Respiratory gated PET/CT in a European multicentre retrospective study: Added diagnostic value in detection and characterization of lung lesions

Luca Guerra, Elena De Ponti, Federica Elisei, Valentino Bettinardi, Claudio Landoni, Maria Picchio, Maria Carla Gilardi, Annibale Versari, Federica Fioroni, Miroslaw Dziuk, Magdalena Koza, Renée Ahond-Vionnet, Bertrand Collin, Cristina Messa

Research output: Contribution to journalArticlepeer-review


Purpose: The aim of our work is to evaluate the added diagnostic value of respiratory gated (4-D) positron emission tomography/computed tomography (PET/CT) in lung lesion detection/characterization in a large patient population of a multicentre retrospective study. Methods: The data of 155 patients (89 men, 66 women, mean age 63.9 ± 11.1 years) from 5 European centres and submitted to standard (3-D) and 4-D PET/CT were retrospectively analysed. Overall, 206 lung lesions were considered for the analysis (mean ± SD lesions dimension 14.7 ± 11.8 mm). Maximum standardized uptake values (SUVmax) and lesion detectability were assessed for both 3-D and 4-D PET/CT studies; 3-D and 4-D PET/CT findings were compared to clinical follow-up as standard reference. Results: Mean ± SD 3-D and 4-D SUVmax values were 5.2 ± 5.1 and 6.8 ± 6.1 (p <0.0001), respectively, with an average percentage increase of 30.8 %. In 3-D PET/CT, 86 of 206 (41.7 %) lesions were considered positive, 70 of 206 (34 %) negative and 50 of 206 (24.3 %) equivocal, while in 4-D PET/CT 117 of 206 (56.8 %) lesions were defined as positive, 80 of 206 (38.8 %) negative and 9 of 206 (4.4 %) equivocal. In 34 of 50 (68 %) 3-D equivocal lesions follow-up data were available and the presence of malignancy was confirmed in 21 of 34 (61.8 %) lesions, while in 13 of 34 (38.2 %) was excluded. In 31 of these 34 controlled lesions, 20 of 34 (58.8 %) and 11 of 34 (32.4 %) were correctly classified by 4-D PET/CT as positive and negative, respectively; 3 of 34 (8.8 %) remained equivocal. With equivocal lesions classified as positive, the overall accuracy of 3-D and 4-D was 85.7 and 92.8 %, respectively, while the same figures were 80.5 and 94.2 % when equivocal lesions were classified as negative. Conclusion: The respiratory gated PET/CT technique is a valuable clinical tool in diagnosing lung lesions, improving quantification and confidence in reporting, reducing 3-D undetermined findings and increasing the overall accuracy in lung lesion detection and characterization.

Original languageEnglish
Pages (from-to)1381-1390
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number9
Publication statusPublished - Sep 2012


  • Computed tomography
  • Lung lesion detection/characterization
  • Positron emission tomography
  • Respiratory gating

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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