We present a systematic approach for studying positron emission tomography-computed tomography (PET/CT) 3-D virtual fly-through endoscopy and for assessing the accuracy of this technology for visualizing and detecting endobronchial lesions as a function of focal lesion morphology and activity.
Capsules designed to simulate endobronchial lesions were filled with activity and introduced into a porcine lung-heart phantom. PET/CT images were acquired, reconstructed, and volume rendered as 3-D fly-through and fly-around visualizations. Anatomical positioning of lesions seen on the 3-D-volume-rendered PET/CT images was compared to the actual position of the capsules.
Lesion size was observed to be highly sensitive to PET threshold parameter settings and careful opacity and color transfer function parameter assignment.
We have demonstrated a phantom model for studies of PET/CT 3-D virtual fly-through bronchoscopy and have applied this model for understanding the effect of PET thresholding on the visualization and detection of lesions.
[Show abstract][Hide abstract] ABSTRACT: The various techniques encompassed in the term 'Thoracic Imaging' have had a dramatic effect on the practice of respiratory medicine over the last 25 years. One of many examples is the increased precision with which lung cancer can be preoperatively staged using CT and PET imaging. The increasing sophistication of thoracic imaging tests brings many benefits, but there are caveats. This review considers a selection of techniques and contains state-of-the-art commentaries by distinguished experts on current challenges and likely future developments.
[Show abstract][Hide abstract] ABSTRACT: Recent advances in multidetector computed tomography (MDCT) technology have transformed the imaging evaluation of the trachea and bronchi. Multiplanar 2-dimensional and 3-dimensional volume reconstruction techniques, including external rendering and virtual bronchoscopy, can be generated in mere minutes, thereby complementing conventional axial CT imaging in the depiction of various central airway disease processes including airway stenoses, central airway neoplasms, and congenital airway disorders. Paired inspiratory and dynamic expiratory MDCT imaging, along with newer cine CT imaging methods, have enhanced the assessment of tracheobronchomalacia in both adults and the pediatric population. In addition, MDCT imaging plays an essential complementary role to conventional bronchoscopy, facilitating planning and guidance of bronchoscopic interventions, and providing a noninvasive method for postprocedural surveillance.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to determine the diagnostic accuracy of (18)F-FDG PET/CT bronchoscopy for the detection of regional lymph node metastases in non-small cell lung cancer (NSCLC) patients; potential differences in the maximum standardized uptake value (SUVmax), mean SUV (SUVmean), short-axis diameter, and distance to the airways when comparing true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) lymph nodes; the smallest bronchus diameter accessible by virtual bronchoscopy; and the duration from the start of the virtual (18)F-FDG PET/CT bronchoscopy viewing tool until the images were displayed.
Sixty-one consecutive NSCLC patients (mean age ± SD, 58 ± 10 y) underwent whole-body (18)F-FDG PET/CT. From these data, virtual (18)F-FDG PET/CT bronchoscopies were reconstructed. The duration from the start of the tool until the display of virtual bronchoscopy images was determined. The diagnostic accuracy of (18)F-FDG PET/CT bronchoscopy for the detection of regional lymph node metastases was evaluated on a lesion basis. Axial (18)F-FDG PET/CT scans served as the standard of reference. The SUVmax, SUVmean, short-axis diameter, and distance to the airways of regional lymph nodes were measured. Lymph nodes were classified as TP, FP, TN, and FN. The smallest bronchus diameter accessible by (18)F-FDG PET/CT bronchoscopy was measured.
The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of virtual (18)F-FDG PET/CT bronchoscopy for the detection of lymph node metastases were 76%, 87%, 85%, 79%, and 81%, respectively. The differences between the SUVmax, SUVmean, short-axis diameter, and distance to the airways of TP and FP as well as TN and FN lymph nodes were statistically significant (P < 0.05). The mean smallest diameter of accessible bronchi by (18)F-FDG PET/CT bronchoscopy was 3 mm. The mean time duration from the start of the virtual (18)F-FDG PET/CT bronchoscopy tool until the display of the images was 22 ± 7 s.
Virtual fly-through 3-dimensional (18)F-FDG PET/CT bronchoscopy yields a high diagnostic accuracy for the detection of regional lymph node metastases and has access to bronchi even in the periphery of the lung. High SUVmax, high SUVmean, large small-axis diameter, and short distance to the airways aid detection of lymph node metastases with (18)F-FDG PET/CT bronchoscopy.
Journal of Nuclear Medicine 09/2011; 52(10):1520-5. DOI:10.2967/jnumed.111.092593 · 6.16 Impact Factor
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