Diagnostic accuracy of visual analysis versus dual time-point imaging with 18 F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake.

Objective: To determine the accuracy of visual analysis and the retention index (RI) with dual-time point ¹⁸ F-FDG PET/CT for the characterization of indeterminate pulmonary nodules (IPN) with low FDG uptake.
Materials and Methods: A retrospective analysis was performed on 43 patients (28 men, 64 ± 11 years old, range 36-83 years) referred for IPN characterization with ¹⁸ F-FDG-PET/CT and maximum standard uptake value ≤ 2.5 at 60 minutes post-injection (SUV _max1 ). Nodules were analyzed by size, visual score for FDG uptake on standard (OSEM 2,8) and high definition (HD) reconstructions, SUV _max1 , SUV _max at 180 minutes post-injection (SUV _max2 ), and RI was calculated. The definitive diagnosis was based on histopathological confirmation (n = 28) or ≥ 2 years of follow-up.
Results: Twenty-four (56%) nodules were malignant. RI ≥ 10% on standard reconstruction detected 18 nodules that would have been considered negative using the standard SUV _max ≥ 2.5 criterion for malignancy. RI ≥ 10% had a sensitivity, specificity, PPV, NPV and accuracy of 75, 73.7, 78.3, 70, and 74.4%, respectively, while for FDG uptake > liver on HD these were 79.1, 63.2, 73.1, 70.6, and 72.1%, respectively. SUV _max1 ≥ 2, SUV _max2 > 2.5 and FDG uptake > liver on standard reconstruction had a PPV of 100%. FDG uptake > mediastinum on HD had a NPV of 100%.
Conclusions: RI ≥ 10% was the most accurate criterion for malignancy, followed by FDG uptake > liver on HD reconstruction. On standard reconstruction, SUV _max1 ≥2 was highly predictive of malignancy, as well as SUV _max2 > 2.5 and FDG uptake > liver. FDG uptake < mediastinum on HD was highly predictive of benign nodules.
(Copyright © 2020 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)