The rationale of this study was to investigate the performance of high-resolution CT (HRCT) versus 18F-FDG PET/CT for the diagnosis of pulmonary lymphangitic carcinomatosis (PLC). Methods: In this retrospective institution-approved study, 94 patients addressed for initial staging of lung cancer with suspicion of PLC were included. Using double-blind analysis, we assessed the presence of signs favoring PLC on HRCT (smooth or nodular septal lines, subpleural nodularity, peribronchovascular thickening, satellite nodules, lymph node enlargement, and pleural effusion). 18F-FDG PET/CT images were reviewed to qualitatively evaluate peritumoral uptake and to quantify tracer uptake in the tumoral and peritumoral areas. Histology performed on surgical specimens served as the gold standard for all patients. Results: Among 94 included patients, 73% (69/94) had histologically confirmed PLC. Peribronchovascular thickening, lymph node involvement, and increased peritumoral uptake were more often present in patients with PLC (P < 0.009). Metabolic variables, including tumor SUVmax, SUVmean, metabolic tumor volume, and total lesion glycolysis, as well as peritumoral SUVmax, SUVmean, and their respective ratios to background, were significantly higher in the PLC group than in the non-PLC group (P ≤ 0.0039). Sensitivity, specificity, and area under the receiver-operating-characteristic curve for peribronchovascular thickening (69%, 83%, and 0.76, respectively; 95% confidence interval [95%CI], 0.67-0.85) and increased peritumoral uptake (94%, 84%, and 0.89, respectively; 95%CI, 0.81-0.97) were similar (P = 0.054). For detecting PLC, sensitivity, specificity, and area under the receiver-operating-characteristic curve were significantly higher, at 97%, 92%, and 0.98, respectively (95%CI, 0.96-1.00), for peritumoral SUVmax and 94%, 88%, and 0.96, respectively (95%CI, 0.92-1.00), for peritumoral SUVmean (all P ≤ 0.025). Conclusion: Qualitative evaluation of 18F-FDG PET/CT and HRCT perform similarly for the diagnosis of PLC, with both being outperformed by 18F-FDG PET/CT quantitative parameters.

中文翻译：

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肺淋巴管癌病：高分辨率CT和18F-FDG PET / CT的诊断性能与临床病理结果相关。

这项研究的基本原理是研究高分辨率CT（HRCT）与18F-FDG PET / CT在诊断肺淋巴管癌（PLC）中的性能。方法：在这项经过机构批准的回顾性研究中，纳入了94例因怀疑患有PLC而开始进行肺癌分期的患者。使用双盲分析，我们评估了HRCT上是否存在有利于PLC的体征（光滑或结节状隔壁，胸膜下结节，支气管周围血管增厚，卫星结节，淋巴结肿大和胸腔积液）。18F-FDG PET / CT图像进行了审查，以定性评估肿瘤周围的摄取，并量化肿瘤和肿瘤周围区域的示踪剂摄取。在手术标本上进行的组织学检查是所有患者的金标准。结果：94名患者中，73％（69/94）有组织学证实的PLC。PLC患者更常出现支气管血管增厚，淋巴结受累和肿瘤周围摄取增加（P <0.009）。PLC组的代谢变量，包括肿瘤SUVmax，SUVmean，代谢肿瘤体积和总病变糖酵解以及肿瘤周围SUVmax，SUVmean及其各自与背景的比率，均显着高于非PLC组（P≤ 0.0039）。受体，特征曲线下支气管周围血管增厚的敏感性，特异性和面积（分别为69％，83％和0.76； 95％置信区间[95％CI]，0.67-0.85）和肿瘤周围摄取增加（94％）分别为84％和0.89； 95％CI为0.81-0.97）相似（P = 0.054）。用于检测PLC，灵敏度，特异性，接受者特征曲线下的面积和面积显着更高，对于瘤周SUVmax分别为97％，92％和0.98（95％CI，0.96-1.00），分别为94％，88％和0.96（ 95％CI，0.92-1.00），针对肿瘤周围SUVmean（均P≤0.025）。结论：18F-FDG PET / CT和HRCT的定性评估在诊断PLC方面表现相似，两者均优于18F-FDG PET / CT定量参数。