Added diagnostic value of respiratory-gated 4D 18F–FDG PET/CT in the detection of liver lesions: a multicenter study

Cinzia Crivellaro, Elena de Ponti, Federica Elisei, Sabrina Morzenti, Maria Picchio, Valentino Bettinardi, Annibale Versari, Federica Fioroni, Miroslaw Dziuk, Konrad Tkaczewski, Renée Ahond-Vionnet, Guillaume Nodari, Sergio Todde, Claudio Landoni, Luca Guerra

Research output: Contribution to journalArticle

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Abstract

Purpose: The aim of the present study was to evaluate the added diagnostic value of respiratory-gated 4D18F–FDG PET/CT in liver lesion detection and characterization in a European multicenter retrospective study. Methods: Fifty-six oncological patients (29 males and 27 females, mean age, 61.2 ± 11.2 years) from five European centers, submitted to standard 3D–PET/CT and liver 4D–PET/CT were retrospectively evaluated. Based on visual analysis, liver PET/CT findings were scored as positive, negative, or equivocal both in 3D and 4D PET/CT. The impact of 4D–PET/CT on the confidence in classifying liver lesions was assessed. PET/CT findings were compared to histology and clinical follow-up as standard reference and diagnostic accuracy was calculated for both techniques. At semi-quantitative analysis, SUVmax was calculated for each detected lesion in 3D and 4D–PET/CT. Results: Overall, 72 liver lesions were considered for the analysis. Based on visual analysis in 3D–PET/CT, 32/72 (44.4%) lesions were considered positive, 21/72 (29.2%) negative, and 19/72 (26.4%) equivocal, while in 4D–PET/CT 48/72 (66.7%) lesions were defined positive, 23/72 (31.9%) negative, and 1/72 (1.4%) equivocal. 4D–PET/CT findings increased the confidence in lesion definition in 37/72 lesions (51.4%). Considering 3D equivocal lesions as positive, sensitivity, specificity, and accuracy were 88.9, 70.0, and 83.1%, respectively, while the same figures were 67.7, 90.0, and 73.8% if 3D equivocal findings were included as negative. 4D–PET/CT sensitivity, specificity, and accuracy were 97.8, 90.0, and 95.4%, respectively, considering equivocal lesions as positive and 95.6, 90.0, and 93.8% considering equivocal lesions as negative. The SUVmax of the liver lesions in 4D–PET (mean ± SD, 6.9 ± 3.2) was significantly higher (p < 0.001) than SUVmax in 3D–PET (mean ± SD, 5.2 ± 2.3). Conclusions: Respiratory-gated PET/CT technique is a valuable clinical tool in diagnosing liver lesions, reducing 3D undetermined findings, improving diagnostic accuracy, and confidence in reporting. 4D–PET/CT also improved the quantification of SUVmax of liver lesions.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
DOIs
Publication statusAccepted/In press - Aug 19 2017

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Multicenter Studies
Liver
Four-Dimensional Computed Tomography
Sensitivity and Specificity
Histology
Retrospective Studies

Keywords

  • Computed tomography
  • Liver lesion detection/characterization
  • Positron emission tomography
  • Respiratory gating
  • SUV

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Added diagnostic value of respiratory-gated 4D 18F–FDG PET/CT in the detection of liver lesions : a multicenter study. / Crivellaro, Cinzia; de Ponti, Elena; Elisei, Federica; Morzenti, Sabrina; Picchio, Maria; Bettinardi, Valentino; Versari, Annibale; Fioroni, Federica; Dziuk, Miroslaw; Tkaczewski, Konrad; Ahond-Vionnet, Renée; Nodari, Guillaume; Todde, Sergio; Landoni, Claudio; Guerra, Luca.

In: European Journal of Nuclear Medicine and Molecular Imaging, 19.08.2017, p. 1-8.

Research output: Contribution to journalArticle

Crivellaro, Cinzia ; de Ponti, Elena ; Elisei, Federica ; Morzenti, Sabrina ; Picchio, Maria ; Bettinardi, Valentino ; Versari, Annibale ; Fioroni, Federica ; Dziuk, Miroslaw ; Tkaczewski, Konrad ; Ahond-Vionnet, Renée ; Nodari, Guillaume ; Todde, Sergio ; Landoni, Claudio ; Guerra, Luca. / Added diagnostic value of respiratory-gated 4D 18F–FDG PET/CT in the detection of liver lesions : a multicenter study. In: European Journal of Nuclear Medicine and Molecular Imaging. 2017 ; pp. 1-8.
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title = "Added diagnostic value of respiratory-gated 4D 18F–FDG PET/CT in the detection of liver lesions: a multicenter study",
abstract = "Purpose: The aim of the present study was to evaluate the added diagnostic value of respiratory-gated 4D18F–FDG PET/CT in liver lesion detection and characterization in a European multicenter retrospective study. Methods: Fifty-six oncological patients (29 males and 27 females, mean age, 61.2 ± 11.2 years) from five European centers, submitted to standard 3D–PET/CT and liver 4D–PET/CT were retrospectively evaluated. Based on visual analysis, liver PET/CT findings were scored as positive, negative, or equivocal both in 3D and 4D PET/CT. The impact of 4D–PET/CT on the confidence in classifying liver lesions was assessed. PET/CT findings were compared to histology and clinical follow-up as standard reference and diagnostic accuracy was calculated for both techniques. At semi-quantitative analysis, SUVmax was calculated for each detected lesion in 3D and 4D–PET/CT. Results: Overall, 72 liver lesions were considered for the analysis. Based on visual analysis in 3D–PET/CT, 32/72 (44.4{\%}) lesions were considered positive, 21/72 (29.2{\%}) negative, and 19/72 (26.4{\%}) equivocal, while in 4D–PET/CT 48/72 (66.7{\%}) lesions were defined positive, 23/72 (31.9{\%}) negative, and 1/72 (1.4{\%}) equivocal. 4D–PET/CT findings increased the confidence in lesion definition in 37/72 lesions (51.4{\%}). Considering 3D equivocal lesions as positive, sensitivity, specificity, and accuracy were 88.9, 70.0, and 83.1{\%}, respectively, while the same figures were 67.7, 90.0, and 73.8{\%} if 3D equivocal findings were included as negative. 4D–PET/CT sensitivity, specificity, and accuracy were 97.8, 90.0, and 95.4{\%}, respectively, considering equivocal lesions as positive and 95.6, 90.0, and 93.8{\%} considering equivocal lesions as negative. The SUVmax of the liver lesions in 4D–PET (mean ± SD, 6.9 ± 3.2) was significantly higher (p < 0.001) than SUVmax in 3D–PET (mean ± SD, 5.2 ± 2.3). Conclusions: Respiratory-gated PET/CT technique is a valuable clinical tool in diagnosing liver lesions, reducing 3D undetermined findings, improving diagnostic accuracy, and confidence in reporting. 4D–PET/CT also improved the quantification of SUVmax of liver lesions.",
keywords = "Computed tomography, Liver lesion detection/characterization, Positron emission tomography, Respiratory gating, SUV",
author = "Cinzia Crivellaro and {de Ponti}, Elena and Federica Elisei and Sabrina Morzenti and Maria Picchio and Valentino Bettinardi and Annibale Versari and Federica Fioroni and Miroslaw Dziuk and Konrad Tkaczewski and Ren{\'e}e Ahond-Vionnet and Guillaume Nodari and Sergio Todde and Claudio Landoni and Luca Guerra",
year = "2017",
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doi = "10.1007/s00259-017-3795-0",
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journal = "European Journal of Pediatrics",
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TY - JOUR

T1 - Added diagnostic value of respiratory-gated 4D 18F–FDG PET/CT in the detection of liver lesions

T2 - a multicenter study

AU - Crivellaro, Cinzia

AU - de Ponti, Elena

AU - Elisei, Federica

AU - Morzenti, Sabrina

AU - Picchio, Maria

AU - Bettinardi, Valentino

AU - Versari, Annibale

AU - Fioroni, Federica

AU - Dziuk, Miroslaw

AU - Tkaczewski, Konrad

AU - Ahond-Vionnet, Renée

AU - Nodari, Guillaume

AU - Todde, Sergio

AU - Landoni, Claudio

AU - Guerra, Luca

PY - 2017/8/19

Y1 - 2017/8/19

N2 - Purpose: The aim of the present study was to evaluate the added diagnostic value of respiratory-gated 4D18F–FDG PET/CT in liver lesion detection and characterization in a European multicenter retrospective study. Methods: Fifty-six oncological patients (29 males and 27 females, mean age, 61.2 ± 11.2 years) from five European centers, submitted to standard 3D–PET/CT and liver 4D–PET/CT were retrospectively evaluated. Based on visual analysis, liver PET/CT findings were scored as positive, negative, or equivocal both in 3D and 4D PET/CT. The impact of 4D–PET/CT on the confidence in classifying liver lesions was assessed. PET/CT findings were compared to histology and clinical follow-up as standard reference and diagnostic accuracy was calculated for both techniques. At semi-quantitative analysis, SUVmax was calculated for each detected lesion in 3D and 4D–PET/CT. Results: Overall, 72 liver lesions were considered for the analysis. Based on visual analysis in 3D–PET/CT, 32/72 (44.4%) lesions were considered positive, 21/72 (29.2%) negative, and 19/72 (26.4%) equivocal, while in 4D–PET/CT 48/72 (66.7%) lesions were defined positive, 23/72 (31.9%) negative, and 1/72 (1.4%) equivocal. 4D–PET/CT findings increased the confidence in lesion definition in 37/72 lesions (51.4%). Considering 3D equivocal lesions as positive, sensitivity, specificity, and accuracy were 88.9, 70.0, and 83.1%, respectively, while the same figures were 67.7, 90.0, and 73.8% if 3D equivocal findings were included as negative. 4D–PET/CT sensitivity, specificity, and accuracy were 97.8, 90.0, and 95.4%, respectively, considering equivocal lesions as positive and 95.6, 90.0, and 93.8% considering equivocal lesions as negative. The SUVmax of the liver lesions in 4D–PET (mean ± SD, 6.9 ± 3.2) was significantly higher (p < 0.001) than SUVmax in 3D–PET (mean ± SD, 5.2 ± 2.3). Conclusions: Respiratory-gated PET/CT technique is a valuable clinical tool in diagnosing liver lesions, reducing 3D undetermined findings, improving diagnostic accuracy, and confidence in reporting. 4D–PET/CT also improved the quantification of SUVmax of liver lesions.

AB - Purpose: The aim of the present study was to evaluate the added diagnostic value of respiratory-gated 4D18F–FDG PET/CT in liver lesion detection and characterization in a European multicenter retrospective study. Methods: Fifty-six oncological patients (29 males and 27 females, mean age, 61.2 ± 11.2 years) from five European centers, submitted to standard 3D–PET/CT and liver 4D–PET/CT were retrospectively evaluated. Based on visual analysis, liver PET/CT findings were scored as positive, negative, or equivocal both in 3D and 4D PET/CT. The impact of 4D–PET/CT on the confidence in classifying liver lesions was assessed. PET/CT findings were compared to histology and clinical follow-up as standard reference and diagnostic accuracy was calculated for both techniques. At semi-quantitative analysis, SUVmax was calculated for each detected lesion in 3D and 4D–PET/CT. Results: Overall, 72 liver lesions were considered for the analysis. Based on visual analysis in 3D–PET/CT, 32/72 (44.4%) lesions were considered positive, 21/72 (29.2%) negative, and 19/72 (26.4%) equivocal, while in 4D–PET/CT 48/72 (66.7%) lesions were defined positive, 23/72 (31.9%) negative, and 1/72 (1.4%) equivocal. 4D–PET/CT findings increased the confidence in lesion definition in 37/72 lesions (51.4%). Considering 3D equivocal lesions as positive, sensitivity, specificity, and accuracy were 88.9, 70.0, and 83.1%, respectively, while the same figures were 67.7, 90.0, and 73.8% if 3D equivocal findings were included as negative. 4D–PET/CT sensitivity, specificity, and accuracy were 97.8, 90.0, and 95.4%, respectively, considering equivocal lesions as positive and 95.6, 90.0, and 93.8% considering equivocal lesions as negative. The SUVmax of the liver lesions in 4D–PET (mean ± SD, 6.9 ± 3.2) was significantly higher (p < 0.001) than SUVmax in 3D–PET (mean ± SD, 5.2 ± 2.3). Conclusions: Respiratory-gated PET/CT technique is a valuable clinical tool in diagnosing liver lesions, reducing 3D undetermined findings, improving diagnostic accuracy, and confidence in reporting. 4D–PET/CT also improved the quantification of SUVmax of liver lesions.

KW - Computed tomography

KW - Liver lesion detection/characterization

KW - Positron emission tomography

KW - Respiratory gating

KW - SUV

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