Chest
Volume 114, Issue 4, October 1998, Pages 1105-1111
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Clinical Investigations: Cancer
Dynamic Positron Emission Tomography With F-18 Fluorodeoxyglucose Imaging in Differentiation of Benign From Malignant Lung/Mediastinal Lesions

https://doi.org/10.1378/chest.114.4.1105Get rights and content

Purpose

This study was done to evaluate the diagnostic utility of dynamic positron emission tomography (PET) with F-18 fluorodeoxyglucose (FDG) imaging in patients with suspected malignant pulmonary lesions. We wanted to test the hypothesis that the rate of FDG uptake (FDG influx constant values) would differentiate malignant from benign lung or mediastinal lesions.

Materials and methods

We performed segmental dynamic PET imaging studies following administration of FDG in 19 patients with indeterminate pulmonary lesions based on chest radiograph and/or CT scans. Patlak analysis was done to compute Ki (FDG influx constant) values and compared with FDG standardized uptake values (SUVs) and histology.

Results

FDG Ki values (mean ± SD) were significantly greater (p < 0.01) in all 12 malignant lesions (0.029 ± 0.02) as compared with 7 benign lesions (0.0024 ± 0.0011) with good correlation to the SUV values. Distinct time activity curve patterns were identified in malignant and benign lesions with continued uptake in malignant lesions.

Conclusion

Dynamic PET-FDG imaging accurately differentiates malignant from benign pulmonary lesions. In certain cases with equivocal findings on visual analysis and SUV values, dynamic imaging may be further helpful in differentiating benign and malignant lesions.

Section snippets

MATERIALS AND METHODS

We studied 19 consecutive patients with an age range of 32 to 78 years referred for F-18 FDG PET studies for suspected malignant lesions in the lungs or in the mediastinum. These successive patients were studied as part of ongoing clinical studies at West Virginia University PET Center. All patients provided an informed consent for the PET studies. All patients fasted for at least 4 h prior to FDG injection. Serum glucose levels ranged from 80 to 160 mg/dL. These patients also had complete

RESULTS

The histologic specimens were obtained by needle biopsy (n = 10), thoracotomy (n = 8), or bronchoscopy (n = 1). Lesions ranged in size from 1 to 3.5 cm.

DISCUSSION

The high metabolism and increased rate of glucose consumption of cancer is associated with increased level of glycolytic enzymes and overexpression of glucose transporters as compared with the surrounding normal tissues.4, 10 It is well accepted that increased rates of transport and phosphorylation of the glucose analog and decreased rate of dephosphorylation of the phosphorylated sugars are important factors in the cellular mechanisms for tumor hypermetabolism.5, 6 Significant correlation has

REFERENCES (18)

  • HubnerKF et al.

    Assessment of primary and metastatic ovarian cancer by positron emission tomography (PET) using 2-(18F)deoxyglucose (2[18F]FDG)

    Gynecol Oncol

    (1993)
  • GuptaNC et al.

    Clinical applications of positron emission tomography in cancer

    Ca Cancer J Clin

    (1993)
  • GuptaNC et al.

    Solitary pulmonary nodules: detection of malignancy with PET with 2-[F-18]-fluoro-2-deoxy-glucose

    Radiology

    (1992)
  • LoweVJ et al.

    Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities

    J Nucl Med

    (1994)
  • MonakhavNK et al.

    Physicochemical properties and isoenzyme composition of hexokinase from normal and malignant human tissues

    J Natl Cancer Inst

    (1978)
  • WarburgOH.

    The metabolism of tumors

    (1931)
  • WeberG.

    Enzymology of cancer cells (first of two parts)

    N Engl J Med

    (1937)
  • GuptaN et al.

    Normal variability in the mediastinal FDG activity on FDG PET studies of lung tumors

    Radiology

    (1994)
  • PatlakCS et al.

    Graphical evaluation of blood-to-brain transfer constant from multipletime uptake data

    J Cereb Blood Flow Metab

    (1981)
There are more references available in the full text version of this article.

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