Ann Thorac Surg 2005;79:984-988
© 2005 The Society of Thoracic Surgeons
Original article: General thoracic
Visual and Semiquantitative Analyses for F-18 Fluorodeoxyglucose PET Scanning in Pulmonary Nodules 1 cm to 3 cm in Size
Hiroaki Nomori, MD, PhDa,*,
Kenichi Watanabe, MDa,
Takashi Ohtsuka, MDa,
Tsuguo Naruke, MD, PhDa,
Keiichi Suemasu, MD, PhDa,
Kimiichi Uno, MD, PhDb
a Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan
b Nishidai Clinic, Tokyo, Japan
Accepted for publication July 29, 2004.
* Address reprint requests to Dr Nomori, Department of Thoracic Surgery, Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan; (E-mail: hnomori{at}qk9.so-net.ne.jp).
 |
Abstract
|
|---|
BACKGROUND: While visual assessment is the simplest way to evaluate positron emission tomography (PET) with fluorodeoxyglucose (FDG), faintly positive nodules are often difficult to evaluate. We performed visual and semiquantitative analyses of pulmonary nodules from 1 to 3 cm in size to determine the optimal method of analysis for PET data, especially for faintly positive nodules on visual assessment.
METHODS: Positron emission tomography data were analyzed for 161 pulmonary nodules from 1 to 3 cm in size (108 malignant and 53 benign nodules). On visual assessment, FDG uptake by the nodules was classified into three grades in comparison with mediastinal blood pool, (ie, definitely positive, faintly positive, and negative). In addition, FDG uptake was measured by the standard uptake value (SUV), the contrast ratio to the contralateral lung (CR-lung), and the contrast ratio to the cerebellum (CR-brain). Cut-off values for each variable were determined from receiver operating characteristics (ROC) curves, and the values were 2.5 for the SUV, 0.4 for the CR-lung, and 0.25 for the CR-brain. Nodules with FDG uptake above these cut-off values were defined as positive in each method.
RESULTS: Visual assessment showed definitely positive for 80 nodules (64 malignant and 16 benign), faintly positive for 22 (17 malignant and 5 benign), and negative for 59 nodules (27 malignant and 32 benign). In the 139 nodules that were definitely positive or negative by visual assessment, there were no significant differences of sensitivity and specificity among the four methods (visual assessment, SUV, CR-lung, and CR-brain). In the 17 malignant nodules that were faintly positive, the SUV did not detect any true-positive nodules, but the CR-lung and CR-brain showed 9 and 5 true-positive nodules, respectively, resulting in a significantly higher sensitivity than the SUV (p < 0.001 and p = 0.02, respectively). Fifteen of 17 faintly positive malignant nodules (88%) were histologically well- or moderately-differentiated adenocarcinoma.
CONCLUSIONS: The semiquantitative methods (SUV, CR-lung, and CR-brain) do not improve the efficacy of visual assessment alone for nodules graded as definitely positive or negative. However, faintly positive nodules on visual assessment should be evaluated by the CR-lung or CR-brain rather than the SUV, and are often differentiated adenocarcinomas.
|
Introduction
|
|---|
In recent years, the use of helical computed tomography (CT) has increased the detection of small peripheral pulmonary nodules [1]. Despite various developments in CT technology, however, surgical resection is still needed to differentiate lung cancer from benign lesions in a significant number of cases [2]. On the other hand, recent advances in positron emission tomography (PET) with fluorodeoxyglucose (FDG) have made a useful contribution to the diagnosis of benign and malignant nodules, and several reports have suggested that PET can reduce the number of patients with pulmonary nodules who undergo unnecessary surgical biopsy [3–7].
Fluorodeoxyglucose uptake on PET has been evaluated in several ways, such as visual assessment, the standard uptake value (SUV), and the ratio of uptake relative to that of a normal organ. Visual assessment is usually based upon comparison of FDG uptake by the lesion with normal mediastinal blood pool [8] and is the simplest among these analyses, but nodules with similar FDG uptake to the mediastinum are difficult to evaluate visually. To assess FDG uptake more objectively, a cut-off value of 2.5 has frequently been used for the SUV. However, a number of factors can affect the SUV, such as body size [9–11], the blood glucose concentration [12, 13], the time after injection [14, 15], and the lesion size [15, 16]. As a result, the mean SUV of malignant nodules has been reported to range widely from 5.5 to 10.1 [3–5, 17–19].
We have recently studied the role of PET for diagnosing small pulmonary nodules and for lymph node staging of lung cancer, with FDG uptake being evaluated as a contrast ratio to the contralateral lung (CR-lung) and to the cerebellum (CR-brain), respectively [20, 21]. In the present study, to determine the optimum method for evaluating small pulmonary nodules, we compared visual assessment, SUV, CR-lung, and CR-brain for the diagnosis of pulmonary nodules from 1 to 3 cm in diameter.
|
Material and Methods
|
|---|
Between December 2001 and April 2004, prospective PET and CT scanning were done for 213 noncalcified pulmonary nodules less than 3 cm in diameter, which were assessed for surgical treatment or biopsy at the Department of Thoracic Surgery of Saiseikai Central Hospital. After informed consent was obtained, PET was performed at Nishidai Clinic within 2 weeks of CT scanning. Among the 213 nodules, 195 could be diagnosed pathologically as malignant or benign by surgical specimens (n = 179) or biopsy specimens (n = 16), while the other 18 remain under follow-up. Of the 195 nodules, 123 were malignant and 72 were benign. We excluded 34 nodules (15 malignant and 19 benign) less than 1 cm in diameter, all of which were negative on PET, because the spatial resolution of the current generation of PET scanners is 0.7 to 0.8 cm and it is difficult to image pulmonary nodules smaller than 1 cm. As a result, we studied 161 nodules measuring from 1 to 3 cm (108 malignant and 53 benign; Tables 1 and 2). Of the 108 malignant nodules, lobectomy was performed for 58 nodules, segmentectomy for 22, wedge resection for 21, pneumonectomy for 1, and biopsy for the remaining 6. Of the 53 benign nodules, thoracoscopic wedge resection was performed for 43 nodules and bronchoscopic biopsy for the remaining 10.
Patients were instructed to fast for at least 4 hours before intravenous administration of F-18 FDG. The dosage of F-18 FDG administered was 125 µCi/Kg (4.6 MBq/kg) for nondiabetic patients and 150 µCi/Kg (5.6 MBq/kg) for diabetic patients. PET imaging was performed approximately 60 minutes after administration of FDG with a POSICAM.HZL mPOWER (Positron Co., Houston, TX). No attenuation-corrected emission scans were initially obtained in two-dimensional, high-sensitivity mode for 4 minutes per bed position and taken from the vertical skull through the midthighs. Immediately thereafter, a two-bed position attenuation-corrected examination was performed, with 6 minutes for the emission sequence and 6 minutes for the transmission sequence at each bed position. The images were usually reconstructed in a 256 x 256 matrix by using ordered subset expectation maximization corresponding to a pixel size of 4x4 mm, with section spacing of 2.66 mm.
Images were reviewed on a consensus basis by two observers who were blinded to the clinical data. Each observer recorded a visual assessment for each nodule using three grades, which were definitely positive, faintly positive, and negative. Lesions that were definitely positive clearly showed greater FDG uptake than that of mediastinal blood pool. Faintly positive lesions showed lower FDG uptake than definitely positive lesions and similar uptake to that of mediastinal blood pool, whereas negative lesions showed almost no FDG uptake.
The PET data were used to calculate the SUV, CR-lung, and CR-brain. To measure the maximum SUV, a region of interest (ROI) was placed over the tumor after correction for radioactive decay. Then the maximum activity in the tumor ROI was calculated as tumor activity/injected dose/body weight. The CR-lung and CR-brain were calculated as reported previously [20, 21]. Briefly, to calculate the CR-lung, ROIs were placed over the tumor and the contralateral normal lung. Then the highest activity in the tumor ROI (T) and in the normal lung ROI (N) were measured, and the CR-lung was calculated as (T – N)/(T + N). To calculate the CR-brain, the highest activity in the tumor ROI (T) and in the cerebellum (C) were measured, and the CR-brain was calculated as T/C. Finally, the SUV, CR-lung, and CR-brain were compared with each other.
Receiver operating characteristics (ROC) curves [22] were constructed using the data on SUV, CR-lung, and CR-brain, and cut-off values were determined for the diagnosis of malignancy by each method. Retrospective analysis demonstrated that the optimal cut-off values for the SUV, CR-lung, and CR-brain were 2.5, 0.4, and 0.25, respectively (Figs 1 to 3). Therefore, nodules with an SUV equal to or greater than 2.5, CR-lung equal to or greater than 0.4, and CR-brain equal to or greater than 0.25 were defined as positive in each method, while nodules with lower values were defined as negative.
View larger version (14K):
[in this window]
[in a new window]
|
Fig 1. The ROC curve and SUV value for diagnosing malignancy for pulmonary nodules 1 to 3 cm in size. The highest activity in the tumor ROI (T) was analyzed by computing SUV, which was calculated by tumor activity concentration/injected dose/body weight. (ROC = receiver operating characteristics; ROI = region of interest; SUV = standard uptake value.)
|
|
View larger version (16K):
[in this window]
[in a new window]
|
Fig 2. The ROC curve and CR-lung value for diagnosing malignancy for pulmonary nodules 1 to 3 cm in size. Highest activities in the tumor ROI (T) and in the contralateral normal lung ROI (N) were measured. The CR was calculated by (T – N)/(T + N) in each nodule as an index of FDG uptake. (CR = contrast ratio; FDG = fluorodeoxyglucose; ROC = receiver operating characteristics; ROI = region of interest.)
|
|
A positive PET scan of a malignant or benign nodule was defined as true positive and false positive, respectively, while a negative PET scan of a malignant or benign nodule was defined as false negative and true negative, respectively. The diagnostic value of PET was assessed by calculating its sensitivity and specificity. Sensitivity was calculated as true-positive/true-positive + false-negative, and specificity as true-negative/true-negative + false-positive. Data were analyzed using the two-tailed Student's t test and p less than 0.05 was accepted as defining significance. Results are given as mean ± SD.
|
Results
|
|---|
By visual assessment of PET scans, 80 nodules (50%) were definitely positive, 22 (14%) were faintly positive, and 59 (36%) were negative. In the malignant nodules, 64 were definitely positive, 17 were faintly positive, and 27 were negative (Table 3). All of the squamous cell carcinomas, large cell carcinomas, and small cell carcinomas were definitely positive by visual assessment. In adenocarcinomas, however, well- or moderately-differentiated tumors were definitely positive in 7 of 33 nodules (21%) and 19 of 30 nodules (63%), respectively, which were lower rates compared with 11 of 12 (92%) poorly-differentiated tumors (p < 0.001 and p = 0.06, respectively). Well-differentiated adenocarcinomas were negative in 18 of 33 tumors (55%), which were higher rate compared with 4 of 30 (13%) moderately-differentiated adenocarcinomas and 0 of 12 (0%) poorly-differentiated ones (p < 0.001). Of the 17 faintly positive malignant nodules, 8 were well-differentiated adenocarcinoma, 7 were moderately-differentiated adenocarcinoma, and 1 each was poorly-differentiated adenocarcinoma and metastatic lung cancer.
In the benign nodules, 16 were definitely positive, 5 were faintly positive, and 32 were negative. Of the 16 definitely positive nodules, 14 were active inflammation, and the remaining 2 were old inflammation and benign tumor, respectively. Nodules with active inflammation were more frequently definitely positive than those with old inflammation or benign lung tumors (p < 0.001 and p = 0.08, respectively).
Table 4 presents a comparison of the results obtained by visual assessment, SUV, CR-lung, and CR-brain in the 139 nodules that were definitely positive or negative by visual estimation. There were no significant differences of sensitivity and specificity among the four methods of assessment.
View this table:
[in this window]
[in a new window]
|
Table 4. Results of Criterion with SUV, CR-Lung, and CR-Brain in 139 Nodules With Definitely Positive or Negative by Visual Estimation
|
|
Table 5 demonstrates a comparison of SUV, CR- lung, and CR-brain for the 22 nodules that were faintly positive by visual assessment. Although none of the 17 malignant nodules (0%) were true-positive based on the SUV, the CR-lung and CR-brain detected 9 (53%) and 5 (29%) true-positive nodules, respectively, revealing significantly higher sensitivity of both CRs than the SUV (p < 0.001 and p = 0.02, respectively). There was no significant difference of sensitivity between the CR-lung and CR-brain. There were no significant differences of specificity among these three methods. The mean values of the SUV, CR-lung, and CR-brain for the 22 faintly positive nodules were 1.6 ± 0.4 (range: 0.9 to 2.4), 0.38 ± 0.11 (range: 0.21 to 0.55), and 0.17 ± 0.07 (range: 0.1 to 0.3), respectively.
View this table:
[in this window]
[in a new window]
|
Table 5. Results of Criterion with SUV, CR-Lung, and CR-Brain in 15 Nodules With Faintly Positive by Visual Estimation
|
|
|
Comment
|
|---|
Lowe and colleagues [8] reported that the SUV, CR-lung, and visual assessment were equally accurate methods of PET analysis for differentiating malignant from benign pulmonary nodules. The present study also obtained the same results for pulmonary nodules that were definitely positive or negative by visual assessment. For the nodules that were faintly positive, however, the SUV demonstrated a significantly lower sensitivity than both the CR-lung and the CR-brain. Histologically, 15 of 17 faintly positive malignant nodules were well- or moderately-differentiated adenocarcinoma. Therefore, although the semiquantitative methods (SUV, CR-lung, and CR-brain) do not improve the efficacy of visual assessment alone for nodules graded as definitely positive or negative, the CR-lung or CR-brain is superior to the SUV for nodules that are faintly positive on visual estimation, which are often differentiated adenocarcinomas. The CR-lung and CR-brain are equally useful, but only the former is available when PET scans are confined to the chest.
An SUV cut-off value of 2.5 has been reported to show a lower sensitivity than visual assessment [23]. Our study also demonstrated the same results, ie, none of the faintly positive malignant nodules had an SUV greater than or equal to 2.5. It has been reported that several factors can affect the SUV, such as the body size [9–11], blood glucose concentration [12, 13], time after injection [14, 15], and lesion size [15, 16]. Whereas the method of body weight normalization used to calculate the SUV is based on the assumption that FDG is distributed equally to all normal tissues, fat shows lower FDG uptake than most other tissues, causing that the SUV actually varies according to the body fat content. Hyperglycemia is also known to cause a decrease of FDG uptake in malignant nodules due to competitive inhibition by high serum glucose concentrations [12, 13]. While we determined that the cut-off value for SUV was 2.5 from the ROC curve based on 161 nodules of the present study, the SUV was still inferior to the CR-lung or CR-brain for the visually faintly positive nodules. If the cut-off value was changed from 2.5 to 2.0, the sensitivity of the SUV increased from 0.56 to 0.63, but the specificity declined from 0.78 to 0.61 (Fig 1). Therefore, we consider that the SUV is not appropriate for evaluation of pulmonary nodules less than 3 cm in diameter with faintly positive on visual assessment.
Although the present study found that both of the CR-lung and CR-brain were superior to the SUV for evaluating nodules that were faintly positive on visual estimation, most of the well-differentiated adenocarcinomas were still negative even using CR-lung or CR-brain. It has been reported that well-differentiated adenocarcinomas show a high false-negative rate on PET because of low glucose metabolism and low tumor cell density [20, 24, 25]. Therefore, it should be kept in mind that small pulmonary nodules showing negative FDG uptake could be well-differentiated adenocarcinomas, especially for nodules showing ground-grass opacity on CT, which is not unusual finding of well-differentiated adenocarcinoma [20, 26]. Accordingly, both CT and PET findings should be equally considered before making a final decision of surgical biopsy for small pulmonary nodules.
View larger version (15K):
[in this window]
[in a new window]
|
Fig 3. The ROC curve and CR-brain value for diagnosing malignancy for pulmonary nodules 1 to 3 cm in size. Highest activities in the tumor ROI (T) and in the cerebellum ROI (C) were measured. The CR was calculated by T/C in each nodule as an index of FDG uptake. (CR = contrast ratio; FDG = fluorodeoxyglucose; ROC = receiver operating characteristics; ROI = region of interest.)
|
|
|
References
|
|---|
- Kaneko M, Eguchi K, Ohmatsu H, et al. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography Radiology 1996;201:798-802.[Abstract/Free Full Text]
- Nomori H, Horio H, Fuyuno G, Kobayashi R, Morinaga S, Suemasu K. Lung adenocarcinomas diagnosed by open or thoracoscopic vs. bronchoscopic biopsy Chest 1998;114:40-44.[Abstract/Free Full Text]
- Scott WJ, Schwabe JL, Gupta NC, et al. Positron emission tomography of lung tumors and mediastinal lymph nodes using[18F]fluorodeoxyglucose Ann Thorac Surg 1994;58:698-703.[Abstract]
- Patz EF, Lowe VJ, Hoffman JM, et al. Focal pulmonary abnormalities: Evaluation with F-18 Fluorodeoxyglucose PET scanning Radiology 1993;188:487-490.[Abstract/Free Full Text]
- Gupta NC, Maloof J, Gunel E. Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET J Nucl Med 1996;37:943-948.[Abstract/Free Full Text]
- Gupta NC, Gill H, Graeber G, et al. Dynamic positron emission tomography with F-18 fluorodeoxyglucose imaging in differentiation of benign from malignant lung/mediastinal lesions Chest 1998;114:1105-1111.[Abstract/Free Full Text]
- Gambhir SS, Shepherd JE, Shah BD, et al. Analytical decision model for the cost-effectiveness management of solitary pulmonary nodules J Clin Oncol 1998;16:2113-2125.[Abstract]
- Lowe VJ, Hoffman JM, DeLong DM, Patz EF, Coleman RE. Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities J Nucl Med 1994;35:1771-1776.[Abstract/Free Full Text]
- Zasadny KR, Wahl RL. Standarized uptake values of normal tissues at PET with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose: variations with body weight and a method for correction Radiology 1993;189:847-850.[Abstract/Free Full Text]
- Kim CK, Gupta NC, Chandramouli B, Alavi A. Standarized uptake values of FDG: body surface area correction is preferable to body weight correction J Nucl Med 1994;35:164-167.[Abstract/Free Full Text]
- Kim CK, Gupta NC. Dependency of standardized uptake values of fluorine-18 fluorodeoxyglucose on body size: comparison of body surface area correction and lean body mass correction Nucl Med Commun 1996;17:890-894.[Medline]
- Lindholm P, Minn H, Leskinen-Kallio S, Bergman J, Ruotsalainen U, Joensuu H. Influence of the blood glucose concentration on FDG uptake in cancer: a PET study J Nucl Med 1993;34:1-6.[Abstract/Free Full Text]
- Langen KJ, Braun U, Rota Kops E, et al. The influence of plasma glucose levels of fluorine-18-fluorodeoxyglucose uptake in bronchial carcinomas J Nucl Med 1993;34:355-359.[Abstract/Free Full Text]
- Hamberg LM, Hunter GI, Alpert NM, Choi NC, Babich JW, Fischman AJ. The dose uptake ratio as an index of glucose metabolixm: useful parameter or oversimplification? J Nucl Med 1994;35:1308-1312.[Abstract/Free Full Text]
- Cremerius U, Fabry U, Neuerburg J, Zimny M, Osieka R, Buell U. Positron emission tomography with 18F-FDG to detect residual disease after therapy for malignant lymphoma Nucl Med Commun 1998;19:1055-1063.[Medline]
- Menda Y, Bushnell DL, Madsen MT, McLaughlin K, Kahn D, Kernstine KH. Evaluation of various corrections to the standardized uptake value for diagnosis of pulmonary malignancy Nucl Med Commun 2001;22:1077-1081.[Medline]
- Dewan NA, Gupta NC, Redepenning LS, et al. Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodulesPotential role in evaluation and management. Chest 1993;104:997-1002.[Abstract/Free Full Text]
- Imdahl A, Jenkner S, Brink I, et al. Validation of FDG positron emission tomography for differentiation of unknown pulmonary lesions Eur J Cardiothorac Surg 2001;20:324-329.[Abstract/Free Full Text]
- Lowe VJ, Fletcher JW, Gobar L, et al. Prospective investigation of positron emission tomography in lung nodules J Clin Onclol 1998;16:1075-1084.
- Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images Lung Cancer 2004;45:19-27.[Medline]
- Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. The size of metastatic foci and lymph nodes yielding false-negative and false-positive lymph node staging with positron emission tomography in patients with lung cancer J Thorac Cardiovasc Surg 2004;127:1087-1092.[Abstract/Free Full Text]
- Moses LE, Shapiro D, Littenberg B. Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations Stat Med 1993;12:1293-1316.[Medline]
- Al-Sugair A, Coleman RE. Applications of PET in lung cancer Semin Nucl Med 1998;28:303-319.[Medline]
- Higashi K, Ueda Y, Seki H, et al. Fluorine-18-FDG PET imaging is negative in bronchioloalveolar carcinoma J Nucl Med 1998;39:1016-1020.[Abstract/Free Full Text]
- Nomori H, Watanabe K, Ohtsuka T, et al. F-18 fluorodeoxyglucose (FDG) PET scanning can predict lymph node metastasis and tumor invasiveness in clinical T1N0M0 lung adenocarcinoma. J Thorac Cardiovasc Surg 2004;128:396–401..
- Nomori H, Ohtsuka T, Naruke T, Suemasu K. Histogram analysis of computed tomography numbers of clinical T1N0M0 lung adenocarcinoma, with special reference to lymph node metastasis and tumor invasiveness J Thorac Cardiovasc Surg 2003;126:1584-1589.[Abstract/Free Full Text]
This article has been cited by other articles:
|
|
|
|
 
Y. Ohba, H. Nomori, H. Shibata, H. Kobayashi, T. Mori, S. Shiraishi, and R. Nakashima
Evaluation of Semiquantitative Assessments of Fluorodeoxyglucose Uptake on Positron Emission Tomography Scans for the Diagnosis of Pulmonary Malignancies 1 to 3 cm in Size.
Ann. Thorac. Surg.,
March 1, 2009;
87(3):
886 - 891.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. H. Kernstine and G. L. Grunkemeier
Invited commentary.
Ann. Thorac. Surg.,
March 1, 2009;
87(3):
891 - 892.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Nomori, T. Mori, K. Ikeda, K. Kawanaka, S. Shiraishi, K. Katahira, and Y. Yamashita
Diffusion-weighted magnetic resonance imaging can be used in place of positron emission tomography for N staging of non-small cell lung cancer with fewer false-positive results.
J. Thorac. Cardiovasc. Surg.,
April 1, 2008;
135(4):
816 - 822.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Cronin, B. A. Dwamena, A. M. Kelly, and R. C. Carlos
Solitary Pulmonary Nodules: Meta-analytic Comparison of Cross-sectional Imaging Modalities for Diagnosis of Malignancy
Radiology,
March 1, 2008;
246(3):
772 - 782.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. C. Ung, D. E. Maziak, J. A. Vanderveen, C. A. Smith, K. Gulenchyn, C. Lacchetti, W. K. Evans, and Lung Cancer Disease Site Group of Cancer Care Onta
18Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis and Staging of Lung Cancer: A Systematic Review
J Natl Cancer Inst,
December 5, 2007;
99(23):
1753 - 1767.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kaji, H. Nomori, K. Watanabe, T. Ohtsuka, T. Naruke, K. Suemasu, and K. Uno
11C-Acetate and 18F-Fluorodeoxyglucose Positron Emission Tomography of Pulmonary Adenocarcinoma
Ann. Thorac. Surg.,
January 1, 2007;
83(1):
312 - 314.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Bryant and R. J. Cerfolio
The maximum standardized uptake values on integrated FDG-PET/CT is useful in differentiating benign from malignant pulmonary nodules.
Ann. Thorac. Surg.,
September 1, 2006;
82(3):
1016 - 1020.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. H. Khandani and F. C. Detterbeck
Positron emission tomographic scanning in the diagnosis and staging of non-small cell lung cancer 2 cm in size or less
J. Thorac. Cardiovasc. Surg.,
July 1, 2006;
132(1):
214 - 215.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.-i. Watanabe, H. Nomori, T. Ohtsuka, T. Naruke, A. Ebihara, H. Orikasa, K. Yamazaki, K. Uno, T. Kobayashi, and T. Goya
[F-18]Fluorodeoxyglucose Positron Emission Tomography Can Predict Pathological Tumor Stage and Proliferative Activity Determined by Ki-67 in Clinical Stage IA Lung Adenocarcinomas
Jpn. J. Clin. Oncol.,
July 1, 2006;
36(7):
403 - 409.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Hashimoto, T. Tsujikawa, C. Kondo, M. Maki, M. Momose, A. Nagai, T. Ohnuki, T. Nishikawa, and K. Kusakabe
Accuracy of PET for Diagnosis of Solid Pulmonary Lesions with 18F-FDG Uptake Below the Standardized Uptake Value of 2.5
J. Nucl. Med.,
March 1, 2006;
47(3):
426 - 431.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Bunyaviroch and R. E. Coleman
PET Evaluation of Lung Cancer
J. Nucl. Med.,
March 1, 2006;
47(3):
451 - 469.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Nomori, N. Kosaka, K. Watanabe, T. Ohtsuka, T. Naruke, T. Kobayashi, and K. Uno
11C-Acetate Positron Emission Tomography Imaging for Lung Adenocarcinoma 1 to 3 cm in Size With Ground-Glass Opacity Images on Computed Tomography
Ann. Thorac. Surg.,
December 1, 2005;
80(6):
2020 - 2025.
[Abstract]
[Full Text]
[PDF]
|
|
|
Top
Abstract
Introduction
