Differentiation of benign from malignant lesions of heart and pericardium: the feasibility of Fluorine-18 fluorodeoxyglucose positron emission tomography CT

Abstract

Objective To assess the feasibility of integrated 18F-FDG PET-CT for the differentiation of malignancy from benign lesions of heart and pericardium. Methods A total of 23 cases (malignancy∶benign= 13∶10) with cardiac and pericardial lesions confirmed by pathology or clinic were analyzed in the present study. All lesions were evaluated semi-quantitatively using maximum standard uptake values (SUVmax) and SUVmax lesion/blood, and the density of the heart and pericardium lesions and the relationship with surrounding tissues were evaluated. The differences of SUVmax and SUVmax lesion/blood between benign and malignant lesions were analyzed using Mann-Whitney test. Subsequently, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for CT and PET-CT respectively. Results The maximum SUV showed significant difference between malignancy(6. 5 ) and benign ( 1.5 ) ( Z = - 3. 601, P ＜ 0. 01 ), the SUVmax Lesion/Blood of malignancy and benign were 3.4 and 0. 9 respectively, also with significant difference(Z = -3. 600, P ＜0. 01 ). The optimal cut-off value of SUVmax is 3.5-4. 0 and SUVmax Lesion/Blood is 1.3-2. 0. The sensitivity, specificity, accuracy, PPV and NPV of CT and PET-CT were 76. 9％ ( 10/13 ), 100. 0％ ( 10/10) ,87.0％ (20/23), 100. 0％ ( 10/10 ), 76. 9％ ( 10/13 ) and 100. 0％ ( 13/13 ), 90. 0％ (9/10), 95.7％(22/23),92.9％ (13/14),100.0％ (9/9) respectively. Conclusion 18F-FDG PET-CT can correctly differentiate benignity and malignancy of cardiac and pericardial lesions. Key words: Pericardium; Heart neoplasms; Tomography, X-ray computed; Positron-emission tomography; Diagnosis, differential