FDG Positron Emission Tomography in the Diagnosis of Peripheral Pulmonary Focal Lesions

Positron emission tomography (PET) using fluoride-18-marked fluoride deoxyglucose (FDG) represents a metabolically based imaging technique capable of providing information on the potential malignancy of peripheral pulmonary focal lesions. In the present prospective study, we investigated the effectiveness of FDG-PET in determining the dignities of 67 such lesions in 35 patients. Findings of FDG-PET were compared with those of computed tomography (CT), as well as with surgical and histological reports, and the value of FDG-PET as a diagnostic method evaluated. FDG-PET correctly identified 38 lesions as positive for malignancy, 18 correctly as negative, 7 incorrectly as negative, and 4 incorrectly as positive. Based on lesions, this yields a sensitivity of 84.4 % and a specificity of 81.8 %. All malignant focal lesions with a diameter of over 1.2 cm were correctly identified (sensitivity: 100 %). In cases of intense FDG uptake, differentiation between a primary lesion, a metastasis, and an acute inflammation is often not possible.

Key words:

Positron emission tomography - Pulmonary focal lesion - Pulmonary metastasis - Fluoride-18 marked fluoride deoxyglucose - FDG-PET

References

• 1 Bury T, Dowlati A, Paulus P. et al . Evaluation of the solitary pulmonary nodule by positron emission tomography imaging.  Eur Respir J.. 1996;  9 410-4
• 2 Dewan N A, Gupta N C, Redepenning L S. et al . Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules: potential role in evaluation and management.  Chest.. 1993;  104 997-1002
• 3 Gupta N C, Frank A R, Dewan N A. et al . Solitary pulmonary nodules: detection of malignancy with PET with 2-[F-18]-fluoro-2deoxy-D-glucose.  Radiology.. 1992;  184 441-4
• 4 Knight S B, Delbeke D, Stewart J R. et al . Evaluation of pulmonary lesions with FDG-PET.  Chest.. 1996;  109 982-8
• 5 Rege S D, Hoh C K, Glaspy J A. et al . Imaging pulmonary mass lesions with Whole-body positron emission tomography and fluoro-deoxy-glucose.  Cancer.. 1993;  72 82-90
• 6 Hawkins R A, Hoh C, Glaspy J. et al . Positron emission tomography scanning in cancer.  Cancer Invest.. 1994;  12 74-87
• 7 Trampert L, Holle L H, Berberich R. et al . FDG beim primären Staging von Lungentumoren.  Nucl-Med.. 1995;  34 79-86
• 8 Storck M, Grimmel S, Henrich M M. et al . Diagnostic value of 18-FDG-PET in patients with lung cancer.  Z Herz-, Thorax-, Gefäßchir.. 1994;  8 126-30
• 9 Knopp M V, Bischoff H, Lorenz W J. et al . PET imaging of lung tumors and mediastinal lymphomas.  Nucl Med Biol.. 1994;  21 749-57
• 10 Knopp M V, Bischoff H, Oberdorfer F. et al . Positronenemissionstomographie des Thorax - Derzeitiger klinischer Stellenwert.  Radiologe.. 1992;  32 290-5
• 11 Schönberger J A, Stollfuß J C, Port M. et al . Association of glucose-transporter 1 gene (glut-1) activation to FDG-uptake in human pancreatic adenocarcinoma.  Eur J Nucl Med.. 1994;  21 737 (Abstract)
• 12 Rhodes C G, Hughes J MB. Pulmonary studies using positron emission tomography.  Eur Respir J.. 1995;  8 1001-17
• 13 Kubota K, Matsuzawa T, Fujiwara T. et al . Differential diagnosis of lung tumor with positron emission tomography: a prospective study.  J Nucl Med.. 1990;  31 1927-33
• 14 Naresh A, Dewan M D, Naresh C. et al . Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules.  Chest.. 1993;  104 997-1001