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European Radiology
Published in: European Radiology 11/2016

Open Access 01-11-2016 | Nuclear Medicine

18F-FDG PET/CT assessment of histopathologically confirmed mediastinal lymph nodes in non-small cell lung cancer using a penalised likelihood reconstruction

Authors: Eugene J. Teoh, Daniel R. McGowan, Kevin M. Bradley, Elizabeth Belcher, Edward Black, Alastair Moore, Annemarie Sykes, Fergus V. Gleeson

Published in: European Radiology | Issue 11/2016

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Abstract

Purpose

To investigate whether using a Bayesian penalised likelihood reconstruction (BPL) improves signal-to-background (SBR), signal-to-noise (SNR) and SUVmax when evaluating mediastinal nodal disease in non-small cell lung cancer (NSCLC) compared to ordered subset expectation maximum (OSEM) reconstruction.

Materials and methods

18F-FDG PET/CT scans for NSCLC staging in 47 patients (112 nodal stations with histopathological confirmation) were reconstructed using BPL and compared to OSEM. Node and multiple background SUV parameters were analysed semi-quantitatively and visually.

Results

Comparing BPL to OSEM, there were significant increases in SUVmax (mean 3.2–4.0, p<0.0001), SBR (mean 2.2–2.6, p<0.0001) and SNR (mean 27.7–40.9, p<0.0001). Mean background SNR on OSEM was 10.4 (range 7.6–14.0), increasing to 12.4 (range 8.2–16.7, p<0.0001). Changes in background SUVs were minimal (largest mean difference 0.17 for liver SUVmean, p<0.001). There was no significant difference between either algorithm on receiver operating characteristic analysis (p=0.26), although on visual analysis, there was an increase in sensitivity and small decrease in specificity and accuracy on BPL.

Conclusion

BPL increases SBR, SNR and SUVmax of mediastinal nodes in NSCLC compared to OSEM, but did not improve the accuracy for determining nodal involvement.

Key Points

• Penalised likelihood PET reconstruction was applied for assessing mediastinal nodes in NSCLC.
• The new reconstruction generated significant increases in signal-to-background, signal-to-noise and SUVmax.
• This led to an improvement in visual sensitivity using the new algorithm.
• Higher SUV max thresholds may be appropriate for semi-quantitative analyses with penalised likelihood.
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Metadata
Title
18F-FDG PET/CT assessment of histopathologically confirmed mediastinal lymph nodes in non-small cell lung cancer using a penalised likelihood reconstruction
Authors
Eugene J. Teoh
Daniel R. McGowan
Kevin M. Bradley
Elizabeth Belcher
Edward Black
Alastair Moore
Annemarie Sykes
Fergus V. Gleeson
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4253-2

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