Impact of computer-aided CT and PET analysis on non-invasive T staging in patients with lung cancer and atelectasis

• Verfasst von: Flechsig, Paul [VerfasserIn]
• Verfasst von: Rastgoo, Ramin [VerfasserIn]
• Verfasst von: Kratochwil, Clemens [VerfasserIn]
• Verfasst von: Martin, Ole [VerfasserIn]
• Verfasst von: Holland-Letz, Tim [VerfasserIn]
• Verfasst von: Harms, Alexander [VerfasserIn]
• Verfasst von: Kauczor, Hans-Ulrich [VerfasserIn]
• Verfasst von: Haberkorn, Uwe [VerfasserIn]
• Verfasst von: Giesel, Frederik L. [VerfasserIn]
• Titel: Impact of computer-aided CT and PET analysis on non-invasive T staging in patients with lung cancer and atelectasis
• Verf.angabe: Paul Flechsig, Ramin Rastgoo, Clemens Kratochwil, Ole Martin, Tim Holland-Letz, Alexander Harms, Hans-Ulrich Kauczor, Uwe Haberkorn & Frederik L. Giesel
• E-Jahr: 2018
• Jahr: 20 December 2018
• Umfang: 9 S.
• Fussnoten: Gesehen am 23.04.2020
• Titel Quelle: Enthalten in: Molecular imaging & biology
• Ort Quelle: Cham : Springer Nature Switzerland, 2002
• Jahr Quelle: 2018
• Band/Heft Quelle: 20(2018), 6, Seite 1044-1052
• ISSN Quelle: 1860-2002
• DOI: doi:10.1007/s11307-018-1196-9
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Aged
• Sach-SW: Area Under Curve
• Sach-SW: Computed tomography
• Sach-SW: FDG-PET/CT
• Sach-SW: Female
• Sach-SW: Fluorodeoxyglucose F18
• Sach-SW: Humans
• Sach-SW: Lung cancer
• Sach-SW: Lung Neoplasms
• Sach-SW: Male
• Sach-SW: Neoplasm Staging
• Sach-SW: Positron Emission Tomography Computed Tomography
• Sach-SW: Pulmonary Atelectasis
• Sach-SW: ROC Curve
• Sach-SW: Staging
• Sach-SW: Tomography, X-Ray Computed
• K10plus-PPN: 1695802020

Abstract

PURPOSE: Tumor delineation within an atelectasis in lung cancer patients is not always accurate. When T staging is done by integrated 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG)-positron emission tomography (PET)/X-ray computer tomography (CT), tumors of neuroendocrine differentiation and slowly growing tumors can present with reduced FDG uptake, thus aggravating an exact T staging. In order to further exhaust information derived from [18F]FDG-PET/CT, we evaluated the impact of CT density and maximum standardized uptake value (SUVmax) for the classification of different tumor subtypes within a surrounding atelectasis, as well as possible cutoff values for the differentiation between the primary tumor and atelectatic lung tissue. - PROCEDURES: Seventy-two patients with histologically proven lung cancer and adjacent atelectasis were investigated. Non-contrast-enhanced [18F]FDG-PET/CT was performed within 2 weeks before surgery/biopsy. Boundaries of the primary within the atelectasis were determined visually on the basis of [18F]FDG uptake; CT density was quantified manually within each primary and each atelectasis. - RESULTS: CT density of the primary (36.4 Hounsfield units (HU) ± 6.2) was significantly higher compared to that of atelectatic lung (24.3 HU ± 8.3; p < 0.01), irrespective of the histological subtype. The discrimination between different malignant tumors using density analysis failed. SUVmax was increased in squamous cell carcinomas compared to adenocarcinomas. Irrespective of the malignant subtype, a possible cutoff value of 24 HU may help to exclude the presence of a primary in lesions below 24 HU, whereas a density above a threshold of 40 HU can help to exclude atelectatic lung. - CONCLUSION: Density measurements in patients with lung cancer and surrounding atelectasis may help to delineate the primary tumor, irrespective of the specific lung cancer subtype. This could improve T staging and radiation treatment planning (RTP) without additional application of a contrast agent in CT, or an additional magnetic resonance imaging (MRI), even in cases of lung tumors of neuroendocrine differentiation or in slowly growing tumors with less avidity to [18F]FDG.