Clinical utility of three-dimensional integrated 18F-fluorodeoxyglucose positron-emission tomography/computed tomography virtual mediastinoscopy.

The objectives of this study were to devise a new image processing technique to reconstruct dynamic three-dimensional (3D) virtual mediastinoscopic images on the basis of positron-emission tomography/computed tomography (PET/CT) datasets, and to examine the clinical utility of this technique for preoperative simulation of and intraoperative guidance during mediastinoscopic nodal biopsy. Of 54 patients with suspected or proven lung cancer (LC) who underwent mediastinoscopy between January 2005 and December 2007, 37 also underwent preoperative PET/CT. Of these 37 patients, we tested our image processing protocol in 15 consecutive patients with significant mediastinal uptake of fluorodeoxyglucose (FDG). We reconstructed 3D virtual mediastinoscopy movies in two mutually complementary demonstration modes--the tracheobronchial- and vessel-modes--with accurate representation of actual mediastinoscopic procedures. The benefit of these virtual imaging was evaluated with regard to their utility in mediastinoscopic nodal biopsy. Our new technique enabled better understanding of the spatial interrelationship between FDG-avid nodes and mediastinal structures. It facilitated more accurate and safer nodal biopsy under virtual guidance. In conclusion, we showed the feasibility of our virtual mediastinoscopic technique, which may improve the procedural safety and diagnostic accuracy of mediastinoscopic nodal biopsy and nodal staging in LC.