Struttura Complessa di Medicina Nucleare, Ospedale del Mare, Napoli, Italy.
Struttura Complessa di Medicina Nucleare, Ospedale San Giuseppe Moscati, Avellino, Italy.
Eur J Nucl Med Mol Imaging. 2018 Oct;45(11):1908-1914. doi: 10.1007/s00259-018-4043-y. Epub 2018 May 5.
Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT.
F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference.
In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT.
Pre-test probability of malignancy can guide the diagnostic strategy of FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary.
孤立性肺结节（SPN）的诊断是一个重要的公共卫生问题，与单独 CT 相比，正电子发射断层扫描/计算机断层扫描（PET/CT）已被证明更为有效。SPN 的术前风险分层和临床表现可能会影响诊断策略。一个相关的问题是，是否可以在 SPN 患者中实施胸部节段（s）-PET/CT。本回顾性多中心研究比较了 FDG 全身（wb）-PET/CT 与 s-PET/CT 的结果。
对 502 例按术前癌症风险分层的 F-FDG PET/CT 进行回顾性分析。将 wb-PET/CT 的胸部部分视为 s-PET/CT，并与 wb-PET/CT 进行比较。研究了临床和 PET/CT 变量，以确定 SPN 的特征，并确定可以进行 s-PET/CT 的患者。组织病理学或随访数据被用作参考。
在研究人群中，36%的患者为恶性，35%的患者为良性，29%的患者为不确定。13%的患者可检测到提示胸内和胸外病变的 FDG 摄取，3%的患者可检测到。所有 13 例胸外转移患者（n=13）均有胸内淋巴结受累，且 SPN 水平的 FDG 摄取最高（阴性预测值 100%）。与 wb-PET/CT 相比，s-PET/CT 可节省约 2/3 的 FDG 剂量、辐射暴露或扫描时间，而不会影响 PET/CT 的临床影响。
术前恶性肿瘤的可能性可指导 SPN 患者 FDG-PET/CT 的诊断策略。在低-中术前概率的患者中，可以提前计划 s-PET/CT 成像，而在高风险且有胸内淋巴结受累的患者中，需要进行 wb-PET/CT。
