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The feasibility of 11C-methionine-PET in diagnosis of solitary lung nodules/masses when compared with 18F-FDG-PET.
Ann Nucl Med. 2008 Jul; 22(6):533-8.AN

Abstract

OBJECTIVE

To differentiate between benign and malignant lesions of the lung, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has limitations such as a lower specificity in cases of non-specific inflammation. The positive predictive value is unsatisfactory in countries where inflammatory lung disorders are prevalent. We present the preliminary results of the usefulness of combining 11C-methionine-PET and 18F-FDG-PET in this context.

METHODS

Fifteen patients with indeterminate solitary pulmonary nodules/masses (10 men, 5 women; average age 64.7 +/- 14.0 years, ranging from 25 to 87 years) were studied using 11C-methionine- and 18F-FDG-PET. Interpretations were primarily made on visual analysis with five-point scale and a consensus of two nuclear medicine physicians, using standardized uptake value as an accessory reference. Foci of abnormal radiotracer uptake were subsequently correlated with clinical follow-up, imaging modalities such as chest radiography, chest computed tomography (CT), serial PET studies, and pathology results from bronchoscopic biopsy and/or surgical specimen.

RESULTS

Diagnoses were established in 14 patients. The 11C-methionine-PET and 18F-FDG-PET studies were both true positive in two cases of adenocarcinoma and true negative in two cases of clinical benign nodules. In one case of lymphoid hyperplasia both 11C-methionine-PET and 18F-FDG-PET showed false-positive findings. Discordant results were obtained in nine cases. In spite of the false-positive results of 18F-FDG-PET, 11C-methionine-PET was true negative in four cases with chronic inflammatory nodules and three cases of pulmonary tuberculosis. Furthermore, (11)C-methionine-PET was true positive in one case of lung metastasis of thyroid cancer, and in another with recurrence of gastric cancer, respectively, for which 18F-FDG-PET imaging was false negative.

CONCLUSIONS

Our experience indicates that 11C-methionine-PET seems more specific and sensitive when compared with 18F-FDG-PET for the purpose of differentiating benign and malignant thoracic nodules/masses. The possibility of an FDG-avid lesion being malignant is decreased if it shows a negative result by 11C-methionine-PET.

Authors+Show Affiliations

Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, China. hsiehhj@tzuchi.com.twNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Evaluation Study
Journal Article

Language

eng

PubMed ID

18670862

Citation

Hsieh, Hung-Jen, et al. "The Feasibility of 11C-methionine-PET in Diagnosis of Solitary Lung Nodules/masses when Compared With 18F-FDG-PET." Annals of Nuclear Medicine, vol. 22, no. 6, 2008, pp. 533-8.
Hsieh HJ, Lin SH, Lin KH, et al. The feasibility of 11C-methionine-PET in diagnosis of solitary lung nodules/masses when compared with 18F-FDG-PET. Ann Nucl Med. 2008;22(6):533-8.
Hsieh, H. J., Lin, S. H., Lin, K. H., Lee, C. Y., Chang, C. P., & Wang, S. J. (2008). The feasibility of 11C-methionine-PET in diagnosis of solitary lung nodules/masses when compared with 18F-FDG-PET. Annals of Nuclear Medicine, 22(6), 533-8. https://doi.org/10.1007/s12149-007-0142-8
Hsieh HJ, et al. The Feasibility of 11C-methionine-PET in Diagnosis of Solitary Lung Nodules/masses when Compared With 18F-FDG-PET. Ann Nucl Med. 2008;22(6):533-8. PubMed PMID: 18670862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The feasibility of 11C-methionine-PET in diagnosis of solitary lung nodules/masses when compared with 18F-FDG-PET. AU - Hsieh,Hung-Jen, AU - Lin,Sheng-Hsiang, AU - Lin,Ko-Han, AU - Lee,Chien-Ying, AU - Chang,Cheng-Pei, AU - Wang,Shyh-Jen, Y1 - 2008/08/01/ PY - 2007/06/26/received PY - 2007/10/09/accepted PY - 2008/8/2/pubmed PY - 2008/10/8/medline PY - 2008/8/2/entrez SP - 533 EP - 8 JF - Annals of nuclear medicine JO - Ann Nucl Med VL - 22 IS - 6 N2 - OBJECTIVE: To differentiate between benign and malignant lesions of the lung, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) has limitations such as a lower specificity in cases of non-specific inflammation. The positive predictive value is unsatisfactory in countries where inflammatory lung disorders are prevalent. We present the preliminary results of the usefulness of combining 11C-methionine-PET and 18F-FDG-PET in this context. METHODS: Fifteen patients with indeterminate solitary pulmonary nodules/masses (10 men, 5 women; average age 64.7 +/- 14.0 years, ranging from 25 to 87 years) were studied using 11C-methionine- and 18F-FDG-PET. Interpretations were primarily made on visual analysis with five-point scale and a consensus of two nuclear medicine physicians, using standardized uptake value as an accessory reference. Foci of abnormal radiotracer uptake were subsequently correlated with clinical follow-up, imaging modalities such as chest radiography, chest computed tomography (CT), serial PET studies, and pathology results from bronchoscopic biopsy and/or surgical specimen. RESULTS: Diagnoses were established in 14 patients. The 11C-methionine-PET and 18F-FDG-PET studies were both true positive in two cases of adenocarcinoma and true negative in two cases of clinical benign nodules. In one case of lymphoid hyperplasia both 11C-methionine-PET and 18F-FDG-PET showed false-positive findings. Discordant results were obtained in nine cases. In spite of the false-positive results of 18F-FDG-PET, 11C-methionine-PET was true negative in four cases with chronic inflammatory nodules and three cases of pulmonary tuberculosis. Furthermore, (11)C-methionine-PET was true positive in one case of lung metastasis of thyroid cancer, and in another with recurrence of gastric cancer, respectively, for which 18F-FDG-PET imaging was false negative. CONCLUSIONS: Our experience indicates that 11C-methionine-PET seems more specific and sensitive when compared with 18F-FDG-PET for the purpose of differentiating benign and malignant thoracic nodules/masses. The possibility of an FDG-avid lesion being malignant is decreased if it shows a negative result by 11C-methionine-PET. SN - 0914-7187 UR - https://www.unboundmedicine.com/medline/citation/18670862/The_feasibility_of_11C_methionine_PET_in_diagnosis_of_solitary_lung_nodules/masses_when_compared_with_18F_FDG_PET_ L2 - https://dx.doi.org/10.1007/s12149-007-0142-8 DB - PRIME DP - Unbound Medicine ER -