Hyun Su Choi1, Ie Ryung Yoo2, Hye Lim Park1, Eun Kyoung Choi1, Sung Hoon Kim1, Won Hyoung Lee3. 1. Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. 2. Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. Electronic address: iryoo@catholic.ac.kr. 3. Department of Nuclear Medicine, Soon Chun Hyang University Hospital, Bucheon city, Gyenggi-do, Korea.
Abstract
OBJECTIVE: Incidental 18-Fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG) uptake in the ribs is a relatively common finding on positron emission tomography/computed tomography (PET/CT) images of cancer patients. This study examined the role of (18)F-FDG PET/CT in differentiating between benign lesions and metastases on the ribs. METHODS: This study included 264 lesions in 172 PET/CT cases with underlying malignancy showing newly developed indeterminate (18)F-FDG rib uptake between June 2009 and May 2010. Patients with more than five FDG rib uptakes or hematologic malignancy were excluded. Malignancy was confirmed either histologically or by imaging studies, and clinical follow-up with serial images was at least 6 months. The maximum standardized uptake value (SUV(max)) of the rib lesion was recorded. The FDG uptake patterns (focal or segmental; discrete or non-discrete) and CT findings (evidence of fracture, soft tissue lesions, osteoblastic and/or osteolytic lesions) were recorded. RESULTS: There were 206 benign lesions and 58 metastases. The SUV(max) was significantly higher in the metastatic group (3.0 ± 1.8) than in the benign group (2.5 ± 1.1), (P=.014). For the differential diagnosis between benign and metastatic lesions, the best SUV(max) cut-off was determined to be 2.4. Significant indicators for metastasis were a segmental FDG uptake pattern (OR=10.262, 95% CI 4.151-25.371), presence of an osteoblastic/-lytic lesion (OR=22.903, 95% CI 10.468 to 50.108) and the absence of fractures on CT (OR=291.629, 95% CI 39.09-2175.666). CONCLUSION: SUV(max) alone is not sufficient to differentiate benign and metastatic rib lesions in cancer patients. The diagnostic accuracy can be further increased when findings of the CT part of PET/CT are considered.
OBJECTIVE: Incidental 18-Fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG) uptake in the ribs is a relatively common finding on positron emission tomography/computed tomography (PET/CT) images of cancerpatients. This study examined the role of (18)F-FDG PET/CT in differentiating between benign lesions and metastases on the ribs. METHODS: This study included 264 lesions in 172 PET/CT cases with underlying malignancy showing newly developed indeterminate (18)F-FDG rib uptake between June 2009 and May 2010. Patients with more than five FDG rib uptakes or hematologic malignancy were excluded. Malignancy was confirmed either histologically or by imaging studies, and clinical follow-up with serial images was at least 6 months. The maximum standardized uptake value (SUV(max)) of the rib lesion was recorded. The FDG uptake patterns (focal or segmental; discrete or non-discrete) and CT findings (evidence of fracture, soft tissue lesions, osteoblastic and/or osteolytic lesions) were recorded. RESULTS: There were 206 benign lesions and 58 metastases. The SUV(max) was significantly higher in the metastatic group (3.0 ± 1.8) than in the benign group (2.5 ± 1.1), (P=.014). For the differential diagnosis between benign and metastatic lesions, the best SUV(max) cut-off was determined to be 2.4. Significant indicators for metastasis were a segmental FDG uptake pattern (OR=10.262, 95% CI 4.151-25.371), presence of an osteoblastic/-lytic lesion (OR=22.903, 95% CI 10.468 to 50.108) and the absence of fractures on CT (OR=291.629, 95% CI 39.09-2175.666). CONCLUSION: SUV(max) alone is not sufficient to differentiate benign and metastatic rib lesions in cancerpatients. The diagnostic accuracy can be further increased when findings of the CT part of PET/CT are considered.
Authors: Francesco Petrella; Giorgio Lo Iacono; Monica Casiraghi; Lorenzo Gherzi; Elena Prisciandaro; Cristiano Rampinelli; Marzia Colandrea; Chiara Maria Grana; Lorenzo Spaggiari Journal: J Thorac Dis Date: 2020-01 Impact factor: 2.895
Authors: Francesco Petrella; Monica Casiraghi; Niccolò Filippi; Riccardo Orlandi; Andrea Alliata; Giorgio Lo Iacono; Luigi Funicelli; Stefania Rizzo; Lorenzo Spaggiari Journal: J Thorac Dis Date: 2020-01 Impact factor: 2.895
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