Hong Cheng, Hou Peng, Chen Hai-Ming, Zhong Kai-Xiang, Guo Wen-Liang, Lin Jie-Long, Wu Xiao-Feng, Lei Yong-Xia, Jia Qiong, Liu Chun-Li, Li Shi-Yue, Wang Xin-Lu
State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510010, China.
Department of Nuclear Medicine, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Road, Guangzhou, 510010, China.
Eur J Nucl Med Mol Imaging. 2022 Oct;49(12):4109-4121. doi: 10.1007/s00259-022-05851-4. Epub 2022 Jun 23.
To evaluate the diagnostic accuracy of computed tomography pulmonary angiography (CTPA) and F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) for pulmonary artery (PA) masses.
Of 2889 patients with PA filling defects of PA on CTPA, 79 consecutive patients suspicious for PA malignancy who subsequently underwent F-FDG PET/CT were enrolled. All masses were diagnosed on the basis of pathological findings or clinical imaging follow-up. For each mass, morphological CT signs, standardized uptake value (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on F-FDG PET/CT were used as diagnostic markers.
Expansive growth, irregular margin, invasion, CT contrast uptake, and wall eclipse sign were strongly associated with the malignant nature of masses. The coexistence of at least 5 CT signs perfectly identified malignant masses, whereas the detection of no more than 4 CT signs did not accurately discriminate between the natures of masses. Mean SUVmax, SUVmean, MTV, and TLG values were significantly higher in malignant masses compared to those in benign masses. The diagnostic accuracy of F-FDG PET/CT parameters (SUV, MTV, and TLG) was excellent in detecting malignant masses. Among patients with 3 or 4 pathological CT signs, SUVmax > 3.4 significantly increased the identification of malignancies.
CTPA is a useful imaging modality for diagnosing PA masses, especially when at least 5 abnormal CT signs are identified. Similarly, F-FDG PET/CT accurately identified malignant masses and provided additional valuable information on diagnostic uncertainties after CTPA.
评估计算机断层扫描肺动脉造影（CTPA）和氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）对肺动脉（PA）肿块的诊断准确性。
在2889例CTPA显示PA充盈缺损的患者中，连续纳入79例怀疑PA恶性肿瘤并随后接受F-FDG PET/CT检查的患者。所有肿块均根据病理结果或临床影像随访进行诊断。对于每个肿块，F-FDG PET/CT上的形态学CT征象、标准化摄取值（SUVmax和SUVmean）、代谢肿瘤体积（MTV）和总病变糖酵解（TLG）用作诊断标志物。
膨胀性生长、边缘不规则、侵袭、CT对比剂摄取和壁缺损征与肿块的恶性性质密切相关。至少5个CT征象同时存在可完美识别恶性肿块，而不超过4个CT征象则不能准确区分肿块的性质。恶性肿块的平均SUVmax、SUVmean、MTV和TLG值显著高于良性肿块。F-FDG PET/CT参数（SUV、MTV和TLG）在检测恶性肿块方面诊断准确性极佳。在具有3或4个病理CT征象的患者中，SUVmax > 3.4显著提高了对恶性肿瘤的识别率。
CTPA是诊断PA肿块的一种有用的成像方式，尤其是在识别出至少5个异常CT征象时。同样，F-FDG PET/CT能准确识别恶性肿块，并在CTPA后为诊断不确定性提供额外有价值的信息。
