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Nuklearmedizin 2015; 54(06): 247-254
DOI: 10.3413/Nukmed-0763-15-08
Original article
Schattauer GmbH

Enhancing 18F-FDG-PET/CT analysis in lung cancer patients

Is CT-CT image fusion helpful in predicting pleural involvement? A pilot studyErweiterte Analysen von 18F-FDG-PET/CT-Studien bei Patienten mit LungenkarzinomIst die CT-CT-Bildfusion hilfreich in der Vorhersage der Pleurainfiltration? Eine Pilot-Studie
A. Kapfhammer
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
,
T. Winkens
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
,
T. Lesser
2   Clinic of Thoracic and Cadiovascular Surgery, SHR Wald-Klinikum, Gera, Germany
,
A. Reissig
3   Department of Internal medicine I, Pneumology & Allergology, Jena University Hospital, Jena, Germany
4   MVZ SRH Poliklinik Gera, GmbH-MVZ I, Praxis Jena, Germany
,
M. Steinert
5   Departement of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
,
M. Freesmeyer
1   Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
› Author Affiliations
Further Information

Publication History

received: 17 August 2015

accepted in revised form: 29 September 2015

Publication Date:
31 January 2018 (online)

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Summary

Aim: To retrospectively evaluate the feasibility and value of CT-CT image fusion to assess the shift of peripheral lung cancers with/-out chest wall infiltration, comparing computed tomography acquisitions in shallow-breathing (SB-CT) and deep-inspiration breath-hold (DIBH-CT) in patients undergoing FDG-PET/ CT for lung cancer staging. Methods: Image fusion of SB-CT and DIBH-CT was performed with a multimodal workstation used for nuclear medicine fusion imaging. The distance of intrathoracic landmarks and the positional shift of tumours were measured using semitransparent overlay of both CT series. Statistical analyses were adjusted for confounders of tumour infiltration. Cutoff levels were calculated for prediction of no-/infiltration. Results: Lateral pleural recessus and diaphragm showed the largest respiratory excursions. Infiltrating lung cancers showed more limited respiratory shifts than non-infiltrating tumours. A large respiratory tumour-motility accurately predicted non-infiltration. However, the tumour shifts were limited and variable, limiting the accuracy of prediction. Conclusion: This pilot fusion study proved feasible and allowed a simple analysis of the respiratory shifts of peripheral lung tumours using CT-CT image fusion in a PET/CT setting. The calculated cutoffs were useful in predicting the exclusion of chest wall infiltration but did not accurately predict tumour infiltration. This method can provide additional qualitative information in patients with lung cancers with contact to the chest wall but unclear CT evidence of infiltration undergoing PET/CT without the need of additional investigations. Considering the small sample size investigated, further studies are necessary to verify the obtained results.

Zusammenfassung

Ziel ist die retrospektive Beurteilung des Nutzens der Bildfusion von zwei CT-Serien – CTScan in flacher Atmung (SB-CT) bzw. tiefer Inspiration (DIBH-CT) – die im Rahmen eines PET/CT-Protokolls akquiriert werden, um Unterschiede in der atemabhängigen Bewegung von peripheren Lungentumoren mit oder ohne Infiltration der Thoraxwand zu erfassen. Methoden: Die Bildfusion der SB-CTund DIBH-CT-Serien erfolgte mit Hilfe einer in der Nuklearmedizin etablierten multimodalen Workstation. Anhand der semitransparent Überlagerten CT-CT-Fusionsbilder wurden die Distanzen definierter intrathorakaler Landmarken und die Bewegung von peripheren Lungentumoren zwischen diesen Serien gemessen. Um die eigentliche Tumorbewegung von der Thoraxbewegung differenzieren zu können, erfolgten statistische Analysen zu Einflussfaktoren. Es wurden Schwellenwerte für die Vorhersage einer Infiltration bzw. Nicht-Infiltration in die Thoraxwand berechnet. Ergebnisse: Die größte atemabhängige Bewegung zeigten der laterale pleurale Recessus und die Zwerchfellkuppel. Infiltrierende Lungentumore wiesen im Vergleich zu nicht-infiltrierenden Tumoren eine verminderte Beweglichkeit auf, wobei eine große Beweglichkeit mit einem hohen positiven Vorhersagewert für die Nicht-Infiltration verbunden war. Insgesamt war die Tumorbeweglichkeit jedoch gering, was die Genauigkeit der Vorhersage limitierte. Schlussfolgerung: Die vorliegende Pilotstudie stellt eine einfache Möglichkeit vor, mit Hilfe der CT-CT-Bildfusion im Rahmen einer PET/CT-Studie die Bewegung intrathorakaler Landmarken und peripherer Lungentumore zu bestimmen. Mit Hilfe der berechneten Schwellenwerte konnte eine Infiltration der Thoraxwand sicher ausgeschlossen werden, während eine genaue Vorhersage einer Infiltration nicht möglich war. Die Methode kann bei unklaren CT-Befunden hinsichtlich einer Thoraxwandinfiltration eine hilfreiche Ergänzung im Rahmen der PET/CT-Diagnostik von Lungenkarzinomen sein. Um die Ergebnisse zu verifizieren, sind weitere Studien mit größeren Patientenzahlen notwendig.

Keywords

Respiratory tumour shift - software-assisted image fusion - bronchial carcinoma - tumour movement - pleural infiltration - CT-CT image fusion

Schlüsselwörter

Atemabhängige Tumorverschieblichkeit - Software- assistierte Bildfusion - Bronchialkarzinom - Tumorbewegung - pleurale Infiltration - CT-CT-Bild-Fusion
 

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