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. 2019 Sep 6;28(3):112-119.
doi: 10.4274/mirt.galenos.2019.65707.

Solitary Pulmonary Nodule: Morphological Effects on Metabolic Activity Assessment

Mehmet Erdoğan  1 , Şehnaz Evrimler  2 , Hüseyin Aydın  2 , Adnan Karaibrahimoğlu  3 , Sevim Süreyya Şengül  1
Affiliations

Solitary Pulmonary Nodule: Morphological Effects on Metabolic Activity Assessment

Mehmet Erdoğan et al. Mol Imaging Radionucl Ther. .

Abstract
in English, Turkish

Objectives: We aimed to evaluate the effects of morphological characteristics of the solitary pulmonary nodules (SPN) on metabolic activity assessment. To the best of our knowledge, this is the first study to compare the volumetric metabolic activity parameters according to the morphologic parameters of the nodules.

Methods: In this retrospective study, 18F-FDG positron emission tomography and computed tomography scans performed between 2011 and 2018 were evaluated by a nuclear and diagnostic radiologist. One hundred thirteen patients with SPNs with biopsy-proven diagnosis were included. SPNs were classified as solid, partially solid (PS), and ground glass opacity (GGO).

Results: SPN diameter, SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG), and density were significantly higher in the malignant group. SUVmax, MTV, TLG increased in direct proportion to the diameter. There was no a significant difference between GGO, PS, and solid nodules in terms of SUVmax values. MTV and TLG values increased in parallel with the density of the nodules, but this increase was only significant in the malignant group. There was a significant difference between SPNs <2 cm and SPNs ≥2 cm in terms of MTV, while there was no difference in terms of SUVmax. The cut-off value determined by the ROC curve was found to be 4.39 for SUVmax, 7.33 mL for MTV and 31.88 g for TLG. The cut-off values for SUVmax of solid and subsolid nodules were close to each other, but cut-off values for MTV and TLG were higher in solid nodules.

Conclusion: SUVmax, MTV, and TLG are affected by diameter and attenuation. We suggest using different MTV and TLG cut-off values for solid and subsolid nodules, but we suggest using same SUVmax values. MTV can be a more reliable parameter than SUVmax in prediction of malignancy in smaller nodules.

Amaç: Soliter pulmoner nodüllerin (SPN) morfolojik özelliklerinin metabolik aktivite değerlendirmesi üzerindeki etkilerini değerlendirmeyi amaçladık. Bildiğimiz kadarıyla, volümetrik metabolik aktivite parametrelerini nodüllerin morfolojik parametrelerine göre karşılaştıran ilk çalışma budur.

Yöntem: 2011 ve 2018 yılları arasında yapılan 18F-FDG pozitron emisyon tomografisi ve bilgisayarlı tomografi taramaları, bir nükleer tıp uzmanı ve radyoloji uzmanı tarafından retrospektif olarak değerlendirildi. Biyopsi ile kanıtlanmış tanısı olan 113 SPN hastası dahil edildi. SPN’ler solid, kısmi solid (PS) ve buzlu cam opasitesi (GGO) olarak sınıflandırıldı

Bulgular: SPN çapı, SUVmaks, metabolik tümör hacmi (MTV), toplam lezyon glikoliz (TLG) ve dansite malign grupta anlamlı olarak yüksek bulundu. SUVmaks, MTV ve TLG değerleri çap ile doğru orantılı olarak arttı. GGO, PS ve solid nodüller arasında SUVmaks değerleri arasında anlamlı bir fark yoktu. MTV, TLG değerleri nodüllerin yoğunluğu ile paralel olarak arttı; ancak sadece malign grupta anlamlı fark bulundu. 2 cm’den küçük grupta MTV için anlamlı fark varken SUVmaks için yoktu. ROC eğrisi ile belirlenen kesme değerinin SUVmaks için 4,39, MTV için 7,33 mL, TLG için 31,88 g olduğu bulundu. Solid ve subsolid nodüllerin SUVmaks için cut-off değeri birbirine yakındı, ancak MTV, TLG için cut-off değer solid nodüllerde daha yüksekti.

Sonuç: SUVmaks, MTV ve TLG çap ve atenüasyondan etkilenmektedir. Solid ve subsolid nodüller için farklı MTV ve TLG cut-off değerlerinin kullanılmasının gerektiğini; ancak SUVmaks için gerekli olmadığını düşünmekteyiz. MTV, küçük nodüller için malignite tahmininde SUVmaks’tan daha güvenilir bir parametre olabilir.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
A well-defined and solid solitary pulmonary nodules was detected in left upper lobe in positron emission tomography (PET) image. (A) Axial non-contrast Thorax computed tomography (CT) at parenchyma window (B), and PET/CT image (C). Measurement of activity parameters were consistent with benign lesions on PET/CT image (D). MIP image of total body PET showed no significant activity (E)
Figure 2
Figure 2
A spiculated and solid solitary pulmonary nodules was detected in left upper lobe in positron emission tomography (PET) image. (A) Axial non-contrast Thorax computed tomography (CT) at parenchyma window (B), and PET/CT image (C). Measurement of activity parameters were consistent with malignancy on PET/CT image (D). MIP image of total body PET showed significant activity in left upper lobe (E)
Figure 3
Figure 3
ROC analysis of SUVmax (A), metabolic tumor volume (B), total lesion glycolysis (C), and density (D) for malignancy
See this image and copyright information in PMC

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