Paul Flechsig1,2, Ramin Rastgoo3, Clemens Kratochwil3, Ole Martin4, Tim Holland-Letz5, Alexander Harms6, Hans-Ulrich Kauczor7,8, Uwe Haberkorn3,7,9, Frederik L Giesel3,7,9,10. 1. Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany. paul.flechsig@med.uni-heidelberg.de. 2. Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany. paul.flechsig@med.uni-heidelberg.de. 3. Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany. 4. Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, 40225, Dusseldorf, Germany. 5. Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany. 6. Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany. 7. Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany. 8. Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany. 9. Clinical Cooperation Unit, Department of Nuclear Medicine, DKFZ, Heidelberg, Germany. 10. Department of Radiology, Columbia University Medical Centre, New York Presbyterian Hospital, New York, NY, USA.
Abstract
PURPOSE: Tumor delineation within an atelectasis in lung cancer patients is not always accurate. When T staging is done by integrated 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG)-positron emission tomography (PET)/X-ray computer tomography (CT), tumors of neuroendocrine differentiation and slowly growing tumors can present with reduced FDG uptake, thus aggravating an exact T staging. In order to further exhaust information derived from [18F]FDG-PET/CT, we evaluated the impact of CT density and maximum standardized uptake value (SUVmax) for the classification of different tumor subtypes within a surrounding atelectasis, as well as possible cutoff values for the differentiation between the primary tumor and atelectatic lung tissue. PROCEDURES: Seventy-two patients with histologically proven lung cancer and adjacent atelectasis were investigated. Non-contrast-enhanced [18F]FDG-PET/CT was performed within 2 weeks before surgery/biopsy. Boundaries of the primary within the atelectasis were determined visually on the basis of [18F]FDG uptake; CT density was quantified manually within each primary and each atelectasis. RESULTS: CT density of the primary (36.4 Hounsfield units (HU) ± 6.2) was significantly higher compared to that of atelectatic lung (24.3 HU ± 8.3; p < 0.01), irrespective of the histological subtype. The discrimination between different malignant tumors using density analysis failed. SUVmax was increased in squamous cell carcinomas compared to adenocarcinomas. Irrespective of the malignant subtype, a possible cutoff value of 24 HU may help to exclude the presence of a primary in lesions below 24 HU, whereas a density above a threshold of 40 HU can help to exclude atelectatic lung. CONCLUSION: Density measurements in patients with lung cancer and surrounding atelectasis may help to delineate the primary tumor, irrespective of the specific lung cancer subtype. This could improve T staging and radiation treatment planning (RTP) without additional application of a contrast agent in CT, or an additional magnetic resonance imaging (MRI), even in cases of lung tumors of neuroendocrine differentiation or in slowly growing tumors with less avidity to [18F]FDG.
PURPOSE:Tumor delineation within an atelectasis in lung cancerpatients is not always accurate. When T staging is done by integrated 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG)-positron emission tomography (PET)/X-ray computer tomography (CT), tumors of neuroendocrine differentiation and slowly growing tumors can present with reduced FDG uptake, thus aggravating an exact T staging. In order to further exhaust information derived from [18F]FDG-PET/CT, we evaluated the impact of CT density and maximum standardized uptake value (SUVmax) for the classification of different tumor subtypes within a surrounding atelectasis, as well as possible cutoff values for the differentiation between the primary tumor and atelectatic lung tissue. PROCEDURES: Seventy-two patients with histologically proven lung cancer and adjacent atelectasis were investigated. Non-contrast-enhanced [18F]FDG-PET/CT was performed within 2 weeks before surgery/biopsy. Boundaries of the primary within the atelectasis were determined visually on the basis of [18F]FDG uptake; CT density was quantified manually within each primary and each atelectasis. RESULTS: CT density of the primary (36.4 Hounsfield units (HU) ± 6.2) was significantly higher compared to that of atelectatic lung (24.3 HU ± 8.3; p < 0.01), irrespective of the histological subtype. The discrimination between different malignant tumors using density analysis failed. SUVmax was increased in squamous cell carcinomas compared to adenocarcinomas. Irrespective of the malignant subtype, a possible cutoff value of 24 HU may help to exclude the presence of a primary in lesions below 24 HU, whereas a density above a threshold of 40 HU can help to exclude atelectatic lung. CONCLUSION: Density measurements in patients with lung cancer and surrounding atelectasis may help to delineate the primary tumor, irrespective of the specific lung cancer subtype. This could improve T staging and radiation treatment planning (RTP) without additional application of a contrast agent in CT, or an additional magnetic resonance imaging (MRI), even in cases of lung tumors of neuroendocrine differentiation or in slowly growing tumors with less avidity to [18F]FDG.
Authors: Paul Flechsig; Peter Choyke; Clemens Kratochwil; Arne Warth; Gerald Antoch; Tim Holland Letz; Daniel Rath; Viktoria Eichwald; Peter E Huber; Hans-Ulrich Kauczor; Uwe Haberkorn; Frederik L Giesel Journal: Diagn Interv Radiol Date: 2016 Jan-Feb Impact factor: 2.630
Authors: Anna C Pfannenberg; Philip Aschoff; Klaus Brechtel; Mark Müller; Roland Bares; Frank Paulsen; Jutta Scheiderbauer; Godehard Friedel; Claus D Claussen; Susanne M Eschmann Journal: Eur J Nucl Med Mol Imaging Date: 2006-08-01 Impact factor: 9.236
Authors: Paul Flechsig; Philipp Frank; Clemens Kratochwil; Gerald Antoch; Daniel Rath; Jan Moltz; Michael Rieser; Arne Warth; Hans-Ulrich Kauczor; Lawrence H Schwartz; Uwe Haberkorn; Frederik L Giesel Journal: Mol Imaging Biol Date: 2017-04 Impact factor: 3.488
Authors: Paul Flechsig; Amit Mehndiratta; Uwe Haberkorn; Clemens Kratochwil; Frederik L Giesel Journal: Semin Nucl Med Date: 2015-07 Impact factor: 4.446
Authors: Torben Haugaard Jensen; Martin Bech; Tina Binderup; Arvid Böttiger; Christian David; Timm Weitkamp; Irene Zanette; Elena Reznikova; Jürgen Mohr; Fritz Rank; Robert Feidenhans'l; Andreas Kjær; Liselotte Højgaard; Franz Pfeiffer Journal: PLoS One Date: 2013-01-18 Impact factor: 3.240