Differentiating benign from malignant lung lesions using "quantitative" parameters of FDG PET images

Clin Nucl Med. 1996 Dec;21(12):941-9. doi: 10.1097/00003072-199612000-00005.


Fluorine-18 labeled deoxyglucose positron-emission tomography (FDG-PET) applications in oncology include the differential diagnosis of chest masses and single pulmonary nodules. However, FDG is not tumor-specific; rather, it also accumulates in inflammatory processes. This study was performed to identify image parameters that would improve the specificity of PET.

Methods: Twenty-six patients who had benign and malignant lung lesions were examined retrospectively. Positron-emission tomography data were acquired in dynamic scanning mode after intravenous bolus of 250-402 MBq of FDG. Standardized uptake values (SUVs) were calculated and Patlak analyses were performed in selected regions of interest in the PET images. Positron-emission tomography results were related to histological diagnosis (N = 49) or clinical follow-up (N = 3).

Results: The specificity and sensitivity of the original PET scan reports, which was based on visual image interpretation and loosely applied SUVs, was 100% and 73%, respectively. Using the SUVs with a cut-off value of 3.8 and Kpat value with a cut-off at 0.025 min-1 improved the specificity to 81% and 85%.

Conclusion: FDG-PET image interpretation can be facilitated by using SUV information or the accumulation rate of the radiotracer (Patlak). With additional validation, this method could have a significant cost-effective impact on the medical/surgical management of chest masses.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Cost-Benefit Analysis
  • Deoxyglucose / administration & dosage
  • Deoxyglucose / analogs & derivatives*
  • Deoxyglucose / pharmacokinetics
  • Diagnosis, Differential
  • Female
  • Fluorine Radioisotopes* / administration & dosage
  • Fluorine Radioisotopes* / pharmacokinetics
  • Fluorodeoxyglucose F18
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Injections, Intravenous
  • Lung Diseases / diagnostic imaging*
  • Lung Diseases / metabolism
  • Lung Diseases / pathology
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / metabolism
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Radiopharmaceuticals* / administration & dosage
  • Radiopharmaceuticals* / pharmacokinetics
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Solitary Pulmonary Nodule / diagnostic imaging
  • Solitary Pulmonary Nodule / metabolism
  • Solitary Pulmonary Nodule / pathology
  • Tomography, Emission-Computed* / economics
  • Tomography, X-Ray Computed


  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18
  • Deoxyglucose