Farid Karim, Poullias Xavier, Alifano Marco, Regnard Jean-Francois, Servois Vincent, Caillat-Vigneron Nadine, Petras Slavomir
aNuclear Medicine Department, AP-HP, Hotel Dieu University Hospital bFaculty of Medicine, Paris Descartes University cChest Surgery Department, AP-HP, Cochin University Hospital dRadiology Department eNuclear Medicine Department, Institut Curie, Paris, France.
Nucl Med Commun. 2015 Jul;36(7):722-7. doi: 10.1097/MNM.0000000000000311.
The aim of the study was to evaluate the effect of 2-((18)F)-fluoro-2-deoxy-D-glucose ((18)F-FDG)-PET/computed tomography (CT) respiratory-gated imaging [four-dimensional (4D)] in the metabolic evaluation of small solitary pulmonary nodules and analyze the cutoff maximum standardized uptake value (SUV(max)) of 2.5 in classifying and distinguishing benign/malignant pulmonary pathologies in 4D studies.
Thirty-two patients with pulmonary lesions measuring 2 cm or less were included during their scheduled (18)F-FDG PET/CT examinations. The whole-body PET/CT acquisition (3D) was followed by a chest-centered PET/CT (4D) study synchronized with the respiratory cycle. The SUV(max) percentage difference (%Diff SUV(max)) was calculated. The nodule size, localization, and relationships with histological/cytological findings were studied.
Fifteen nodules were 10 mm or smaller and 17 were larger than 10 mm [mean size = 12 mm (7-20)]. The mean 3D-SUV(max) was 2.5 (0.7-6.1) and the mean 4D-SUV(max) 3.2 (0.9-7.2) (P < 0.001). The mean %Diff SUV(max) was 38% for all patients (7-90), 45% in subcentimetric (7-90%) and 31% (7-75%) in supracentimetric lesions (P = NS). Histology was obtained in 23/32 (72%) cases and the pathologic benign/malignant ratio was 4/19. Malignancies were diagnosed as lung adenocarcinoma, solitary metastases, large cell lung carcinoma, and sarcoma in 13 (41%), 3 (9%), 2 (6%), and 1 (3%) case, respectively. Malignant lesions showed mean 4D-SUV(max) of 3.8 (1.2-7.2). The cutoff SUV(max) of 2.5 did not classify and distinguish between benign/malignant pulmonary pathologies, neither in 3D nor in 4D studies.
Respiratory gating improves the detectability and metabolic evaluation of solitary pulmonary nodules, mostly those that are subcentimetric. However, as expected, the cutoff SUV(max) of 2.5 does not distinguish between benign/malignant lesions in either 4D or 3D studies.
本研究旨在评估2-[(18)F]-氟-2-脱氧-D-葡萄糖[(18)F-FDG]-PET/计算机断层扫描(CT)呼吸门控成像[四维(4D)]在小的孤立性肺结节代谢评估中的作用，并分析在4D研究中2.5的截断最大标准化摄取值(SUV(max))在分类和鉴别良性/恶性肺部病变中的意义。
纳入32例肺部病变直径2 cm及以下的患者，在其计划的(18)F-FDG PET/CT检查期间进行研究。全身PET/CT采集(3D)之后，进行与呼吸周期同步的以胸部为中心的PET/CT(4D)研究。计算SUV(max)百分比差异(%Diff SUV(max))。研究结节大小、位置以及与组织学/细胞学检查结果的关系。
15个结节直径为10 mm及以下，17个结节直径大于10 mm[平均大小 = 12 mm(7 - 20)]。平均3D-SUV(max)为2.5(0.7 - 6.1)，平均4D-SUV(max)为3.2(0.9 - 7.2)(P < 0.001)。所有患者的平均%Diff SUV(max)为38%(7 - 90)，直径小于1 cm的结节为45%(7 - 90%)，直径大于1 cm的病变为31%(7 - 75%)(P = 无显著性差异)。23/32(72%)例获得了组织学结果，病理良性/恶性比例为4/19。恶性病变分别诊断为肺腺癌、孤立性转移瘤、大细胞肺癌和肉瘤，各有13例(41%)、3例(9%)、2例(6%)和1例(3%)。恶性病变的平均4D-SUV(max)为3.8(1.2 - 7.2)。在3D和4D研究中，2.5的截断SUV(max)均不能对良性/恶性肺部病变进行分类和鉴别。
呼吸门控可提高孤立性肺结节的可检测性和代谢评估，主要是对直径小于1 cm的结节。然而，正如预期的那样，在4D或3D研究中，2.5的截断SUV(max)均不能区分良性/恶性病变。
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