Abstract
ObjectiveThe aim of our study was to evaluate the role of 18F-FDG PET/CT integrated imaging in differentiating malignant from benign pleural effusion.MethodsA total of 176 patients with pleural effusion who underwent 18F-FDG PET/CT examination to differentiate malignancy from benignancy were retrospectively researched. The images of CT imaging, 18F-FDG PET imaging and 18F-FDG PET/CT integrated imaging were visually analyzed. The suspected malignant effusion was characterized by the presence of nodular or irregular pleural thickening on CT imaging. Whereas on PET imaging, pleural 18F-FDG uptake higher than mediastinal activity was interpreted as malignant effusion. Images of 18F-FDG PET/CT integrated imaging were interpreted by combining the morphologic feature of pleura on CT imaging with the degree and form of pleural 18F-FDG uptake on PET imaging.ResultsOne hundred and eight patients had malignant effusion, including 86 with pleural metastasis and 22 with pleural mesothelioma, whereas 68 patients had benign effusion. The sensitivities of CT imaging, 18F-FDG PET imaging and 18F-FDG PET/CT integrated imaging in detecting malignant effusion were 75.0%, 91.7% and 93.5%, respectively, which were 69.8%, 91.9% and 93.0% in distinguishing metastatic effusion. The sensitivity of 18F-FDG PET/CT integrated imaging in detecting malignant effusion was higher than that of CT imaging (p = 0.000). For metastatic effusion, 18F-FDG PET imaging had higher sensitivity (p = 0.000) and better diagnostic consistency with 18F-FDG PET/CT integrated imaging compared with CT imaging (Kappa = 0.917 and Kappa = 0.295, respectively). The specificities of CT imaging, 18F-FDG PET imaging and 18F-FDG PET/CT integrated imaging were 94.1%, 63.2% and 92.6% in detecting benign effusion. The specificities of CT imaging and 18F-FDG PET/CT integrated imaging were higher than that of 18F-FDG PET imaging (p = 0.000 and p = 0.000, respectively), and CT imaging had better diagnostic consistency with 18F-FDG PET/CT integrated imaging compared with 18F-FDG PET imaging (Kappa = 0.881 and Kappa = 0.240, respectively).Conclusion18F-FDG PET/CT integrated imaging is a more reliable modality in distinguishing malignant from benign pleural effusion than 18F-FDG PET imaging and CT imaging alone. For image interpretation of 18F-FDG PET/CT integrated imaging, the PET and CT portions play a major diagnostic role in identifying metastatic effusion and benign effusion, respectively.
Highlights
Pleural effusion caused by a number of malignant and benign diseases is a common and challenging medical problem
18F-FDG positron emission tomography (PET) imaging had higher sensitivity (p = 0.000) and better diagnostic consistency with 18F-FDG PET/Computed tomography (CT) integrated imaging compared with CT imaging (Kappa = 0.917 and Kappa = 0.295, respectively)
Their purposes were to evaluate a series of parameters such as density of the effusion, morphology of any solid pleural abnormality and increased uptake of 18F-FDG in pleural effusion and pleura, and the solid pleural abnormality and pleural uptake were significant parameters used for differentiation [4,5]
Summary
Pleural effusion caused by a number of malignant and benign diseases is a common and challenging medical problem. Several studies have been implemented to discuss the role of PET/CT using 18F-fluoro-2-deoxy-D-glucose (18F-FDG) in assessing the nature of pleural effusion [4,5,6,7,8] Their purposes were to evaluate a series of parameters such as density of the effusion, morphology of any solid pleural abnormality and increased uptake of 18F-FDG in pleural effusion and pleura, and the solid pleural abnormality and pleural uptake were significant parameters used for differentiation [4,5]. The other purpose of the current study was to investigate the diagnostic role of CT and PET portions from 18F-FDG PET/CT integrated imaging in the differential diagnosis of pleural effusion
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