F-FDG PET/CT predicts acute exacerbation in idiopathic pulmonary fibrosis after thoracic surgery.

BACKGROUND

Acute exacerbation (AE) is the most lethal postoperative complication in idiopathic pulmonary fibrosis (IPF); however, prediction before surgery is difficult. We investigated the role of F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) in predicting postoperative AE in IPF.

METHOD

Clinical data of 48 IPF patients who underwent 18F-FDG PET/CT before thoracic surgery were retrospectively analyzed. Mean and maximal standardized uptake values (SUV and SUV, respectively) were measured in the fibrotic area. Additionally, adjusted values-SUV ratio (SUVR, defined as SUV-to-liver SUV ratio), tissue fraction-corrected SUV (SUV), and SUVR (SUVR)-were calculated.

RESULTS

The mean age of the subjects was 67.8 years and 91.7% were male. After thoracic surgery, 21 (43.8%) patients experienced postoperative complications including prolonged air leakage (29.2%), death (14.6%), and AE (12.5%) within 30 days. Patients who experienced AE showed higher SUV, SUVR, SUV, and SUVR than those who did not, but other clinical parameters were not different between patients with and without AE. The SUV parameters did not differ for other complications. The SUVR (odds ratio [OR] 29.262; P = 0.030), SUV (OR 3.709; P = 0.041) and SUVR (OR 20.592; P = 0.017) were significant predicting factors for postoperative AE following a multivariate logistic regression analysis. On receiver operating characteristics curve analysis, SUVR had the largest area under the curve (0.806, P = 0.007) for predicting postoperative AE among SUV parameters.

CONCLUSIONS

Our findings suggest that F-FDG PET/CT may be useful in predicting postoperative AE in IPF patients and among SUVs, SUVR is the best parameter for predicting postoperative AE in IPF patients.