Allen-Auerbach Martin, Yeom Kristen, Park John, Phelps Michael, Czernin Johannes
Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Center, UCLA David Geffen School of Medicine, Los Angeles, California, USA.
J Nucl Med. 2006 Feb;47(2):298-301.
The incidence of malignancy associated with subcentimeter pulmonary nodules (micronodules) in patients with malignant disease has been reported to be as high as 58%. Thus, detection of small lung nodules is important for appropriate staging of lung cancer. Because of respiratory motion, small parenchymal lung lesions can be missed on CT acquired during shallow breathing. Micronodules are usually too small to be characterized reliably with 18F-FDG PET. We aimed to determine the incidence of missed pulmonary micronodules on PET/CT studies acquired during shallow breathing.
The study included 142 consecutive cancer patients (62 male and 80 female; mean age, 54 y) who underwent whole-body PET/CT during shallow breathing and breath-hold CT of the chest during maximal inspiration. CT findings were reviewed independently, and noncalcified nodules missed on the shallow-breathing scan were evaluated for size, location, and metabolic activity.
Breath-hold chest CT detected an additional 125 parenchymal lung nodules (mean size, 3.4 +/- 1.6 mm; range, 1-9 mm) in 48 (34%) of the 142 patients. In these patients, 3 nodules, on average, were missed during shallow breathing. In 18 patients (13%), micronodules were identified exclusively on breath-hold images. None of the missed nodules demonstrated 18F-FDG uptake.
Acquisition of standard PET/CT chest images during shallow breathing is inadequate for comprehensive cancer staging.
据报道，恶性疾病患者中与亚厘米级肺结节（微小结节）相关的恶性肿瘤发生率高达58%。因此，检测小肺结节对于肺癌的准确分期很重要。由于呼吸运动，在浅呼吸时采集的CT上可能会遗漏小的肺实质病变。微小结节通常太小，无法通过18F-FDG PET可靠地进行特征描述。我们旨在确定在浅呼吸时采集的PET/CT研究中遗漏肺微小结节的发生率。
该研究纳入了142例连续的癌症患者（62例男性和80例女性；平均年龄54岁），这些患者在浅呼吸时接受了全身PET/CT检查，并在最大吸气时进行了胸部屏气CT检查。独立复查CT结果，并对浅呼吸扫描中遗漏的非钙化结节的大小、位置和代谢活性进行评估。
屏气胸部CT在142例患者中的48例（34%）中额外检测到125个肺实质结节（平均大小3.4±1.6 mm；范围1-9 mm）。在这些患者中，浅呼吸时平均遗漏3个结节。在18例患者（13%）中，微小结节仅在屏气图像上被识别。所有遗漏的结节均未显示18F-FDG摄取。
在浅呼吸时采集标准的PET/CT胸部图像不足以进行全面的癌症分期。
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