18F-FDG PET/CT predicts acute exacerbation in idiopathic pulmonary fibrosis after thoracic surgery

• Published in: BMC pulmonary medicine Vol. 21; no. 1; pp. 1 - 294
• Main Authors: Yoon, Hee-Young, Lee, Suk Hyun, Ha, Sejin, Ryu, Jin-Sook, Song, Jin Woo
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 16.09.2021; BioMed Central; BMC
• Subjects: Acute exacerbation; Chest; Complications; Complications and side effects; Computed tomography; CT imaging; Fibrosis; Gender; Idiopathic pulmonary fibrosis; Lung diseases; Medical prognosis; Ostomy; Patients; PET imaging; Physiology; Positron emission tomography; Positron emission tomography/computed tomography; Post-operative; Prediction; Pulmonary fibrosis; Pulmonology; Risk factors; Surgery; Thoracic surgery; Thorax; Tomography; Variables; South Korea; United States > US
• ISSN: 1471-2466; 1471-2466
• DOI: 10.1186/s12890-021-01659-4

Abstract Background Acute exacerbation (AE) is the most lethal postoperative complication in idiopathic pulmonary fibrosis (IPF); however, prediction before surgery is difficult. We investigated the role of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) in predicting postoperative AE in IPF. Method Clinical data of 48 IPF patients who underwent 18F-FDG PET/CT before thoracic surgery were retrospectively analyzed. Mean and maximal standardized uptake values (SUV mean and SUV max , respectively) were measured in the fibrotic area. Additionally, adjusted values-SUV ratio (SUVR, defined as SUV max -to-liver SUV mean ratio), tissue fraction-corrected SUV mean (SUV meanTF ), and SUVR (SUVR TF )-were calculated. Results The mean age of the subjects was 67.8 years and 91.7% were male. After thoracic surgery, 21 (43.8%) patients experienced postoperative complications including prolonged air leakage (29.2%), death (14.6%), and AE (12.5%) within 30 days. Patients who experienced AE showed higher SUV max , SUVR, SUV meanTF , and SUVR TF than those who did not, but other clinical parameters were not different between patients with and without AE. The SUV parameters did not differ for other complications. The SUVR (odds ratio [OR] 29.262; P  = 0.030), SUV meanTF (OR 3.709; P  = 0.041) and SUVR TF (OR 20.592; P  = 0.017) were significant predicting factors for postoperative AE following a multivariate logistic regression analysis. On receiver operating characteristics curve analysis, SUVR TF had the largest area under the curve (0.806, P  = 0.007) for predicting postoperative AE among SUV parameters. Conclusions Our findings suggest that 18 F-FDG PET/CT may be useful in predicting postoperative AE in IPF patients and among SUVs, SUVR TF is the best parameter for predicting postoperative AE in IPF patients.