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Evaluation of Dual–Time-Point ¹⁸F-FDG PET for Staging in Patients with Lung Cancer

¹ Department of Respiratory Medicine, University of Fukui, Fukui, Japan; ² Third Department of Internal Medicine, University of Fukui, Fukui, Japan; ³ Department of Thoracic Surgery, University of Fukui, Fukui, Japan; and ⁴ Biochemical Imaging Reserch Center, University of Fukui, Fukui, Japan

View larger version (17K): [in this window] [in a new window]   FIGURE 1.  Correlation between SUV levels of all metastases and primary tumors in PET of lung cancer patients: early imaging (y = 0.523x + 2.123; r = 0.525) (A); delayed imaging (y = 0.551x + 2.542; r = 0.549) (B); and RI SUV (y = 0.829x + 4.667; r = 0.783) (C). Using RI SUV results of 95% prediction interval (broken line), upper linear approximation becomes y = 1.534x + 6.417 and lower linear approximation becomes y = 0.426x + 0.886 (straight pink lines). We indicated yellow area (0.5–2 times RI SUV of primary tumors) for deciding on metastatic lesions.

View larger version (12K): [in this window] [in a new window]   FIGURE 2.  Correlation between highest SUV levels of all metastases and primary tumors in PET of lung cancer patients: early imaging (y = 0.59x + 2.751; r = 0.521) (A); delayed imaging (y = 0.605x + 3.569; r = 0.549) (B); and RI SUV (y = 0.904x + 7.619; r = 0.846) (C).

View larger version (10K): [in this window] [in a new window]   FIGURE 3.  Comparison of SUV level (early and delayed) and RI SUV ratio of primary lesion and remote site (blue = metastatic uptake; red = nonmetastatic uptake): early imaging (A), delayed imaging (B), and RI SUV (C). In cases in which PET-positive findings are defined as yellow area (0.5–2 times RI SUV of primary tumors), uptakes of metastatic and nonmetastatic lesions are distinguishable.

View larger version (103K): [in this window] [in a new window]   FIGURE 4.  Representative case of adenocarcinoma and mediastinal lymph node metastasis (lymph node 7) in subcarinal area: chest CT (A), early imaging (B), and delayed imaging (C). CT images show nodule in right lung with no significant mediastinal lymph node swelling. Early imaging shows strong accumulation in nodule and faint accumulation in lymph node 7. PET shows increased uptake in lung nodule (early SUV = 6.85, delayed SUV = 10.01, RI SUV = 46.1%) and uptake in lymph node 7 (early SUV = 3.49, delayed SUV = 5.08, RI SUV = 45.6%).

View larger version (93K): [in this window] [in a new window]   FIGURE 5.  Representative case of adenocarcinoma and sarcoid reaction of mediastinal lymph node swelling: chest CT (A), early imaging (B), and delayed imaging (C). PET showed 18F-FDG uptake in primary tumor (early SUV = 1.81, delayed SUV = 2.02) (arrows) and focal uptake in mediastinal lymph nodes (lymph node 3: early SUV = 2.91, delayed SUV = 4.2; lymph node 7: early SUV = 3.89, delayed SUV = 5.086). RI SUV in primary tumor was 11.6%; however, RI SUVs in these lymph nodes were much higher (30.8%–44.3%). These nodal uptakes were confirmed at surgery as sarcoid reaction.