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(18)F-FDG PET versus (18)F-FDG PET/CT for adrenal gland lesion characterization: a comparison of diagnostic efficacy in lung cancer patients.

Sung YM, Lee KS, Kim BT, Choi JY, Chung MJ, Shim YM, Yi CA, Kim TS - Korean J Radiol (2008 Jan-Feb)

Bottom Line: PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake.The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test.Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, Korea.

ABSTRACT

Objective: The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone.

Materials and methods: Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test.

Results: Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively).

Conclusion: The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.

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Related in: MedlinePlus

A false-negative interpretation with the use of PET only, but a true positive interpretation with the use of integrated PET/CT in a 33-year-old woman with an adrenal metastasis confirmed by clinical follow-up. The patient also had adenocarcinoma in the right lower lobe of the lung.A. PET demonstrates increased uptake (arrow) in the left adrenal gland area with a maximum SUV of 3.5. Uptake was regarded as benign by PET alone because the uptake was interpreted as left kidney uptake.B. An unenhanced CT scan shows an 11-mm-sized nodule (arrow) in the left adrenal gland.C. On an integrated PET/CT image, the uptake (arrow) falls on the left adrenal gland, thus enabling a correct interpretation as positive uptake (uptake extent is equal to that of liver).D. The nodule (arrow) in the left adrenal gland shows an increase in size at a 7-month follow-up CT. Hepatic metastasis is also noted (arrowhead).
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Figure 4: A false-negative interpretation with the use of PET only, but a true positive interpretation with the use of integrated PET/CT in a 33-year-old woman with an adrenal metastasis confirmed by clinical follow-up. The patient also had adenocarcinoma in the right lower lobe of the lung.A. PET demonstrates increased uptake (arrow) in the left adrenal gland area with a maximum SUV of 3.5. Uptake was regarded as benign by PET alone because the uptake was interpreted as left kidney uptake.B. An unenhanced CT scan shows an 11-mm-sized nodule (arrow) in the left adrenal gland.C. On an integrated PET/CT image, the uptake (arrow) falls on the left adrenal gland, thus enabling a correct interpretation as positive uptake (uptake extent is equal to that of liver).D. The nodule (arrow) in the left adrenal gland shows an increase in size at a 7-month follow-up CT. Hepatic metastasis is also noted (arrowhead).

Mentions: PET and PET/CT made six discordant interpretations. In four cases, PET produced a false-positive result because FDG uptake in the liver or lymph nodes was misinterpreted as adrenal uptake. In one case in which a patient underwent FDG PET/CT twice with a two-month interval, false-negative results we obtained by PET and by PET/CT at the initial study. However, at the follow-up study, PET continued to show a false-negative result, but PET/CT produced a true-positive result. In this particular case, the adrenal lesion was 6 mm in diameter as determined at the initial study and 11 mm in diameter as determined at the second study. In the remaining single case, a nodule was regarded as benign by PET as the adrenal uptake was interpreted as uptake in the adjacent left kidney, whereas it was correctly interpreted as metastasis by the use of integrated PET/CT (Fig. 4).


(18)F-FDG PET versus (18)F-FDG PET/CT for adrenal gland lesion characterization: a comparison of diagnostic efficacy in lung cancer patients.

Sung YM, Lee KS, Kim BT, Choi JY, Chung MJ, Shim YM, Yi CA, Kim TS - Korean J Radiol (2008 Jan-Feb)

A false-negative interpretation with the use of PET only, but a true positive interpretation with the use of integrated PET/CT in a 33-year-old woman with an adrenal metastasis confirmed by clinical follow-up. The patient also had adenocarcinoma in the right lower lobe of the lung.A. PET demonstrates increased uptake (arrow) in the left adrenal gland area with a maximum SUV of 3.5. Uptake was regarded as benign by PET alone because the uptake was interpreted as left kidney uptake.B. An unenhanced CT scan shows an 11-mm-sized nodule (arrow) in the left adrenal gland.C. On an integrated PET/CT image, the uptake (arrow) falls on the left adrenal gland, thus enabling a correct interpretation as positive uptake (uptake extent is equal to that of liver).D. The nodule (arrow) in the left adrenal gland shows an increase in size at a 7-month follow-up CT. Hepatic metastasis is also noted (arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627169&req=5

Figure 4: A false-negative interpretation with the use of PET only, but a true positive interpretation with the use of integrated PET/CT in a 33-year-old woman with an adrenal metastasis confirmed by clinical follow-up. The patient also had adenocarcinoma in the right lower lobe of the lung.A. PET demonstrates increased uptake (arrow) in the left adrenal gland area with a maximum SUV of 3.5. Uptake was regarded as benign by PET alone because the uptake was interpreted as left kidney uptake.B. An unenhanced CT scan shows an 11-mm-sized nodule (arrow) in the left adrenal gland.C. On an integrated PET/CT image, the uptake (arrow) falls on the left adrenal gland, thus enabling a correct interpretation as positive uptake (uptake extent is equal to that of liver).D. The nodule (arrow) in the left adrenal gland shows an increase in size at a 7-month follow-up CT. Hepatic metastasis is also noted (arrowhead).
Mentions: PET and PET/CT made six discordant interpretations. In four cases, PET produced a false-positive result because FDG uptake in the liver or lymph nodes was misinterpreted as adrenal uptake. In one case in which a patient underwent FDG PET/CT twice with a two-month interval, false-negative results we obtained by PET and by PET/CT at the initial study. However, at the follow-up study, PET continued to show a false-negative result, but PET/CT produced a true-positive result. In this particular case, the adrenal lesion was 6 mm in diameter as determined at the initial study and 11 mm in diameter as determined at the second study. In the remaining single case, a nodule was regarded as benign by PET as the adrenal uptake was interpreted as uptake in the adjacent left kidney, whereas it was correctly interpreted as metastasis by the use of integrated PET/CT (Fig. 4).

Bottom Line: PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake.The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test.Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, Korea.

ABSTRACT

Objective: The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone.

Materials and methods: Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test.

Results: Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively).

Conclusion: The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.

Show MeSH
Related in: MedlinePlus