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Improving the imaging diagnostic strategy for pulmonary artery masses based on 18F-FDG PET/CT integrated with CTPA
European Journal of Nuclear Medicine and Molecular Imaging ( IF 9.1 ) Pub Date : 2022-06-23 , DOI: 10.1007/s00259-022-05851-4
Cheng Hong 1 , Peng Hou 2 , Hai-Ming Chen 1 , Kai-Xiang Zhong 2 , Wen-Liang Guo 1 , Jie-Long Lin 3 , Xiao-Feng Wu 1 , Yong-Xia Lei 3 , Qiong Jia 2 , Chun-Li Liu 1 , Shi-Yue Li 1 , Xin-Lu Wang 2
Affiliation  

Objective

To evaluate the diagnostic accuracy of computed tomography pulmonary angiography (CTPA) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for pulmonary artery (PA) masses.

Methods

Of 2889 patients with PA filling defects of PA on CTPA, 79 consecutive patients suspicious for PA malignancy who subsequently underwent 18F-FDG PET/CT were enrolled. All masses were diagnosed on the basis of pathological findings or clinical imaging follow-up. For each mass, morphological CT signs, standardized uptake value (SUVmax and SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on 18F-FDG PET/CT were used as diagnostic markers.

Results

Expansive growth, irregular margin, invasion, CT contrast uptake, and wall eclipse sign were strongly associated with the malignant nature of masses. The coexistence of at least 5 CT signs perfectly identified malignant masses, whereas the detection of no more than 4 CT signs did not accurately discriminate between the natures of masses. Mean SUVmax, SUVmean, MTV, and TLG values were significantly higher in malignant masses compared to those in benign masses. The diagnostic accuracy of 18F-FDG PET/CT parameters (SUV, MTV, and TLG) was excellent in detecting malignant masses. Among patients with 3 or 4 pathological CT signs, SUVmax > 3.4 significantly increased the identification of malignancies.

Conclusions

CTPA is a useful imaging modality for diagnosing PA masses, especially when at least 5 abnormal CT signs are identified. Similarly, 18F-FDG PET/CT accurately identified malignant masses and provided additional valuable information on diagnostic uncertainties after CTPA.



中文翻译:

基于18F-FDG PET/CT联合CTPA改进肺动脉肿块影像学诊断策略

客观的

评估计算机断层扫描肺血管造影 (CTPA) 和18 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描 ( 18 F-FDG PET/CT) 对肺动脉 (PA) 肿块的诊断准确性。

方法

在 2889 名 CTPA 显示 PA 存在 PA 充盈缺损的患者中,连续 79 名疑似 PA 恶性肿瘤并随后接受18F -FDG PET/CT 的患者被纳入。所有肿块均根据病理结果或临床影像学随访进行诊断。对于每个肿块,使用18 F-FDG PET/CT 上的形态学 CT 征象、标准化摄取值(SUVmaxSUVmean)、代谢肿瘤体积(MTV)和总病变糖酵解(TLG)作为诊断标志物。

结果

膨胀性生长、不规则边缘、浸润、CT造影剂摄取和壁蚀征与肿块的恶性性质密切相关。至少同时存在 5 个 CT 征象可完美识别恶性肿块,而检测到不超过 4 个 CT 征象则不能准确区分肿块的性质。与良性肿块相比,恶性肿块的平均SUVmaxSUVmeanMTVTLG值显着更高。18F -FDG PET/CT 参数(SUVMTVTLG )的诊断准确性在检测恶性肿块方面非常出色。在具有 3 或 4 个病理 CT 征象的患者中,SUVmax  > 3.4 显着提高了恶性肿瘤的识别率。

结论

CTPA 是诊断 PA 肿块的一种有用的成像方式,尤其是当至少识别出 5 个异常 CT 体征时。同样,18F -FDG PET/CT 准确识别恶性肿块,并提供了有关 CTPA 后诊断不确定性的额外有价值信息。

更新日期:2022-06-23
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