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Improving the imaging diagnostic strategy for pulmonary artery masses based on 18F-FDG PET/CT integrated with CTPA

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

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.

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Abbreviations

CTPA:

Computed tomography pulmonary angiography

18F-FDG PET/CT:

18F-fluorodeoxyglucose positron emission tomography/computed tomography

PA:

Pulmonary artery

PTE:

Pulmonary thromboembolism

PAS:

Pulmonary artery sarcoma

TE:

Tumoral embolism

CT:

Computed tomography

MRI:

Magnetic resonance imaging

SUVmax :

Maximum standardized uptake value

SUVmean :

Mean standardized uptake value

MTV :

Metabolic tumor volume

TLG :

Total lesion glycolysis

WES:

Wall eclipse sign

OS:

Overall survival

ROC:

Receiver operating characteristics

AUC :

Area under the ROC curve

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Acknowledgements

We would like to express our special thanks to Wei-Jie Guan and Tao Wang (State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510010, China) for their guidance in editing the manuscript. We thank all participants who took part in this study.

Funding

This project was supported by the Natural Science Foundation of Guangdong Province, China (Grant No. 2021A1515011373), and the Science and Technology Program of Guangzhou, China (Grant No. 202102010252).

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Correspondence to Xin-lu Wang.

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Ethics approval

This study is approved by the ethics committee of the First Affiliated Hospital of Guangzhou Medical University (No. 2021-K-36).

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The authors declare no competing interests.

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This article is part of the Topical Collection on Cardiology

Cheng Hong, Peng Hou, Hai-ming Chen, and Kai-xiang Zhong are joint first authors

Take-home message

18F-FDG PET/CT integrated with CTPA identified the nature of pulmonary artery mass.

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Hong, C., Hou, P., Chen, Hm. et al. Improving the imaging diagnostic strategy for pulmonary artery masses based on 18F-FDG PET/CT integrated with CTPA. Eur J Nucl Med Mol Imaging 49, 4109–4121 (2022). https://doi.org/10.1007/s00259-022-05851-4

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  • DOI: https://doi.org/10.1007/s00259-022-05851-4

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