Top

Annals of Nuclear Medicine

Published in:

Open Access 01-02-2013 | Original Article

Dual-time-point F-18 FDG PET/CT imaging for differentiating the lymph nodes between malignant lymphoma and benign lesions

Authors: Michihiro Nakayama, Atsutaka Okizaki, Shunta Ishitoya, Miki Sakaguchi, Junichi Sato, Tamio Aburano

Published in: Annals of Nuclear Medicine | Issue 2/2013

Abstract

Purpose

The purpose of the present study is to evaluate the clinical value of dual-time-point F-18 FDG PET/CT imaging to differentiate malignant lymphoma (ML) from benign lymph node (BLN).

Materials and methods

The subjects were 310 lymph nodes in 84 patients (195 ML lesions in 30 patients and 115 BLN in 54 patients associated with various etiologies.). F-18 FDG PET/CT scan was performed at 50 min (early scan) and at 100 min (delayed scan) after the injection. First, the maximum standardized uptake value (SUVmax) of each lesion at early and delayed scans was calculated. Second, we estimated the difference between early and delayed SUVmax (D-SUVmax) and the retention index (RI-SUVmax) to evaluate the change of tracers in the lesions. Furthermore, proper cut-off values of them were evaluated using receiver operating characteristic analysis. The efficacy of each parameter was analyzed with ANOVA.

Results

Delayed SUVmax and D-SUVmax in ML were significantly higher than those in BLN. Proper cut-off value in delayed SUVmax was 4.0 and in D-SUVmax was 1.0. When the proper cut-off value in D-SUVmax was applied, the D-SUVmax yielded the role of diagnosis with sensitivity of 82.6 %, specificity of 65.2 %, positive predictive value of 80.1 % and negative predictive value of 68.8 %, respectively.

Conclusions

The delayed SUVmax and D-SUVmax were useful indices to differentiate ML from BLN, regardless of histologic subtype. Dual-time-point F-18 FDG PET/CT imaging may help to consider whether there is any need to proceed to more invasive tests, such as biopsy, in individual patients.

Jhanwar YS, Straus DJ. The role of PET in lymphoma. J Nucl Med. 2006;47:1326–34.PubMed

Shinya T, Fujii S, Asakura S, Taniguchi T, Yoshio K, Alafate A, et al. Dual-time-point F-18 FDG PET/CT for evaluation in patients with malignant lymphoma. Ann Nucl Med. 2012;13 [Epub ahead of print].

Ahmadzadehfar H, Rodrigues M, Zakavi R, Knoll P, Mirzaei S. Prognostic significance of the standardized uptake value of pre-therapeutic (18)F-FDG PET in patients with malignant lymphoma. Med Oncol. 2011;28:1570–6.PubMedCrossRef

Kakhki VR. Positron emission tomography in the management of lung cancer. Ann Thorac Med. 2007;2:69–76.PubMedCrossRef

Schrepfer T, Haerle SK, Strobel K, Schaefer N, Hälg RA, Huber GF. The value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for staging of primary extranodal head and neck lymphomas. Laryngoscope. 2010;120:937–44.PubMed

Kapoor V, McCook BM, Torok FS. An introduction to PET-CT imaging. Radiographics. 2004;24:523–43.PubMedCrossRef

Tamura M, Oda M, Matsumoto I, Waseda R, Watanabe G. Pattern and predictors of false positive lymph node involvement on positron emission tomography in patients with non-small cell lung cancer. Thorac Cardiovasc Surg. 2012;60:105–10.PubMedCrossRef

Castellucci P, Zinzani P, Pourdehnad M, Alinari L, Nanni C, Farsad M, et al. 18F-FDG PET in malignant lymphoma: significance of positive findings. Eur J Nucl Med Mol Imaging. 2005;32:749–56.PubMedCrossRef

Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics. 1999;19:61–77.PubMed

10.

Zhuang H, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, et al. Dual-time-point 18F-FDG PET imaging for differentiating malignant from inflammatory processes. J Nucl Med. 2001;42:1412–7.PubMed

11.

Sonet A, Graux C, Nollevaux MC, Krug B, Bosly A, Vander Borght T. Unsuspected FDG-PET findings in the follow-up of patients with lymphoma. Ann Hematol. 2007;86:9–15.PubMedCrossRef

12.

Zinzani PL, Tani M, Trisolini R, et al. Histological verification of positive positron emission tomography findings in the follow-up of patients with mediastinal lymphoma. Haematologica. 2007;92:771–7.PubMedCrossRef

13.

Maayan H, Ashkenazi Y, Nagler A, Izbicki G. Sarcoidosis and lymphoma: case series and literature review. Sarcoidosis Vasc Diffuse Lung Dis. 2011;28:146–52.PubMed

14.

Isasi CR, Lu P, Blaufox MD. A metaanalysis of 18F–2-deoxy-2-fluori-d-glucose positron emission tomography in the staging and restaging of patients with lymphoma. Cancer. 2005;104:1066–74.PubMedCrossRef

15.

Zijlstra JM, Lindauer-van der Werf G, Hoekstra OS, Hooft L, Riphagen II, Huijgens PC. 18F-fluoro-deoxyglucose positron emission tomography for post-treatment evaluation of malignant lymphoma: a systematic review. Haematologica. 2006;91:522–9.PubMed

16.

Hustinx R, Smith RJ, Benard F, Rosenthal DI, Machtay M, Farber LA, et al. Dual-time-point fluorine-18 fluorodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck. Eur J Nucl Med. 1999;26:1345–8.PubMedCrossRef

17.

Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual time point 18F-FDG PET for the evaluation of pulmonary nodules. J Nucl Med. 2002;43:871–5.PubMed

18.

Suga K, Kawakami Y, Hiyama A, Sugi K, Okabe K, Matsumoto T, et al. Differential diagnosis between (18)F-FDG-avid metastatic lymph nodes in non-small cell lung cancer and benign nodes on dual-time-point PET/CT scan. Ann Nucl Med. 2009;23:523–31.PubMedCrossRef

19.

Mavi A, Urhan M, Yu JQ, Zhuang H, Houseni M, Cermik TF, et al. Dual-time-point 18F-FDG PET imaging detects breast cancer with high sensitivity and correlates well with histologic subtypes. J Nucl Med. 2006;47:1440–6.PubMed

20.

Nakamoto Y, Higashi T, Sakahara H, Tamaki N, Kogire M, Doi R, et al. Delayed (18)F-fluoro-2-deoxy-d-glucose positron emission tomography scan for differentiation between malignant and benign lesions in the pancreas. Cancer. 2000;89:2547–54.PubMedCrossRef

21.

Tian R, Su M, Tian Y, Li F, Li L, Kuang A, et al. Dual-time point PET/CT with F-18 FDG for the differentiation of malignant and benign bone lesions. Skeletal Radiol. 2009;38:451–8.PubMedCrossRef

22.

Kumar R, Loving VA, Chauhan A, Zhuang H, Mitchell S, Alavi A. Potential of dual-time-point imaging to improve breast cancer diagnosis with (18)F-FDG PET. J Nucl Med. 2005;46:1819–24.PubMed

23.

Hamberg LM, Hunter GJ, Alpert NM, Choi NC, Babich JW, Fischman AJ. The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification? J Nucl Med. 1994;35:1308–12.PubMed

24.

Lodge MA, Lucas JD, Marsden PK, Cronin BF, O’Doherty MJ, Smith MA. A PET study of 18FDG uptake in soft tissue masses. Eur J Nucl Med. 1999;26:22–30.PubMedCrossRef

25.

Khandani AH, Dunphy CH, Meteesatien P, Dufault DL, Ivanovic M, Shea TC. Glut1 and Glut3 expression in lymphoma and their association with tumor intensity on 18F-fluorodeoxyglucose positron emission tomography. Nucl Med Commun. 2009;30:594–601.PubMedCrossRef

26.

Bedigian MP, Benard F, Smith RJ, Karp JS, Alavi A. Whole-body positron emission tomography for oncology imaging using singles transmission scanning with segmentation and ordered subsets-expectation maximization (OS-EM) reconstruction. Eur J Nucl Med. 1998;25:659–61.PubMed

27.

Papajík T, Mysliveček M, Sedová Z, Buriánková E, Procházka V, Koranda P, et al. Standardised uptake value of 18F-FDG on staging PET/CT in newly diagnosed patients with different subtypes of non-Hodgkin’s lymphoma. Eur J Haematol. 2011;86:32–7.PubMedCrossRef

28.

Wu X, Pertovaara H, Korkola P, Vornanen M, Eskola H, Kellokumpu-Lehtinen PL. Glucose metabolism correlated with cellular proliferation in diffuse large B-cell lymphoma. Leuk Lymphoma. 2011;53:400–5.PubMedCrossRef

29.

Kubota K, Itoh M, Ozaki K, Ono S, Tashiro M, Yamaguchi K, et al. Advantage of delayed whole-body FDG-PET imaging for tumour detection. Eur J Nucl Med. 2001;28:696–703.PubMedCrossRef

30.

Gupta N, Gill H, Graeber G, Bishop H, Hurst J, Stephens T. Dynamic positron emission tomography with F-18 fluorodeoxyglucose imaging in differentiation of benign from malignant lung/mediastinal lesions. Chest. 1998;114:1105–11.PubMedCrossRef

31.

Nagamachi S, Hoshi H, Jinnouchi S, Ohnishi T, Flores LG 2nd, Futami S, Nakahara H, et al. 201TL SPECT for evaluating head and neck cancer. Ann Nucl Med. 1996;10:105–11.PubMedCrossRef

32.

Lyshchik A, Higashi T, Nakamoto Y, Fujimoto K, Doi R, Imamura M, et al. Dual-phase 18F-fluoro-2-deoxy-d-glucose positron emission tomography as a prognostic parameter in patients with pancreatic cancer. Eur J Nucl Med Mol Imaging. 2005;32:389–97.PubMedCrossRef

33.

Uesaka D, Demura Y, Ishizaki T, Ameshima S, Miyamori I, Sasaki M, et al. Evaluation of dual-time-point 18F-FDG PET for staging in patients with lung cancer. J Nucl Med. 2008;49:1606–12.PubMedCrossRef

34.

Chun H, Kim CK, Krynckyi BR, Machac J. The usefulness of a repeat study for differentiating between bowel activity and local tumor recurrence on FDG PET scans. Clin Nucl Med. 2003;28:672–3.PubMed

35.

Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation. Semin Nucl Med. 1996;26:308–14.PubMedCrossRef

36.

Miyake KK, Nakamoto Y, Togashi K. Dual-time-point 18F-FDG PET/CT in patients with colorectal cancer: clinical value of early delayed scanning. Ann Nucl Med. 2012;26:492–500.PubMedCrossRef

Title: Dual-time-point F-18 FDG PET/CT imaging for differentiating the lymph nodes between malignant lymphoma and benign lesions
Authors: Michihiro Nakayama
Atsutaka Okizaki
Shunta Ishitoya
Miki Sakaguchi
Junichi Sato
Tamio Aburano
Publication date: 01-02-2013
Publisher: Springer Japan
Published in: Annals of Nuclear Medicine / Issue 2/2013
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-012-0669-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Dual-time-point F-18 FDG PET/CT imaging for differentiating the lymph nodes between malignant lymphoma and benign lesions

Abstract

Purpose

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2013

Is further evaluation needed for incidental focal uptake in the prostate in 18-fluoro-2-deoxyglucose positron emission tomography–computed tomography images?

Quantitative evaluation improves specificity of myocardial perfusion SPECT in the assessment of functionally significant intermediate coronary artery stenoses: a comparative study with fractional flow reserve measurements

Role of F-18 FDG PET/CT in assessing bone marrow involvement in pediatric Hodgkin’s lymphoma

Serum tumor markers and PET/CT imaging for tumor recurrence detection

Predictors of post-stress LVEF drop 6 months after reperfused myocardial infarction: a gated myocardial perfusion SPECT study

Iodine-123 metaiodobenzylguanidine imaging can predict future cardiac events in Japanese patients with Parkinson’s disease