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Added diagnostic value of respiratory-gated 4D 18F–FDG PET/CT in the detection of liver lesions: a multicenter study

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Abstract

Purpose

The aim of the present study was to evaluate the added diagnostic value of respiratory-gated 4D18F–FDG PET/CT in liver lesion detection and characterization in a European multicenter retrospective study.

Methods

Fifty-six oncological patients (29 males and 27 females, mean age, 61.2 ± 11.2 years) from five European centers, submitted to standard 3D–PET/CT and liver 4D–PET/CT were retrospectively evaluated. Based on visual analysis, liver PET/CT findings were scored as positive, negative, or equivocal both in 3D and 4D PET/CT. The impact of 4D–PET/CT on the confidence in classifying liver lesions was assessed. PET/CT findings were compared to histology and clinical follow-up as standard reference and diagnostic accuracy was calculated for both techniques. At semi-quantitative analysis, SUVmax was calculated for each detected lesion in 3D and 4D–PET/CT.

Results

Overall, 72 liver lesions were considered for the analysis. Based on visual analysis in 3D–PET/CT, 32/72 (44.4%) lesions were considered positive, 21/72 (29.2%) negative, and 19/72 (26.4%) equivocal, while in 4D–PET/CT 48/72 (66.7%) lesions were defined positive, 23/72 (31.9%) negative, and 1/72 (1.4%) equivocal. 4D–PET/CT findings increased the confidence in lesion definition in 37/72 lesions (51.4%). Considering 3D equivocal lesions as positive, sensitivity, specificity, and accuracy were 88.9, 70.0, and 83.1%, respectively, while the same figures were 67.7, 90.0, and 73.8% if 3D equivocal findings were included as negative. 4D–PET/CT sensitivity, specificity, and accuracy were 97.8, 90.0, and 95.4%, respectively, considering equivocal lesions as positive and 95.6, 90.0, and 93.8% considering equivocal lesions as negative. The SUVmax of the liver lesions in 4D–PET (mean ± SD, 6.9 ± 3.2) was significantly higher (p < 0.001) than SUVmax in 3D–PET (mean ± SD, 5.2 ± 2.3).

Conclusions

Respiratory-gated PET/CT technique is a valuable clinical tool in diagnosing liver lesions, reducing 3D undetermined findings, improving diagnostic accuracy, and confidence in reporting. 4D–PET/CT also improved the quantification of SUVmax of liver lesions.

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Authors and Affiliations

  1. Nuclear Medicine, San Gerardo Hospital, Monza, Italy

    Cinzia Crivellaro, Federica Elisei, Claudio Landoni & Luca Guerra

  2. University of Milan-Bicocca, Milan, Italy

    Cinzia Crivellaro, Claudio Landoni & Luca Guerra

  3. Medical Physics, San Gerardo Hospital, Monza, Italy

    Elena De Ponti & Sabrina Morzenti

  4. Nuclear Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Maria Picchio & Valentino Bettinardi

  5. Nuclear Medicine, Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy

    Annibale Versari

  6. Medical Physics, Santa Maria Nuova Hospital IRCCS, Reggio Emilia, Italy

    Federica Fioroni

  7. Military Institute of Medicine, Warsaw, Poland

    Miroslaw Dziuk & Konrad Tkaczewski

  8. Service de Médecine Nucléaire, Hôpital Pierre Beregovoy, Cedex, Nevers, France

    Renée Ahond-Vionnet & Guillaume Nodari

  9. Tecnomed Foundation, University of Milan-Bicocca, Monza, Italy

    Sergio Todde

Authors
  1. Cinzia Crivellaro
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  2. Elena De Ponti
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  3. Federica Elisei
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  4. Sabrina Morzenti
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  5. Maria Picchio
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  11. Renée Ahond-Vionnet
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  12. Guillaume Nodari
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  13. Sergio Todde
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  14. Claudio Landoni
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  15. Luca Guerra
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Corresponding author

Correspondence to Cinzia Crivellaro.

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Financial support

The authors disclose that they did not receive any personal or financial support for this multicenter study.

Conflict of interest

Luca Guerra has had honorarium from GE Healthcare for speaking at symposia. All other authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants included in the study.

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Crivellaro, C., De Ponti, E., Elisei, F. et al. Added diagnostic value of respiratory-gated 4D 18F–FDG PET/CT in the detection of liver lesions: a multicenter study. Eur J Nucl Med Mol Imaging 45, 102–109 (2018). https://doi.org/10.1007/s00259-017-3795-0

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  • DOI: https://doi.org/10.1007/s00259-017-3795-0

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