Diagnostic Performance of Dynamic Whole-Body Patlak [ 18 F]FDG-PET/CT in Patients with Indeterminate Lung Lesions and Lymph Nodes

• Published in: Journal of clinical medicine Vol. 12; no. 12; p. 3942
• Main Authors: Weissinger, Matthias, Atmanspacher, Max, Spengler, Werner, Seith, Ferdinand, Von Beschwitz, Sebastian, Dittmann, Helmut, Zender, Lars, Smith, Anne M, Casey, Michael E, Nikolaou, Konstantin, Castaneda-Vega, Salvador, la Fougère, Christian
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 09.06.2023; MDPI
• Subjects: Clinical medicine; dynamic PET; FDG; Glucose; Lung cancer; Lymphatic system; parametric FDG; Patients; Patlak; PET/CT; Software; Statistical analysis; whole-body; United States > US; Germany; FDG; dynamic PET; Patlak; parametric FDG; whole-body; PET/CT
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12123942

Static [ F]FDG-PET/CT is the imaging method of choice for the evaluation of indeterminate lung lesions and NSCLC staging; however, histological confirmation of PET-positive lesions is needed in most cases due to its limited specificity. Therefore, we aimed to evaluate the diagnostic performance of additional dynamic whole-body PET. A total of 34 consecutive patients with indeterminate pulmonary lesions were enrolled in this prospective trial. All patients underwent static (60 min p.i.) and dynamic (0-60 min p.i.) whole-body [ F]FDG-PET/CT (300 MBq) using the multi-bed-multi-timepoint technique (Siemens mCT FlowMotion). Histology and follow-up served as ground truth. Kinetic modeling factors were calculated using a two-compartment linear Patlak model (FDG influx rate constant = Ki, metabolic rate = MR-FDG, distribution volume = DV-FDG) and compared to SUV using ROC analysis. MR-FDG provided the best discriminatory power between benign and malignant lung lesions with an AUC of 0.887. The AUC of DV-FDG (0.818) and SUV (0.827) was non-significantly lower. For LNM, the AUCs for MR-FDG (0.987) and SUV (0.993) were comparable. Moreover, the DV-FDG in liver metastases was three times higher than in bone or lung metastases. Metabolic rate quantification was shown to be a reliable method to detect malignant lung tumors, LNM, and distant metastases at least as accurately as the established SUV or dual-time-point PET scans.