Using neighborhood gray tone difference matrix texture features on dual time point PET/CT images to differentiate malignant from benign FDG-avid solitary pulmonary nodules

Cancer Imaging. 2019 Aug 16;19(1):56. doi: 10.1186/s40644-019-0243-3.


Objective: Lung cancer usually presents as a solitary pulmonary nodule (SPN) on diagnostic imaging during the early stages of the disease. Since the early diagnosis of lung cancer is very important for treatment, the accurate diagnosis of SPNs has much importance. The aim of this study was to evaluate the discriminant power of dual time point imaging (DTPI) PET/CT in the differentiation of malignant and benign FDG-avid solitary pulmonary nodules by using neighborhood gray-tone difference matrix (NGTDM) texture features.

Methods: Retrospective analysis was carried out on 116 patients with SPNs (35 benign and 81 malignant) who had DTPI 18F-FDG PET/CT between January 2005 and May 2015. Both PET and CT images were acquired at 1 h and 3 h after injection. The SUVmax and NGTDM texture features (coarseness, contrast, and busyness) of each nodule were calculated on dual time point images. Patients were randomly divided into training and validation datasets. Receiver operating characteristic (ROC) curve analysis was performed on all texture features in the training dataset to calculate the optimal threshold for differentiating malignant SPNs from benign SPNs. For all the lesions in the testing dataset, two visual interpretation scores were determined by two nuclear medicine physicians based on the PET/CT images with and without reference to the texture features.

Results: In the training dataset, the AUCs of delayed busyness, delayed coarseness, early busyness, and early SUVmax were 0.87, 0.85, 0.75 and 0.75, respectively. In the validation dataset, the AUCs of visual interpretations with and without texture features were 0.89 and 0.80, respectively.

Conclusion: Compared to SUVmax or visual interpretation, NGTDM texture features derived from DTPI PET/CT images can be used as good predictors of SPN malignancy. Improvement in discriminating benign from malignant nodules using SUVmax and visual interpretation can be achieved by adding busyness extracted from delayed PET/CT images.

Keywords: Fluorodeoxyglucose F18; Lung neoplasms; Positron emission tomography computed tomography; Solitary pulmonary nodules.

MeSH terms

  • Aged
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography / methods*
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Solitary Pulmonary Nodule / diagnostic imaging*
  • Solitary Pulmonary Nodule / pathology


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18