FDG-PET and CT characterization of adrenal lesions in cancer patients

Suman Jana, Tong Zhang, David M. Milstein, Carmen R. Isasi, M. Donald Blaufox

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Purpose: Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) may differentiate benign from malignant adrenal lesions. In this study, standardized uptake values (SUVs), visual interpretation, and computed tomography (CT) data were correlated with the final diagnosis to determine the contribution of adrenal FDG-PET in patients with known non-adrenal cancer. Methods: Ninety-two patients with adrenal lesions on CT underwent FDG-PET. Eighty adrenals in 74 patients met the inclusion criteria (PET scan within 4 weeks of CT plus >1 year of follow-up after PET scan with repeat CT or biopsy for final diagnosis). CT was considered positive for metastases (CT+) based on two of the following three criteria: >4 cm, Hounsfield units (HU) >30, and delayed contrast enhancement. Lesions with <2 cm, with HU <20, and showing no enhancement were considered benign (CT-). Remaining lesions were considered indeterminate (CT-Ind). Visually, adrenal uptake exceeding liver uptake was considered PET positive (PET+). Diagnosis of metastases was based on biopsy or interval CT growth (unchanged >1 year=benign). SUVmax and SUVavg were calculated from a 4x4 pixel region of interest drawn from CT, PET, and fused images. A receiver operator curve (ROC) determined the SUV with the best sensitivity and specificity. Results: Overall, PET was 93% sensitive and 96% specific for metastases. A SUVmax of 3.4 was 95% sensitive and 86% specific. A SUVavg of 3.1 was 95% sensitive and 90% specific. There was no significant difference between visual interpretation and SUV (SUVmax or SUVavg). Among CT+ and CT- lesions, PET was 100% sensitive and 96% specific; CT was 86% sensitive and 100% specific. In the CT-Ind group, PET was 88% sensitive and 96% specific. Conclusion: PET accurately characterized adrenal lesions. Visual interpretation was as accurate as SUV. FDG-PET was most useful in the 52.5% of cancer patients with inconclusive adrenal lesions on CT.

Original languageEnglish (US)
Pages (from-to)29-35
Number of pages7
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume33
Issue number1
DOIs
StatePublished - Jan 2006

Fingerprint

Tomography
Positron-Emission Tomography
Neoplasms
Positron Emission Tomography Computed Tomography
Neoplasm Metastasis
Fluorodeoxyglucose F18
Biopsy
Sensitivity and Specificity

Keywords

  • Adrenal lesions
  • Adrenal metastases
  • FDG-PET
  • Image fusion
  • PET/CT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

FDG-PET and CT characterization of adrenal lesions in cancer patients. / Jana, Suman; Zhang, Tong; Milstein, David M.; Isasi, Carmen R.; Blaufox, M. Donald.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 33, No. 1, 01.2006, p. 29-35.

Research output: Contribution to journalArticle

Jana, Suman ; Zhang, Tong ; Milstein, David M. ; Isasi, Carmen R. ; Blaufox, M. Donald. / FDG-PET and CT characterization of adrenal lesions in cancer patients. In: European Journal of Nuclear Medicine and Molecular Imaging. 2006 ; Vol. 33, No. 1. pp. 29-35.
@article{dd92fb6dd7dc49d1bd44a7a20b806ef2,
title = "FDG-PET and CT characterization of adrenal lesions in cancer patients",
abstract = "Purpose: Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) may differentiate benign from malignant adrenal lesions. In this study, standardized uptake values (SUVs), visual interpretation, and computed tomography (CT) data were correlated with the final diagnosis to determine the contribution of adrenal FDG-PET in patients with known non-adrenal cancer. Methods: Ninety-two patients with adrenal lesions on CT underwent FDG-PET. Eighty adrenals in 74 patients met the inclusion criteria (PET scan within 4 weeks of CT plus >1 year of follow-up after PET scan with repeat CT or biopsy for final diagnosis). CT was considered positive for metastases (CT+) based on two of the following three criteria: >4 cm, Hounsfield units (HU) >30, and delayed contrast enhancement. Lesions with <2 cm, with HU <20, and showing no enhancement were considered benign (CT-). Remaining lesions were considered indeterminate (CT-Ind). Visually, adrenal uptake exceeding liver uptake was considered PET positive (PET+). Diagnosis of metastases was based on biopsy or interval CT growth (unchanged >1 year=benign). SUVmax and SUVavg were calculated from a 4x4 pixel region of interest drawn from CT, PET, and fused images. A receiver operator curve (ROC) determined the SUV with the best sensitivity and specificity. Results: Overall, PET was 93{\%} sensitive and 96{\%} specific for metastases. A SUVmax of 3.4 was 95{\%} sensitive and 86{\%} specific. A SUVavg of 3.1 was 95{\%} sensitive and 90{\%} specific. There was no significant difference between visual interpretation and SUV (SUVmax or SUVavg). Among CT+ and CT- lesions, PET was 100{\%} sensitive and 96{\%} specific; CT was 86{\%} sensitive and 100{\%} specific. In the CT-Ind group, PET was 88{\%} sensitive and 96{\%} specific. Conclusion: PET accurately characterized adrenal lesions. Visual interpretation was as accurate as SUV. FDG-PET was most useful in the 52.5{\%} of cancer patients with inconclusive adrenal lesions on CT.",
keywords = "Adrenal lesions, Adrenal metastases, FDG-PET, Image fusion, PET/CT",
author = "Suman Jana and Tong Zhang and Milstein, {David M.} and Isasi, {Carmen R.} and Blaufox, {M. Donald}",
year = "2006",
month = "1",
doi = "10.1007/s00259-005-1915-8",
language = "English (US)",
volume = "33",
pages = "29--35",
journal = "European Journal of Nuclear Medicine and Molecular Imaging",
issn = "1619-7070",
publisher = "Springer Verlag",
number = "1",

}

TY - JOUR

T1 - FDG-PET and CT characterization of adrenal lesions in cancer patients

AU - Jana, Suman

AU - Zhang, Tong

AU - Milstein, David M.

AU - Isasi, Carmen R.

AU - Blaufox, M. Donald

PY - 2006/1

Y1 - 2006/1

N2 - Purpose: Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) may differentiate benign from malignant adrenal lesions. In this study, standardized uptake values (SUVs), visual interpretation, and computed tomography (CT) data were correlated with the final diagnosis to determine the contribution of adrenal FDG-PET in patients with known non-adrenal cancer. Methods: Ninety-two patients with adrenal lesions on CT underwent FDG-PET. Eighty adrenals in 74 patients met the inclusion criteria (PET scan within 4 weeks of CT plus >1 year of follow-up after PET scan with repeat CT or biopsy for final diagnosis). CT was considered positive for metastases (CT+) based on two of the following three criteria: >4 cm, Hounsfield units (HU) >30, and delayed contrast enhancement. Lesions with <2 cm, with HU <20, and showing no enhancement were considered benign (CT-). Remaining lesions were considered indeterminate (CT-Ind). Visually, adrenal uptake exceeding liver uptake was considered PET positive (PET+). Diagnosis of metastases was based on biopsy or interval CT growth (unchanged >1 year=benign). SUVmax and SUVavg were calculated from a 4x4 pixel region of interest drawn from CT, PET, and fused images. A receiver operator curve (ROC) determined the SUV with the best sensitivity and specificity. Results: Overall, PET was 93% sensitive and 96% specific for metastases. A SUVmax of 3.4 was 95% sensitive and 86% specific. A SUVavg of 3.1 was 95% sensitive and 90% specific. There was no significant difference between visual interpretation and SUV (SUVmax or SUVavg). Among CT+ and CT- lesions, PET was 100% sensitive and 96% specific; CT was 86% sensitive and 100% specific. In the CT-Ind group, PET was 88% sensitive and 96% specific. Conclusion: PET accurately characterized adrenal lesions. Visual interpretation was as accurate as SUV. FDG-PET was most useful in the 52.5% of cancer patients with inconclusive adrenal lesions on CT.

AB - Purpose: Fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) may differentiate benign from malignant adrenal lesions. In this study, standardized uptake values (SUVs), visual interpretation, and computed tomography (CT) data were correlated with the final diagnosis to determine the contribution of adrenal FDG-PET in patients with known non-adrenal cancer. Methods: Ninety-two patients with adrenal lesions on CT underwent FDG-PET. Eighty adrenals in 74 patients met the inclusion criteria (PET scan within 4 weeks of CT plus >1 year of follow-up after PET scan with repeat CT or biopsy for final diagnosis). CT was considered positive for metastases (CT+) based on two of the following three criteria: >4 cm, Hounsfield units (HU) >30, and delayed contrast enhancement. Lesions with <2 cm, with HU <20, and showing no enhancement were considered benign (CT-). Remaining lesions were considered indeterminate (CT-Ind). Visually, adrenal uptake exceeding liver uptake was considered PET positive (PET+). Diagnosis of metastases was based on biopsy or interval CT growth (unchanged >1 year=benign). SUVmax and SUVavg were calculated from a 4x4 pixel region of interest drawn from CT, PET, and fused images. A receiver operator curve (ROC) determined the SUV with the best sensitivity and specificity. Results: Overall, PET was 93% sensitive and 96% specific for metastases. A SUVmax of 3.4 was 95% sensitive and 86% specific. A SUVavg of 3.1 was 95% sensitive and 90% specific. There was no significant difference between visual interpretation and SUV (SUVmax or SUVavg). Among CT+ and CT- lesions, PET was 100% sensitive and 96% specific; CT was 86% sensitive and 100% specific. In the CT-Ind group, PET was 88% sensitive and 96% specific. Conclusion: PET accurately characterized adrenal lesions. Visual interpretation was as accurate as SUV. FDG-PET was most useful in the 52.5% of cancer patients with inconclusive adrenal lesions on CT.

KW - Adrenal lesions

KW - Adrenal metastases

KW - FDG-PET

KW - Image fusion

KW - PET/CT

UR - http://www.scopus.com/inward/record.url?scp=28944446237&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=28944446237&partnerID=8YFLogxK

U2 - 10.1007/s00259-005-1915-8

DO - 10.1007/s00259-005-1915-8

M3 - Article

C2 - 16193311

AN - SCOPUS:28944446237

VL - 33

SP - 29

EP - 35

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

SN - 1619-7070

IS - 1

ER -