Dynamisches Ganzkörper-[18F]FDG-PET/CT bei Patienten/innen mit Bronchialkarzinom

Abstract

Static [18F]FDG-PET/CT is the imaging method of choice for 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. Methods: 34 consecutive patients with indeterminate pulmonary lesions were enrolled in this prospective trial. All patients underwent a static (60 min p.i) and dynamic (0-60min p.i.) whole-body [18F]FDG-PET/CT (300 MBq) using multi-bed-multi-timepoint technique (Siemens mCT FlowMotion). Histology and follow-up served as ground truth. Kinetic modelling factors were calculated using a 2-compartment linear Patlak model (FDG influx rate constant =Ki, metabolic rate = MR-FDG, distribution volume = DV-FDG) and compared to SUV using ROC-analysis. Results: MR-FDGmean provided the best discriminatory power between benign and malignant lung lesions with AUC of 0.887. AUC of DV-FDGmean (0.818) and SUVmean (0.827) was non-significantly lower. For LNM, the AUCs for MR-FDGmean (0.987) and SUVmean (0.993) were comparable. Moreover, the DV-FDGmean in liver metastases was three times higher than in bone or lung metastases. Conclusions: Metabolic rate quantification was shown to be a reliable method to detect malign lung tumors, LNM and distant metastases at least as accurately as the established SUV or dual time-point PET scans.