Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, Korea.
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Radiol. 2019 Aug;20(8):1293-1299. doi: 10.3348/kjr.2018.0843.
The purpose of this study was to evaluate the diagnostic performance of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for chronic empyema-associated malignancy (CEAM).
We retrospectively reviewed the ¹⁸F-FDG PET/CT images of 33 patients with chronic empyema, and analyzed the following findings: 1) shape of the empyema cavity, 2) presence of fistula, 3) maximum standardized uptake value (SUV) of the empyema cavity, 4) uptake pattern of the empyema cavity, 5) presence of a protruding soft tissue mass within the empyema cavity, and 6) involvement of adjacent structures. Final diagnosis was determined based on histopathology or clinical follow-up for at least 6 months. The abovementioned findings were compared between the ¹⁸F-FDG PET/CT images of CEAM and chronic empyema. A receiver operating characteristic (ROC) analysis was also performed.
Six lesions were histopathologically proven as malignant; there were three cases of diffuse large B-cell lymphoma, two of squamous cell carcinoma, and one of poorly differentiated carcinoma. Maximum SUV within the empyema cavity ( < 0.001) presence of a protruding soft tissue mass ( = 0.002), and involvement of the adjacent structures ( < 0.001) were significantly different between the CEAM and chronic empyema images. The maximum SUV exhibited the highest diagnostic performance, with the highest specificity (96.3%, 26/27), positive predictive value (85.7%, 6/7), and accuracy (97.0%, 32/33) among all criteria. On ROC analysis, the area under the curve of maximum SUV was 0.994.
¹⁸F-FDG PET/CT can be useful for diagnosing CEAM in patients with chronic empyema. The maximum SUV within the empyema cavity is the most accurate ¹⁸F-FDG PET/CT diagnostic criterion for CEAM.
本研究旨在评估 ¹⁸F-氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（¹⁸F-FDG PET/CT）对慢性脓胸相关恶性肿瘤（CEAM）的诊断性能。
我们回顾性分析了 33 例慢性脓胸患者的 ¹⁸F-FDG PET/CT 图像，并分析了以下发现：1）脓腔形状，2）瘘管存在，3）脓腔最大标准化摄取值（SUV），4）脓腔摄取模式，5）脓腔内突出的软组织肿块，以及 6）邻近结构受累。最终诊断基于组织病理学或至少 6 个月的临床随访。比较了 CEAM 和慢性脓胸的 ¹⁸F-FDG PET/CT 图像的上述发现。还进行了受试者工作特征（ROC）分析。
6 个病变经组织病理学证实为恶性；弥漫性大 B 细胞淋巴瘤 3 例，鳞状细胞癌 2 例，低分化癌 1 例。脓腔内最大 SUV（<0.001）、存在突出的软组织肿块（=0.002）和邻近结构受累在 CEAM 和慢性脓胸图像之间有显著差异。最大 SUV 的诊断性能最高，特异性（96.3%，26/27）、阳性预测值（85.7%，6/7）和准确性（97.0%，32/33）最高。在 ROC 分析中，最大 SUV 的曲线下面积为 0.994。
¹⁸F-FDG PET/CT 可用于诊断慢性脓胸中的 CEAM。脓腔内最大 SUV 是诊断 CEAM 的最准确的 ¹⁸F-FDG PET/CT 诊断标准。
