Document Detail

A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules.
MedLine Citation:
PMID:  18199626     Owner:  NLM     Status:  MEDLINE    
CT and PET are widely used to characterize solitary pulmonary nodules (SPNs). However, most CT accuracy studies have been performed with outdated technology and methods, and previous PET studies have been limited by small sample sizes and incomplete masking. Our objective was to compare CT and PET accuracy in veterans with SPN. METHODS: Between January 1999 and June 2001, we recruited 532 participants with SPNs newly diagnosed on radiography and untreated. The SPNs were 7-30 mm. All patients underwent (18)F-FDG PET and CT. A masked panel of 3 PET and 3 CT experts rated the studies on a 5-point scale. SPN tissue diagnosis or 2-y follow-up established the final diagnosis. RESULTS: A definitive diagnosis was established for 344 participants. The prevalence of malignancy was 53%. The average size was 16 mm. Likelihood ratios (LRs) for PET and CT results for combined ratings of either definitely benign (33% and 9% of patients, respectively) or probably benign (27% and 12%) were 0.10 and 0.11, respectively. LRs for PET and CT results for combined ratings of indeterminate (1% and 25%), probably malignant (21% and 39%), or definitely malignant (35% and 15%) were 5.18 and 1.61, respectively. Area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.90-0.95) for PET and 0.82 (95% confidence interval, 0.77-0.86) for CT (P < 0.0001 for the difference). PET inter- and intraobserver reliability was superior to CT. CONCLUSION: Definitely and probably benign results on PET and CT strongly predict benign SPN. However, such results were 3 times more common with PET. Definitely malignant results on PET were much more predictive of malignancy than were these results on CT. A malignant final diagnosis was approximately 10 times more likely than a benign final diagnosis in participants with PET results rated definitely malignant.
James W Fletcher; Steven M Kymes; Michael Gould; Naomi Alazraki; R Edward Coleman; Val J Lowe; Charles Marn; George Segall; Lyn A Thet; Kelvin Lee;
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2008-01-16
Journal Detail:
Title:  Journal of nuclear medicine : official publication, Society of Nuclear Medicine     Volume:  49     ISSN:  0161-5505     ISO Abbreviation:  J. Nucl. Med.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-04     Completed Date:  2008-03-26     Revised Date:  2009-04-02    
Medline Journal Info:
Nlm Unique ID:  0217410     Medline TA:  J Nucl Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  179-85     Citation Subset:  IM    
Department of Radiology, Indiana University School of Medicine, University Hospital, Indianapolis, Indiana 46202-5253, USA.
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MeSH Terms
Fluorodeoxyglucose F18 / diagnostic use*
Image Enhancement / methods
Image Interpretation, Computer-Assisted / methods*
Lung Neoplasms / radiography,  radionuclide imaging
Positron-Emission Tomography / methods*
Radiopharmaceuticals / diagnostic use
Reproducibility of Results
Sensitivity and Specificity
Solitary Pulmonary Nodule / radiography*,  radionuclide imaging*
Tomography, X-Ray Computed / methods*
Reg. No./Substance:
0/Radiopharmaceuticals; 63503-12-8/Fluorodeoxyglucose F18
Comment In:
J Nucl Med. 2009 Feb;50(2):326; author reply 326-7   [PMID:  19164230 ]
Erratum In:
J Nucl Med. 2008 Mar;49(3):353

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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