Search

Objective: The purpose of this study was to directly compare nodule-enhancement CT and 18F-FDG PET in the characterization of indeterminate solitary pulmonary nodules (SPNs) greater than 7 mm in size., Materials and Methods: Examinations from patients undergoing both nodule-enhancement CT and 18F-FDG PET to characterize the same indeterminate SPN were reviewed. For nodule-enhancement CT, an SPN was considered malignant when it showed an unenhanced to peak contrast-enhanced increase in attenuation greater than 15 H. Fluorine-18-FDG PET studies were blindly reinterpreted by two qualified nuclear radiologists. SPNs qualitatively showing hypermetabolic activity greater than the mediastinal blood pool were interpreted as malignant. These interpretations were compared with the original prospective clinical readings and to semiquantitative standardized uptake value (SUV) analysis. Results were compared with pathologic and clinical follow-up., Results: Forty-two pulmonary nodules were examined. Twenty-five (60%) were malignant, and 17 (40%) were benign. Nodule-enhancement CT was positive in all 25 malignant nodules and in 12 benign nodules, with sensitivity and specificity of 100% and 29%, respectively, and with a positive predictive value (PPV) and negative predictive value (NPV) of 68% and 100%, respectively. Qualitative 18F-FDG PET interpretations were positive in 24 of the 25 malignant nodules and in four benign nodules. Fluorine-18-FDG PET was considered negative in one malignant nodule and in 13 of the 17 benign nodules. This correlates with a sensitivity and specificity of 96% and 76%, respectively, and with a PPV and NPV of 86% and 93%, respectively. Original prospective 18F-FDG PET and semiquantitative SUV analysis showed sensitivity, specificity, PPV, and NPV of 88%, 76%, 85%, and 81% and 84%, 82%, 88%, and 78%, respectively., Conclusion: Due to its much higher specificity and only slightly reduced sensitivity, 18F-FDG PET is preferable to nodule-enhancement CT in evaluating indeterminate pulmonary nodules. However, nodule-enhancement CT remains useful due to its high NPV, convenience, and lower cost. Qualitative 18F-FDG PET interpretation provided the best balance of sensitivity and specificity when compared with original prospective interpretation or SUV analysis.

Unlabelled: Hürthle cell carcinoma is an uncommon differentiated thyroid cancer characterized by an aggressive clinical course and low avidity for (131)I. Treatment usually involves an aggressive surgical approach often combined with (131)I. (18)F-FDG PET has been helpful in the staging and evaluation of many types of aggressive malignancy. No reports to date have described the utility of PET in a series of patients with Hürthle cell cancer. We reviewed our experience with (18)F-FDG PET in the care of patients with Hürthle cell carcinoma to determine the likelihood of uptake in these cancers and the effect of (18)F-FDG PET on patient care., Methods: Patients with Hürthle cell cancer who were seen between June 2000 and April 2002 and were imaged with (18)F-FDG PET were included. Imaging and clinical data were reviewed. PET results were compared with the results of anatomic imaging (CT, sonography, or MRI) and (131)I imaging when performed. Patient charts were reviewed to identify any change in management that resulted from the (18)F-FDG PET findings., Results: Fourteen (18)F-FDG PET scans of 12 patients were obtained in the time frame indicated. All patients had documented Hürthle cell carcinoma. PET showed intense (18)F-FDG uptake in all known Hürthle cell cancer lesions but one. PET showed disease not identified by other imaging methods in 7 of the 14 PET scans. PET identified distant metastatic disease (5) or local disease (2) that was more extensive than otherwise demonstrated. In 7 of the 14 scans, the information provided by PET was used to guide or change therapy., Conclusion: Hürthle cell carcinoma demonstrates intense uptake on (18)F-FDG PET images. PET improves disease detection and disease management in patients with Hürthle cell carcinoma relative to anatomic or iodine imaging. (18)F-FDG PET should be recommended for the evaluation and clinical management of patients with Hürthle cell carcinoma.