Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea.
Department of Nuclear Medicine, Dankook University Medical Center, Cheonan, Chungnam, Republic of Korea.
Eur Radiol. 2021 Jul;31(7):4606-4614. doi: 10.1007/s00330-021-07894-x. Epub 2021 Apr 14.
2-Deoxy-2-[F]fluoro-D-glucose ([F]FDG) positron-emission tomography/computed tomography (PET/CT) is widely used to evaluate lung nodules, although respiratory motion artefacts may occur. We investigated the value of prone position PET/CT (pPET/CT) in lung nodule evaluation compared with standard supine position PET/CT (sPET/CT).
We retrospectively reviewed 28 consecutive patients (20 men; age, 65.6 ± 12.1 years) with a lung nodule (size, 16.8 ± 5.5 mm) located below the sub-carinal level who underwent [F]FDG PET/CT in a standard supine position and additional prone position. The maximum standardised uptake value (SUV), metabolic tumour volume (MTV), difference of diaphragm position between PET and CT (DDP), Dice's similarity coefficient (DSC) and occurrence of mis-registration were analysed. The [F]FDG uptake of 20 biopsy-confirmed (15 malignant) nodules was evaluated visually.
pPET/CT yielded a significantly higher SUV, lower MTV and shorter DDP than with sPET/CT (p = 0.043, 0.007 and 0.021, respectively). Mis-registration occurred in 53.6% of cases in sPET/CT and in 28.6% of cases in pPET/CT (p = 0.092). Among the 15 patients with mis-registration in sPET/CT, 10 patients (66.7%) did not show mis-registration in pPET/CT. DSC was higher in pPET/CT than in sPET/CT in 18 out of 28 patients (64.3%). In visual analysis, malignant nodules exhibited a higher [F]FDG uptake positivity than benign nodules in pPET/CT (93.3% vs. 40.0%, p = 0.032) but not in sPET/CT (80.0% vs. 40.0%, p = 0.131).
pPET/CT reduces respiratory motion artefact and enables more-precise measurements of PET parameters.
• In prone position PET/CT, the decrease in the blurring effect caused by reduced respiratory motion resulted in a higher SUV and lower MTV in lung nodules than that with supine position PET/CT. • Prone position PET/CT was useful to interpret correctly malignant lung nodules as being positive in individual cases that had a negative result in supine position PET/CT.
2-脱氧-2-[F]氟代-D-葡萄糖([F]FDG)正电子发射断层扫描/计算机断层扫描(PET/CT)广泛用于评估肺结节，尽管可能会出现呼吸运动伪影。我们研究了俯卧位 PET/CT(pPET/CT)与标准仰卧位 PET/CT(sPET/CT)在肺结节评估中的价值。
我们回顾性分析了 28 例连续患者(20 例男性;年龄 65.6±12.1 岁)，肺结节位于隆突以下水平，在标准仰卧位和额外的俯卧位进行[F]FDG PET/CT。分析最大标准化摄取值(SUV)、代谢肿瘤体积(MTV)、PET 和 CT 之间膈肌位置差异(DDP)、Dice 相似系数(DSC)和配准错误的发生。对 20 个经活检证实的(15 个恶性)结节的[F]FDG 摄取情况进行了视觉评估。
pPET/CT 获得的 SUV 显著高于 sPET/CT，MTV 更低，DDP 更短(p=0.043，0.007 和 0.021)。在 sPET/CT 中，53.6%的病例发生配准错误，在 pPET/CT 中，28.6%的病例发生配准错误(p=0.092)。在 sPET/CT 中配准错误的 15 例患者中，10 例(66.7%)在 pPET/CT 中没有配准错误。在 28 例患者中，18 例患者的 pPET/CT 中 DSC 高于 sPET/CT(64.3%)。在视觉分析中，恶性结节在 pPET/CT 中的[F]FDG 摄取阳性率高于良性结节(93.3%比 40.0%，p=0.032)，但在 sPET/CT 中则没有(80.0%比 40.0%，p=0.131)。
pPET/CT 减少了呼吸运动伪影，使 PET 参数的测量更精确。
在俯卧位 PET/CT 中，由于呼吸运动减少导致的模糊效应降低，与仰卧位 PET/CT 相比，肺结节的 SUV 更高，MTV 更低。
俯卧位 PET/CT 有助于正确解释恶性肺结节，对于在仰卧位 PET/CT 中呈阴性的病例，俯卧位 PET/CT 可正确解释为阳性。
