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¹⁸F-FDG Accumulation with PET for Differentiation Between Benign and Malignant Lesions in the Thorax

¹ Third Department of Internal Medicine, Fukui Medical University, Fukui, Japan
² Department of Radiology, Fukui Medical University, Fukui, Japan
³ Department of Fundamental Nursing, Fukui Medical University, Fukui, Japan
⁴ Second Department of Surgery, Fukui Medical University, Fukui, Japan
⁵ Biomedical Imaging Research Center, Fukui Medical University, Fukui, Japan

Recent reports have indicated the value and limitations of ¹⁸F-FDG PET and ²⁰¹Tl SPECT for determination of malignancy. We prospectively assessed and compared the usefulness of these scintigraphic examinations as well as ¹⁸F-FDG PET delayed imaging for the evaluation of thoracic abnormalities. Methods: Eighty patients with thoracic nodular lesions seen on chest CT images were examined using early and delayed ¹⁸F-FDG PET and ²⁰¹Tl-SPECT imaging within 1 wk of each study. The results of ¹⁸F-FDG PET and ²⁰¹Tl SPECT were evaluated and compared with the histopathologic diagnosis. Results: Fifty of the lesions were histologically confirmed to be malignant, whereas 30 were benign. On ¹⁸F-FDG PET, all malignant lesions showed higher standardized uptake value (SUV) levels at 3 than at 1 h, and benign lesions revealed the opposite results. Correlations were seen between ¹⁸F-FDG PET imaging and the degree of cell differentiation in malignant tumors. No significant difference in accuracy was found between ¹⁸F-FDG PET single-time-point imaging and ²⁰¹Tl SPECT for the differentiation of malignant and benign thoracic lesions. However, the retention index (RI) of ¹⁸F-FDG PET (RI-SUV) significantly improved the accuracy of thoracic lesion diagnosis. Furthermore, ¹⁸F-FDG PET delayed imaging measuring RI-SUV metastasis was useful for diagnosing nodal involvement and it improved the specificity of mediastinal staging. Conclusion: No significant difference was found between ¹⁸F-FDG PET single-time-point imaging and ²⁰¹Tl SPECT for the differentiation of malignant and benign thoracic lesions. The RI calculated by ¹⁸F-FDG PET delayed imaging provided more accurate diagnoses of lung cancer.

Key Words: ¹⁸F-FDG PET • ²⁰¹Tl SPECT • retention index • lung cancer • nodal staging

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