nodule as malignant between the initial and later images.…”

Section: Lung Cancermentioning

confidence: 99%

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Schillaci

2012

Seminars in Nuclear Medicine

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“…For dual-time-point imaging, the SUVmax of the initial scan was SUVmax initial and the SUVmax of the delayed scan was SUVmax delayed . The retention index (RI) represented the percent change of 18 F-FDG uptake and was calculated as follows: RI = ΔSUVmax/SUVmax initial x100%, ΔSUVmax = SUVmax delayed -SUVmax initial and RI >10% was considered as a criterion for the diagnosis of malignancy, a threshold that has been widely used in previous studies (2)(3)(4)(5). In this study, we limited metabolic tumor volume (MTV) by a fixed SUV of 2.5, a threshold that has been widely used for diagnosis in previous studies (6)(7)(8).…”

Section: F-fdg Pet-ctmentioning

confidence: 99%

Predictive value of 18F-fluorodeoxyglucose positron emission tomography - computed tomography compared to postoperative pathological findings for patients with non-small-cell lung cancer

Xue

Zheng

Guo

et al. 2014

Molecular and Clinical Oncology

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Abstract. This study was conducted to investigate the predictive value of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET-CT) in patients with non-small-cell lung cancer (NSCLC), compared to that of postoperative pathological findings, for T and N staging and the associations of the metabolic parameters of the primary tumor with histological type and differentiation. The preoperative contrast-enhanced CT and 18 F-FDG PET-CT and postoperative pathological findings of 112 NSCLC patients treated with lobectomy or pneumonectomy combined with systematic mediastinal lymphadenectomy were retrospectively reviewed. Compared to the postoperative pathological findings, the effect of contrast-enhanced CT and 18 F-FDG PET-CT on T and N staging were evaluated. The metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) of the primary tumor were measured. The associations between these metabolic parameters and histological type and differentiation were also evaluated. The differences in the accuracy in overall staging and T staging between PET-CT and contrast-enhanced CT were significant (91.1 vs. 69.6%, P=0.000; and 92.9 vs. 76.8%, P=0.000, respectively). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of regional lymph node metastasis detection were 91.7, 93.0, 86.5, 95.8 and 92.6%, respectively, with PET-CT; and 71.3, 77.2, 60.6, 84.5 and 75.2%, respectively, with contrast-enhanced CT. The SUVmax , t=4.48, P=0.000) were significantly higher for squamous cell carcinoma (SCC) compared to those for adenocarcinoma (AC). There was a positive correlation between the MTV and SUVmax of the primary tumor (Pearson's r=0.838, P=0.000). Significant differences were observed among differentiation subgroups in the SUVmax and MTV of the primary tumor for both SCC and AC. In conclusion, compared to the postoperative pathological findings, the predictive value of 18 F-FDG PET-CT for T and N staging in NSCLC was higher compared to that of contrast-enhanced CT. The FDG uptake of the primary tumor was associated with histological type and differentiation and the difference was statistically significant. Therefore, the SUVmax and MTV of the primary tumor may be valuable indices to partly predict the histological type and grade of differentiation of NSCLC.

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“…Recently, similar to the present study, Xiu et al [18] conducted a study to compare the accuracy of dual-time point and single-time FDG PET imaging in the evaluation of lung nodules with minimally increased metabolic activity. In their study, the lowest diagnostic accuracies came from the visual and single SUV analysis on the initial images and the visual and single SUV analyses on the delayed images produced increased accuracy.…”

Section: Discussionmentioning

confidence: 96%

“…However, very few study adopted the dual phase acquisition of F-18 FDG PET for the evaluation of pulmonary nodules with low F-18 FDG uptake [18].…”

mentioning

confidence: 99%

Characterization of Pulmonary Lesions with Low F-18 FDG Uptake Using Double Phase F-18 FDG PET/CT: Comparison of Visual and Quantitative Analyses

Ij¹,

Sj²,

Kim³

et al. 2009

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Background of the present study was to assess the usefulness of double phase positron emission tomography/computed tomography (peT/CT) to differentiate malignant from benign pulmonary lesions with low fluorine-18 fluorodeoxyglucose (F-18 FDG) uptake.of 218 consecutive patients who underwent double phase F-18 FDG peT/CT to evaluate pulmonary lesions found on CT, we retrospectively analyzed 30 who had focal pulmonary lesions with an sUV of <2.5. all patients underwent peT/CT of the thorax at two time points: scan 1 at 60 min and scan 2 at 120 min after the intravenous injection of 2.5 mBq F-18 FDG. The F-18 FDG peT/CT images were analyzed visually and quantitatively.of 30 evaluated nodules, 13 (43%) proved to be malignant and 17 (57%) benign. The sUV max1 (maximal sUV of early image), sUV max2 (maximal sUV of delayed image), %∆sUV max (percent change of maximal sUV), CR 1 (contrast ratio of early image), and CR 2 (contrast ratio of delayed image) of malignant pulmonary lesion were significantly higher than those of benign. However, %∆CR (percent change of contrast ratio) revealed no statistical differences. among the quantitative indices, sUV max1 , sUV max2 , and CR 2 were superior to the visual analysis for differentiation of malignant from benign pulmonary lesions. The sUV max1 , sUV max2 , and %∆sUV max were superior to %∆CR for differentiation of malignant from benign pulmonary lesions.Based on the presented results, the quantitative indices except %∆CR were higher in malignant nodules than benign pulmonary nodules. However, the diagnostic performances were similar between visual and quantitative analyses. Further studies are needed to confirm these results and improve statistical accuracy.

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Dual-Time Point FDG PET Imaging in the Evaluation of Pulmonary Nodules With Minimally Increased Metabolic Activity

Abstract: Dual-time FDG PET imaging has the potential for improving accuracy of a test in the evaluation of lung nodules with only borderline levels of increased metabolic activity.

Cited by 110 publications

References 24 publications

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Predictive value of 18F-fluorodeoxyglucose positron emission tomography - computed tomography compared to postoperative pathological findings for patients with non-small-cell lung cancer

Characterization of Pulmonary Lesions with Low F-18 FDG Uptake Using Double Phase F-18 FDG PET/CT: Comparison of Visual and Quantitative Analyses

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