Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
권호 표지

The Usefulness of F-18 FDG PET to Discriminate between Malignant and benign Nodule in Idiopathic Pulmonary Fibrosis

특발성 폐섬유증에서 발견된 폐결절의 악성여부 감별에서 F-18 FDG PET의 유용성

  • Kim, Bom-Sahn (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Kang, Won-Jun (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Dong-Soo (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Chung, June-Key (Department of Nuclear Medicine, Seoul National University College of Medicine) ;
  • Lee, Myung-Chul (Department of Nuclear Medicine, Seoul National University College of Medicine)
  • 김범산 (서울대학교 의과대학 핵의학교실) ;
  • 강원준 (서울대학교 의과대학 핵의학교실) ;
  • 이동수 (서울대학교 의과대학 핵의학교실) ;
  • 정준기 (서울대학교 의과대학 핵의학교실) ;
  • 이명철 (서울대학교 의과대학 핵의학교실)
  • Published : 2006.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Incidence of lung canter in patients with idiopathic pulmonary fibrosis (IPF) is known to be higher than that in general population. However, it is difficult to discriminate pulmonary nodule in patients with IPF, because underlying IPF can be expressed as lung nodules. We evaluated the diagnostic performance of FDG PET in discriminating lung nodule in patients with IPF. Methods: We retrospectively reviewed 28 lung nodules in 16 subjects (age; $67.53{\pm}9.53$, M:F=14:2). Two patients had previous history of malignant cancer (small cell lung cancer and subglottic cancer). The diagnostic criteria on chest CT were size, morphology and serial changes of size. FDG PET was visually interpreted, and maximal SUV was calculated for quantitative analysis. Results: from 28 nodules, 18 nodules were interpreted as benign nodules, 10 nodules as malignant nodules by histopahthology or follow-up chest CT. The sensitivity and specificity of FDG PET were 100% and 94.4%, while those of CT were 70.0% and 44.4%, respectively. Malignant nodule was higher maxSUV than that of benign lung nodules ($7.68{\pm}3.96\;vs.\;1.22{\pm}0.65$, p<0.001). Inflammatory lesion in underlying IPF was significantly lower maxSUV than that of malignant nodules ($1.80{\pm}0.43$, p<0.001). The size of malignant and benign nodule were $23.95{\pm}10.15mm\;and\;10.83{\pm}5.23mm$ (p<0.01). Conclusion: FDG PET showed superior diagnostic performance to chest CT in differentiating lung nodules in patients with underlying IPF. FDG PET could be used to evaluate suspicious malignant lung nodule detected by chest in patients with IPF.

목적: 특발성 폐섬유증(Idiopathic pulmonary fibrosis: IPF)에서 폐암의 발생빈도가 정상인에 비하여 증가되어 있음이 알려져 있다. IPF 환자의 흥부전산화단층촬영(chest CT)에서 폐 결절이 관찰되는 경우 폐암의 발생과 IPF자체의 결절을 감별하기 어렵다. 이 연구에서는 IPF 환자의 chest CT에서 관찰된 결절의 악성 여부를 FDG PET을 이용해 분석하였다. 대상 및 방법 : IPF로 진단된 환자 중, chest CT에서 악성 결절이 의심되어 FDG PET을 시행한 16명을 대상으로 하였다. 총 16명 (남: 14, 여: 2, 나이: $67.53{\pm}9.83$세)의 환자에서 관찰된 28개의 결절에 대하여 FDG PET과 CT소견을 분석 하였다. 대상 환자 중 2명은 소세포암과 성문하암으로 치료 받은 병력이 있었으며, 나머지 환자는 악성종양의 기왕력이 없었다. 결절의 악성도 여부는 조직검사와 CT 추적검사로 판정 하였다. 결과 : 10개 의 결절은 폐암으로 진단되었고, 18개의 결절은 양성 결절로 판정되었다(조직병리검사: 6예, chest CT 추적검사: 22예). FDG PET의 예민도는 100%이었으며 특이도는 94.4%이었다. 크기와 형태 및 크기 변화 등을 참고한 CT의 예민도는 70%이었고.특이도는 44.4%이었다. 악성 결절의 maxSUV는 $7.68{\pm}3.96$, 양성 결절은 $1.22{\pm}0.65$ 이었다(p<0.001). 폐섬유증부위에서 측정한 maxSUV는 $1.80{\pm}0.43$로써 악성 결절보다 낮은 값이었으며, 양성 결절보다는 높은 값이었다(p<0.001; p<0.001). CT에서 측정한 악성 결절의 크기는 $23.95{\pm}10.15mm$, 양성 결절은 $10.83{\pm}5.23mm$이었다(p<0.02). 결론 : FDG PET은 IPF 환자의 CT에서 발견된 폐 결절을 감별하는데 도움이 되었다.

Keywords

References

  1. King TE Jr. Clinical advances in the diagnosis and therapy of the interstitial lung diseases. Am J Respir Crit Care Med 2005;172: 268-79 https://doi.org/10.1164/rccm.200503-483OE
  2. Raghu G. Interstitial lung disease: a diagnostic approach. Are CT scan and lung biopsy indicated in every patient- Am J Respir Crit Care Med 1995;151:909-14 https://doi.org/10.1164/ajrccm.151.3.7881691
  3. Marinelli WA. Idiopathic pulmonary fibrosis: progress and challenge. Chest 1995;108:297-8 https://doi.org/10.1378/chest.108.2.297
  4. King TE Jr. Diagnostic advances in idiopathic pulmonary fibrosis. Chest 1991;100:238-41 https://doi.org/10.1378/chest.100.1.238
  5. American Thoracic Society. Idiopathic pulmonary fibrosis: diagnosis and treatment. International consensus statement: American Thoracic Society and the European Respiratory Society. Am J Respir Crit Care Med 2000;161:646-64 https://doi.org/10.1164/ajrccm.161.2.ats3-00
  6. Coultas DB, Zumwalt RE, Black WC, Sobonya RE. The epidemiology of interstitial lung disease. Am J Respir Crit Care Med 1994;150:967-72 https://doi.org/10.1164/ajrccm.150.4.7921471
  7. Friedrich G.. Periphere Lungenkrebse auf dem Bodem Pleuranaher. Virchow's Arch Path Anat 1939;230
  8. fibrosis (fibrosing alveolitis), atypical epithelial proliferation and lung cancer. Am J Med 1968;45:211-9 https://doi.org/10.1016/0002-9343(68)90039-9
  9. Kinoshita A, Hirose K, Taniguchi T, Soda H, Rikitake T, Tsurukawa Y, et al. Lung cancer associated with idiopathic interstitial pneumonia. Jpn J thorac Dis 1990;28:852-8
  10. Mizushima Y, Kobayashi M. Clinical characteristics of synchronous multiple lung cancer associated with idiopathic pulmonary fibrosis. A review of Japanese cases. Chest 1995;108:1272-7 https://doi.org/10.1378/chest.108.5.1272
  11. Nagai A, Chiyotani A, Nakadate T, Konno K. Lung cancers in patients with idiopathic pulmonary fibrosis. Tohoku J Exp Med 1992;167:231-7 https://doi.org/10.1620/tjem.167.231
  12. Kawai T, Yakumaru K, Suzuki M, Kageyama K. Diffuse interstitial pulmonary fibrosis and lung cancer. Acta pathol Jpn 1987;37:11-9
  13. Lee HJ, Im JG, Ahn JM, Yean KM. Lung cancer in patients with idiopathic pulmonary fibrosis. J Comput Assist Tomog 1996;20: 979-82 https://doi.org/10.1097/00004728-199611000-00020
  14. Sakai S, Ono M, Nishio T, Kawarada Y, Nagashima A, Toyoshima S. Lung cancer associated with diffuse pulmonary fibrosis: CT-pathologic correlation. J Thorac Imaging 2003;18:67-71 https://doi.org/10.1097/00005382-200304000-00002
  15. Meissner HH, Soo Hoo GW, Khonsary SA, Mandelkern M, Brown CV, Santiago SM. Idiopathic Pulmonary Fibrosis: Evaluation with Positron Emission Tomography. Respiration 2005 Aug 3［Epub ahead of print]
  16. Bakheet SM, Saleem M, Powe J, Al-Amro A, Larsson SG, Mahassin Z. F-18 fluorodeoxyglucose chest uptake in lung inflammation and infection. Clin Nucl Med 2000;25:273-8 https://doi.org/10.1097/00003072-200004000-00007
  17. Yoshimura A, Kudoh S. Idiopathic pulmonary fibrosis and lung cancer. Gan To Kagaku Ryoho 2003;30:215-22
  18. Lyburn ID, Lowe JE, Wong WL. Idiopathic pulmonary fibrosis on F-18 FDG Positron Emission Tomography. Clin Nucl Med 2005;30:27 https://doi.org/10.1097/00003072-200501000-00008
  19. Park J, Kim DS, Shim TS, Lim CM, Koh Y, Lee SD, et al. Lung cancer in patients with idiopathic pulmonary fibrosis. Eur Respir J 2001;17:1216-9 https://doi.org/10.1183/09031936.01.99055301
  20. Aubry MC, Myers JL, Douglas WW, Tazelaar HD, Washington Stephens TL, Hartman TE, et al. Primary pulmonary carcinoma in patients with idiopathic pulmonary fibrosis. Mayo Clin Proc 2002; 77:763-70 https://doi.org/10.4065/77.8.763
  21. Nakamoto Y, Osman M, Cohade C, Marshall LT, Links JM, Kohlmyer S, et al. PET/CT: Comparison of Quantitative Tracer Uptake Between Germanium and CT Transmission Attenuation- Corrected Images. J Nucl Med 2002;43:1137-43
  22. Kim JS, Lee JS, Lee DS, Park EK, Kim JH, Kim JI, Lee HJ, Chung JK, Lee MC. Quantitative Differences between X-Ray CT-Based and $^{137}Cs$-Based Attenuation Correction in Philips Gemini PET/CT. Korean J Nucl Med 2005;39:182-90
  23. Kinahan PE, Townsend DW, Beyer T, Sashin D. Attenuation correction for combined 3D PET/CT scanner. Med Phys 1998;25: 2046-53 https://doi.org/10.1118/1.598392
  24. Kamel EM, Burger C, Buck A, von Schulthess GK, Goerres GW. PET emission activities after $^{68}Ge$-transmission correction or CT-based attenuation correction. Eur J Nucl Med 2001;28:969
  25. Kamel EM, Hany TF, Burger CN, Tokman A, Altman H, von Schulthess GK. CT-based vs Ge-68 rotating source attenuation correction in a combined PET-CT scanner. Radiology 2001; 221:564
  26. Kim JS, Lee JS, Lee BI, Lee DS, Chung JK, Lee MC. Performance Characteristics of 3D GSO PET/CT Scanner (Philips GEMINI PET/CT). Korean J Nucl Med 2004;38:318-24