Article

Total lesion glycolysis as the best F-18-FDG PET/CT parameter in differentiating intermediate-high risk adrenal incidentaloma

Nuclear Medicine Communications (Impact Factor: 1.67). 03/2014; 35(6). DOI: 10.1097/MNM.0000000000000101
Source: PubMed

ABSTRACT

Characterization of intermediate-high risk adrenal incidentaloma (AI) is important because biopsy or surgery should be performed to confirm the malignancy. We investigated which parameters of F-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) had an additive role in distinguishing malignancies in patients with incidental adrenal masses of intermediate-high risk.
From January 2008 to July 2013, 52 patients with a pathologically proven diagnosis of AI were retrospectively enrolled (age=56.4±12.7 years, M : F=34 : 18; benign : malignant=14 : 38). Volumetric parameters were size and volume according to combined CT, and metabolic parameters were peak standardized uptake value (SUVpeak), maximum SUV (SUVmax), mean SUV (SUVmean), and tumor-to-background ratio (SUVmax of adrenal mass/SUVmean of liver). Metabolovolumetric parameters of metabolic tumor volume and total lesion glycolysis (TLG, SUVmean×metabolic tumor volume) were also included and compared with the diagnostic value. In addition, the highest diagnostic parameters among volumetric and metabolic parameters were combined and compared in terms of diagnostic accuracy.
Compared with benign adrenal adenoma, malignant lesions showed significantly higher values of all F-FDG PET/CT volumetric, metabolic, and metabolovolumetric parameters. Size showed the highest area under the curve (AUC) of 0.759 among the volumetric parameters, and SUVpeak showed the highest AUC of 0.853 among the metabolic parameters. Among all the PET/CT parameters, TLG showed the highest AUC of 0.900, with a sensitivity of 92.1% and specificity of 78.6% at a cutoff of 12.0. The combined value of size and SUVpeak showed lower diagnostic value than TLG.
We found that TLG showed the best result in distinguishing intermediate-high risk AI among PET/CT parameters. TLG can be a useful PET/CT parameter for differential diagnosis of AI.

Download full-text

Full-text

Available from: Gi Jeong Cheon, Apr 17, 2014
  • Source

    Preview · Article · Feb 2011 · American Journal of Roentgenology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to determine the usefulness of MRI-assisted positron emission tomography (PET) parameters provided by simultaneous (18)F-fluorocholine (FCH) PET/MRI for characterization of primary prostate cancer. Thirty patients with localized prostate cancer (mean age 69.4 ± 6.7 years) confirmed by biopsy were prospectively enrolled for simultaneous PET/MRI imaging. The patients underwent (18)F-FCH PET/MRI 1 week before undergoing total prostatectomy. Multiple parameters of diffusion-weighted MRI [minimum and mean apparent diffusion coefficient (ADCmin and ADCmean)], metabolic PET [maximum and mean standardized uptake value (SUVmax and SUVmean)], and metabolic volumetric PET [metabolic tumor volume (MTV) and uptake volume product (UVP)] were compared with laboratory, pathologic, and immunohistochemical (IHC) features of the prostate cancer specimen. PET parameters were divided into two categories as follows: volume of interest (VOI) of prostate by SUV cutoff 2.5 (SUVmax, SUVmean, MTVSUV, and UVPSUV) and MRI-assisted VOI of prostate cancer (SUVmaxMRI, SUVmeanMRI, MTVMRI, and UVPMRI). The rates of prostate cancer-positive cases identified by MRI alone, (18)F-FCH PET alone, and (18)F-FCH PET/MRI were 83.3, 80.0, and 93.3 %, respectively. Among the multiple PET/MRI parameters, MTVMRI showed fair correlation with serum prostate-specific antigen (PSA; r = 0.442, p = 0.014) and highest correlation with tumor volume (r = 0.953, p < 0.001). UVPMRI showed highest correlation with serum PSA (r = 0.531, p = 0.003), good correlation with tumor volume (r = 0.908, p < 0.001), and it was significantly associated with Gleason score (p = 0.041). High MTVMRI and UVPMRI values were significant for perineural invasion, lymphatic invasion, extracapsular extension, seminal vesicle invasion, and positive B-cell lymphoma 2 (Bcl-2) expression (all p < 0.05). Simultaneous (18)F-FCH PET/MRI demonstrated a better diagnostic value for localized prostate cancer detection than each individual modality. MRI-assisted metabolic volumetric PET parameters (MTVMRI and UVPMRI) provided more accurate characterization of prostate cancer than conventional PET and MRI parameters.
    Full-text · Article · Mar 2015 · European journal of nuclear medicine and molecular imaging
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: In-pentetreotide has been used for neuroendocrine tumors expressing somatostatin receptors. Recently, (68)Ga-DOTATOC PET has been used with the advantage of high image quality. In this study, we compared quantitative indices between (111)In-pentetreotide SPECT/CT and (68)Ga-DOTATOC PET/CT. Methods: Thirteen patients diagnosed with neuroendocrine tumors were prospectively recruited. Patients underwent (111)In-pentetreotide scans with SPECT/CT and (68)Ga-DOTATOC PET/CT before treatment. The number and location of lesions were analyzed on both imaging techniques to compare lesion detectability. Additionally, the maximal uptake count of each lesion and mean uptake count of the lungs were measured on both imagings, and target-to-normal lung ratios (TNR) were calculated as quantitative indices. Results: Among 13 patients, 10 exhibited lesions with increased uptake on (111)In-pentetreotide SPECT/CT and/or (68)Ga-DOTATOC PET/CT. Scans with SPECT/CT detected 19 lesions, all of which were also detected on PET/CT. Moreover, 16 additional lesions were detected on PET/CT (6 in the liver, 9 in the pancreas and 1 in the spleen). PET/CT exhibited a significantly higher sensitivity than SPECT/CT (100 % vs. 54 %, P < 0.001). TNR was significantly higher on PET/CT than on SPECT/CT (99.9 ± 84.3 vs. 71.1 ± 114.9, P < 0.001) in spite of a significant correlation (r = 0.692, P = 0.01). Conclusion: Ga-DOTATOC PET/CT has a higher diagnostic sensitivity than (111)In-pentetreotide scans with SPECT/CT. The TNR on PET/CT is higher than that of SPECT/CT, which also suggests the higher sensitivity of PET/CT. (111)In-pentetreotide SPECT/CT should be used carefully if it is used instead of (68)Ga-DOTATOC PET/CT.
    Full-text · Article · Aug 2015
Show more