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Performance of sodium iodide based 18F-fluorodeoxyglucose positron emission tomography in the characterization of indeterminate pulmonary nodules or masses

A G Pitman, BMedSc, MBBS, FRANZCR1, R J Hicks, MBBS, MD, FRACP1, D S Binns, DipAppSc, ANMT1, R E Ware, MBBS, FCP1, V Kalff, BMedSci, MBBS, FRACP1, A F McKenzie, MBBS, FRANZCR1, D L Ball, MBBS, FRANZCR2 and M P MacManus, MD, MRCP, FRCR2

Departments of 1Diagnostic Imaging and 2Radiation Oncology, Peter MacCallum Cancer Institute, St Andrews Place, East Melbourne, Victoria 3002, Australia



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  		Figure 1. Graph showing the correlation between tumour-to-blood pool ratio (TBPR) lesion size in millimetres and final diagnosis ({circ}, benign; , malignant) of the lesions for 50 indeterminate pulmonary masses or nodules examined with positron emission tomography.

 


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  		Figure 2. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) of an 82-year-old female with a newly identified asymptomatic 2.5 cm right upper lobe nodule. PET characterized the nodule as malignant, but in addition identified previously unsuspected metastases in the left iliac crest and lumbar subcutaneous tissues. Despite the PET findings, the patient underwent thoracotomy, which confirmed squamous cell carcinoma. The patient died of widespread metastases 2 months following the thoracotomy. (a) Axial image through the nodule (arrow) showing intense 18F-FDG uptake, consistent with malignancy. (b) Coronal image through the nodule (thin arrow), also showing focal increased 18F-FDG uptake in the left iliac crest (thick arrow) consistent with a metastasis. (c) Mid sagittal image showing a subcutaneous focus of markedly elevated 18F-FDG uptake (arrow) subsequently proven to be a subcutaneous metastasis.

 




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