Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
Eur Radiol. 2020 Mar;30(3):1759-1769. doi: 10.1007/s00330-019-06463-7. Epub 2019 Nov 14.
To examine whether the texture analysis of dual-time-point (DTP) F-18-fluorodeoxyglucose (F-FDG)-PET/CT imaging can differentiate between F-FDG-avid benign and malignant pulmonary lesions.
We compared standardized uptake value (SUV)-related (SUVmax [g/ml] and SUVmean [g/ml]), volumetric (metabolic tumor volume [MTV] [cm] and total lesion glycolysis [TLG] [g]), and texture (entropy, homogeneity, dissimilarity, intensity variability [IV], size-zone variability [SZV], and zone percentage [ZP]) (MTV ≥ 5.0 cm and SUV ≥ 2.5 g/ml) parameters between 13 benign and 46 malignant lesions using the Mann-Whitney U test. Diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis. Stepwise logistic regression analysis was performed to identify and use the independent variables that correctly differentiate between benign and malignant lesions.
Malignant pulmonary lesions showed significantly higher SUVmax, SUVmean, MTV, TLG, entropy, dissimilarity, IV, and SZV and significantly lower homogeneity and ZP than benign pulmonary lesions (all p < 0.05) in both early and delayed images. Their areas under the ROC curves (AUCs) ranged between 0.69 and 0.94, and diagnostic accuracies between 64.4% and 93.2%. Entropy-early (p = 0.014), SUVmean-delay (p = 0.039), and dissimilarity-delay (p = 0.027) were independent parameters, and combined use of them yielded the highest AUC (0.98) with 100% sensitivity (46/46), 84.6% specificity (11/13), and 96.7% (57/59) accuracy for distinguishing between benign and malignant lesions.
The individual early and delayed SUV-related, volumetric, and texture parameters showed a wide range of accuracy. Combined use of independent parameters extracted from DTP imaging might yield a high diagnostic accuracy with balanced sensitivity and specificity to differentiate between benign and malignant F-FDG-avid pulmonary lesions.
• Malignant pulmonary lesions showed significantly higher SUV-related (SUVmax and SUVmean) and volumetric (MTV and TLG) parameters than benign pulmonary lesions in both early and delayed images. • Malignant pulmonary lesions showed significantly more heterogeneousF-FDG uptake than benign pulmonary lesions in both early and delayed images. • Combined use of independent parameters extracted from DTP imaging might yield a high diagnostic accuracy to differentiate between benign and malignantF-FDG-avid pulmonary lesions.
探讨双时相（DTP）F-18-氟脱氧葡萄糖（F-FDG）-PET/CT 成像的纹理分析是否能区分 F-FDG 摄取的良性和恶性肺病变。
我们比较了标准化摄取值（SUV）相关（SUVmax[g/ml]和 SUVmean[g/ml]）、容积（代谢肿瘤体积[MTV][cm]和总病变糖酵解[TLG][g]）和纹理（熵、同质性、不相似性、强度变异性[IV]、大小-区域变异性[SZV]和区域百分比[ZP]）（MTV≥5.0cm，SUV≥2.5g/ml）参数，采用 Mann-Whitney U 检验比较 13 例良性和 46 例恶性病变之间的参数。采用受试者工作特征（ROC）分析评价诊断性能。进行逐步逻辑回归分析，以确定并使用正确区分良性和恶性病变的独立变量。
恶性肺病变在早期和延迟图像中均显示出显著更高的 SUVmax、SUVmean、MTV、TLG、熵、不相似性、IV 和 SZV，以及显著更低的同质性和 ZP（均 p<0.05）。ROC 曲线下面积（AUC）在 0.69 至 0.94 之间，诊断准确性在 64.4%至 93.2%之间。早期的熵（p=0.014）、延迟的 SUVmean（p=0.039）和延迟的不相似性（p=0.027）是独立参数，联合使用这三个参数可获得最高的 AUC（0.98），同时具有 100%的敏感性（46/46）、84.6%的特异性（11/13）和 96.7%的准确性（57/59），用于区分良性和恶性病变。
个体的早期和延迟 SUV 相关、容积和纹理参数显示出广泛的准确性。联合使用从 DTP 成像中提取的独立参数可能会产生高诊断准确性，具有平衡的敏感性和特异性，以区分良性和恶性 F-FDG 摄取的肺病变。
