Role of 18F-FDG PET/CT Radiomics Features in the Differential Diagnosis of Solitary Pulmonary Nodules: Diagnostic Accuracy and Comparison between Two Different PET/CT Scanners

Abstract

The aim of this retrospective study was to investigate the ability of 18 fluorine-fluorodeoxyglucose positron emission tomography/CT (¹⁸F-FDG-PET/CT) metrics and radiomics features (RFs) in predicting the final diagnosis of solitary pulmonary nodules (SPN). We retrospectively recruited 202 patients who underwent a ¹⁸F-FDG-PET/CT before any treatment in two PET scanners. After volumetric segmentation of each lung nodule, 8 PET metrics and 42 RFs were extracted. All the features were tested for significant differences between the two PET scanners. The performances of all features in predicting the nature of SPN were analyzed by testing three classes of final logistic regression predictive models: two were built/trained through exploiting the separate data from the two scanners, and the other joined the data together. One hundred and twenty-seven patients had a final diagnosis of malignancy, while 64 were of a benign nature. Comparing the two PET scanners, we found that all metabolic features and most of RFs were significantly different, despite the cross correlation being quite similar. For scanner 1, a combination between grey level co-occurrence matrix (GLCM), histogram, and grey-level zone length matrix (GLZLM) related features presented the best performances to predict the diagnosis; for scanner 2, it was GLCM and histogram-related features and metabolic tumour volume (MTV); and for scanner 1 + 2, it was histogram features, standardized uptake value (SUV) metrics, and MTV. RFs had a significant role in predicting the diagnosis of SPN, but their accuracies were directly related to the scanner.

Keywords: 18F-FDG PET/CT; lung cancer; radiomics; solitary pulmonary nodule; texture analysis.

Figure 1

Flowchart of patients included. SPN: solitary pulmonary nodule.

Figure 2

Résumé of statistical analyses performed.

Figure 3

A 77-year-old male with a SPN of 22 mm of diameter in the right lung and increased FDG uptake (A–D). Another case of a 54-year-old female with a 12 mm lung nodule in the inferior lobe of the left lung without significant FDG uptake (E–H).

Figure 4

Correlation map for all first-order and second-order radiomics features between the two scanners (scanner DSTE (A); scanner 690 (B)). Red means high positive correlation; blue means high negative correlation; white means no correlation.