Impact of Dual-Time-Point F-18 FDG PET/CT in the Assessment of Pleural Effusion in Patients With Non-Small-Cell Lung Cancer

Alkhawaldeh, Khaled; Biersack, H. J.; Henke, Anna; Ezziddin, Samer

doi:10.1097/rlu.0b013e3182173823

Cited by 30 publications

(30 citation statements)

References 19 publications

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“…DP FDG-PET can improve the diagnostic accuracy in differentiating benign from malignant pleural disease and would help to avoid many unnecessary biopsies. In a retrospective study, including 61 NSCLC patients with pleural effusion, 48 all of them were submitted to total-body FDG-PET/CT imaging at 60 Ϯ 10 minutes after tracer injection, and 31 patients had second delayed imaging for the chest (at 90 Ϯ 10 minutes). In this series, the change in SUVs over time calculated with DP technique was helpful in differentiating malignant pleural disease from benign inflammatory process (sensitivity 100%, specificity 94%, and accuracy 97%).…”

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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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 Cancermentioning

confidence: 99%

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

Schillaci

2012

Seminars in Nuclear Medicine

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“…In these numerous studies, attempts have been made to qualify and quantify the impact of the length of the injection-to-scan time interval on differentiating malignant processes from benign processes. As one might expect, the findings reported amongst these various investigators have been highly variable, with some supporting the use of delayed phase and dual-time-point diagnostic 18 F-FDG PET imaging approaches [66-77,81-84,86,87,91-93,95-100,103-108,110,111,113,114,117-122,124-128,131,133,134,136,138,141,143,146,149,152,153,155,157,160-163,165,167,169], and with others not [65,78,89,90,94,101,102,109,115,116,123,129,130,132,135,137,139,140,147,148,150,151,156,158,164,166,168]. …”

Section: Discussionmentioning

confidence: 99%

18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals derived from a single-institution 18F-FDG-directed surgery experience: feasibility and quantification of 18F-FDG accumulation within 18F-FDG-avid lesions and background tissues

et al. 2014

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Background18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a well-established imaging modality for a wide variety of solid malignancies. Currently, only limited data exists regarding the utility of PET/CT imaging at very extended injection-to-scan acquisition times. The current retrospective data analysis assessed the feasibility and quantification of diagnostic 18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals.Methods18F-FDG-avid lesions (not surgically manipulated or altered during 18F-FDG-directed surgery, and visualized both on preoperative and postoperative 18F-FDG PET/CT imaging) and corresponding background tissues were assessed for 18F-FDG accumulation on same-day preoperative and postoperative 18F-FDG PET/CT imaging. Multiple patient variables and 18F-FDG-avid lesion variables were examined.ResultsFor the 32 18F-FDG-avid lesions making up the final 18F-FDG-avid lesion data set (from among 7 patients), the mean injection-to-scan times of the preoperative and postoperative 18F-FDG PET/CT scans were 73 (±3, 70-78) and 530 (±79, 413-739) minutes, respectively (P < 0.001). The preoperative and postoperative mean 18F-FDG-avid lesion SUVmax values were 7.7 (±4.0, 3.6-19.5) and 11.3 (±6.0, 4.1-29.2), respectively (P < 0.001). The preoperative and postoperative mean background SUVmax values were 2.3 (±0.6, 1.0-3.2) and 2.1 (±0.6, 1.0-3.3), respectively (P = 0.017). The preoperative and postoperative mean lesion-to-background SUVmax ratios were 3.7 (±2.3, 1.5-9.8) and 5.8 (±3.6, 1.6-16.2), respectively, (P < 0.001).Conclusions18F-FDG PET/CT oncologic imaging can be successfully performed at extended injection-to-scan acquisition time intervals of up to approximately 5 half-lives for 18F-FDG while maintaining good/adequate diagnostic image quality. The resultant increase in the 18F-FDG-avid lesion SUVmax values, decreased background SUVmax values, and increased lesion-to-background SUVmax ratios seen from preoperative to postoperative 18F-FDG PET/CT imaging have great potential for allowing for the integrated, real-time use of 18F-FDG PET/CT imaging in conjunction with 18F-FDG-directed interventional radiology biopsy and ablation procedures and 18F-FDG-directed surgical procedures, as well as have far-reaching impact on potentially re-shaping future thinking regarding the “most optimal” injection-to-scan acquisition time interval for all routine diagnostic 18F-FDG PET/CT oncologic imaging.

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“…81 As stated earlier, it has been reported that dualtime point 18 F-FDG-PET can provide better discrimination of benign and malignant lung nodules and pleural changes when compared with that using structural imaging. 72,82 Thus, FDG-PET might have some role in pneumoconiosis diagnostic or prognostic monitoring, but much more clinical evaluation is required.…”

Section: Nononcologic Applicationsmentioning

confidence: 99%

PET/MRI and PET/CT in Lung Lesions and Thoracic Malignancies

Flechsig

Mehndiratta

Haberkorn

et al. 2015

Seminars in Nuclear Medicine

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Impact of Dual-Time-Point F-18 FDG PET/CT in the Assessment of Pleural Effusion in Patients With Non-Small-Cell Lung Cancer

Abstract: Dual-time-point F-18 FDG PET can improve the diagnostic accuracy in differentiating benign from malignant pleural disease, with high sensitivity and good specificity.

Cited by 30 publications

References 19 publications

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

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

18F-FDG PET/CT oncologic imaging at extended injection-to-scan acquisition time intervals derived from a single-institution 18F-FDG-directed surgery experience: feasibility and quantification of 18F-FDG accumulation within 18F-FDG-avid lesions and background tissues

PET/MRI and PET/CT in Lung Lesions and Thoracic Malignancies

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