Abstract
BackgroundAcute exacerbation (AE) is the most lethal postoperative complication in idiopathic pulmonary fibrosis (IPF); however, prediction before surgery is difficult. We investigated the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in predicting postoperative AE in IPF.MethodClinical data of 48 IPF patients who underwent 18F-FDG PET/CT before thoracic surgery were retrospectively analyzed. Mean and maximal standardized uptake values (SUVmean and SUVmax, respectively) were measured in the fibrotic area. Additionally, adjusted values-SUV ratio (SUVR, defined as SUVmax-to-liver SUVmean ratio), tissue fraction-corrected SUVmean (SUVmeanTF), and SUVR (SUVRTF)-were calculated.ResultsThe mean age of the subjects was 67.8 years and 91.7% were male. After thoracic surgery, 21 (43.8%) patients experienced postoperative complications including prolonged air leakage (29.2%), death (14.6%), and AE (12.5%) within 30 days. Patients who experienced AE showed higher SUVmax, SUVR, SUVmeanTF, and SUVRTF than those who did not, but other clinical parameters were not different between patients with and without AE. The SUV parameters did not differ for other complications. The SUVR (odds ratio [OR] 29.262; P = 0.030), SUVmeanTF (OR 3.709; P = 0.041) and SUVRTF (OR 20.592; P = 0.017) were significant predicting factors for postoperative AE following a multivariate logistic regression analysis. On receiver operating characteristics curve analysis, SUVRTF had the largest area under the curve (0.806, P = 0.007) for predicting postoperative AE among SUV parameters.ConclusionsOur findings suggest that 18F-FDG PET/CT may be useful in predicting postoperative AE in IPF patients and among SUVs, SUVRTF is the best parameter for predicting postoperative AE in IPF patients.
Highlights
Idiopathic pulmonary fibrosis (IPF) is a disorder characterized by chronic progressive pulmonary fibrosis of unknown etiology [1], but shows variable course, including acute exacerbation (AE)
On receiver operating characteristics curve analysis, S UVRTF had the largest area under the curve (0.806, P = 0.007) for predicting postoperative Acute exacerbation (AE) among standardized uptake value (SUV) parameters
Our findings suggest that 18F-FDG Positron emission tomography (PET)/CT may be useful in predicting postoperative AE in idiopathic pulmonary fibrosis (IPF) patients and among SUVs, Tissue fraction-corrected mean standardized uptake value ratio (SUVRTF) is the best parameter for predicting postoperative AE in IPF patients
Summary
Idiopathic pulmonary fibrosis (IPF) is a disorder characterized by chronic progressive pulmonary fibrosis of unknown etiology [1], but shows variable course, including acute exacerbation (AE). In another study involving 56 IPF patients, no association between clinical parameters (lung function, levels of surfactant protein-D [SP-D] and Krebs von den Lungen-6 [KL-6], and operation type and time) and postoperative AE was observed [6]. Due to these conflicting results, predictors for postoperative AE in IPF are not well defined. Acute exacerbation (AE) is the most lethal postoperative complication in idiopathic pulmonary fibrosis (IPF); prediction before surgery is difficult. We investigated the role of 18F-fluorodeoxyglucose positron emis‐ sion tomography/computed tomography (18F-FDG PET/CT) in predicting postoperative AE in IPF
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