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. 2017 Winter;5(1):22-29.
doi: 10.22038/aojnmb.2016.7996.

Assessment of Mediastinal Tumors Using SUVmax and Volumetric Parameters on FDG-PET/CT

Takahiro Morita  1 , Mitsuaki Tatsumi  2 , Mana Ishibashi  1 , Kayako Isohashi  1 , Hiroki Kato  1 , Osamu Honda  3 , Eku Shimosegawa  4 , Noriyuki Tomiyama  3 , Jun Hatazawa  1
Affiliations

Assessment of Mediastinal Tumors Using SUVmax and Volumetric Parameters on FDG-PET/CT

Takahiro Morita et al. Asia Ocean J Nucl Med Biol. 2017 Winter.

Abstract

Objectives: This study aimed to evaluate the role of pretreatment SUVmax and volumetric FDG positron emission tomography (PET) parameters in the differentiation between benign and malignant mediastinal tumors. In addition, we investigated whether pretreatment SUVmax and volumetric FDG-PET parameters could distinguish thymomas from thymic carcinomas, and low-risk from high-risk thymomas.

Methods: This study was conducted on 52 patients with mediastinal tumors undergoing FDG-PET/CT. Histological examination indicated that 29 mediastinal tumors were benign, and 23 cases were malignant. To obtain quantitative PET/CT parameters, we determined the maximum standardized uptake value (SUVmax), volumetric parameters, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors using SUVmax cut-off value of 2.5. SUVmax, MTV and TLG of benign and malignant tumors were compared using the Mann-Whitney U test. Moreover, receiver-operating curve (ROC) analysis was applied to identify the cut-off values of SUVmax, MTV and TLG for the accurate differentiation of benign and malignant tumors. SUVmax, MTV and TLG were compared between thymomas and thymic carcinomas, as well as low-risk and high-risk thymomas.

Results: Mean SUVmax, MTV and TLG of malignant mediastinal tumors were significantly higher compared to benign tumors (P<0.001). Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of SUVmax were 78.2%, 86.2%, 82.6%, 81.8%, and 83.3%, respectively. These values were estimated at 82.6%, 96.6%, 90.4%, 95%, and 87.5% for MTV and TLG, respectively. Additionally, optimal cut-off values for the differentiation of benign and malignant mediastinal tumors were determined at 4.2 and 22.3 mL and 79.7 g for SUVmax, MTV and TLG, respectively. Mean SUVmax, MTV and TLG of thymic carcinomas were significantly higher compared to thymomas (P<0.01), while no significant differences were observed in the mean quantitative parameters between low-risk and high-risk thymomas.

Conclusion: Although SUVmax, MTV and TLG could not distinguish between low-risk and high-risk thymomas, these parameters might be able to differentiate benign tumors from malignant mediastinal tumors noninvasively. These parameters could be used to distinguish between thymomas and thymic carcinomas as well. Therefore, FDG-PET/CT parameters seem to be accurate indices for the detection of malignant mediastinal tumors.

Keywords: FDG-PET/CT; Mediastinal tumor; Metabolic tumor volume; Total lesion glycolysis.

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Figures

Figure 1
Figure 1
(A) Contrast-enhanced CT image shows a partially ill-defined, heterogeneous left-anterior mediastinal tumor (arrow); (B) PET/CT image shows low FDG uptake (arrow); SUVmax, MTV and TLG estimated at 2.0, zero and zero, respectively A 44-year-old man with type B1 thymoma
Figure 2
Figure 2
A 64-year-old woman with thymic carcinoma (A) Contrast-enhanced CT image shows a well-defined, homogeneous anterior mediastinal tumor (arrow); (B) PET/CT image shows high FDG uptake (arrow); SUVmax, MTV and TLG estimated at 5.4, 27.7 mL and 88.7 g, respectively
Figure 3
Figure 3
Distribution of SUVmax, MTV and TLG between benign and malignant mediastinal tumors
Figure 4
Figure 4
Distribution of SUVmax, MTV and TLG between thymomas and thymic carcinomas
Figure 5
Figure 5
Distribution of SUVmax, MTV and TLG between low-risk and high-risk thymomas
Figure 6
Figure 6
ROC curve for differentiation between benign and malignant mediastinal tumors
See this image and copyright information in PMC

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