Korean J Radiol.  2008 Feb;9(1):19-28. 10.3348/kjr.2008.9.1.19.

(18)F-FDG PET versus (18)F-FDG PET/CT for Adrenal Gland Lesion Characterization: a Comparison of Diagnostic Efficacy in Lung Cancer Patients

• Sung YM
• Lee KS
• Kim BT
• Choi JY
• Chung MJ
• Shim YM
• Yi CA
• Kim TS

• KMID: 1734271
• DOI: http://doi.org/10.3348/kjr.2008.9.1.19

Abstract

OBJECTIVE
The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone. MATERIALS AND METHODS: Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test. RESULTS: Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively). CONCLUSION: The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.

Keyword

(18)F-FDG; PET; PET/CT; Lung cancer; Adrenal metastasis

MeSH Terms

Adrenal Gland Neoplasms/pathology/*radiography/*radionuclide imaging/secondary
Adult
Aged
Biopsy
Diagnosis, Differential
Female
Fluorodeoxyglucose F18/*diagnostic use
Humans
Lung Neoplasms/pathology/*radiography/*radionuclide imaging
Male
Middle Aged
Positron-Emission Tomography/*methods
Radiopharmaceuticals/*diagnostic use
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 A false-positive interpretation with the use of PET only, but a true negative interpretation with the use of integrated PET/CT in a 57-year-old man with adenocarcinoma in the right upper lobe of the lung. A. PET demonstrates increased uptake (arrow) in the right adrenal gland area with a maximum standardized uptake value of 3.2. PET alone regarded the uptake as positive. B. Unenhanced CT scan shows hepatic cysts (arrowheads). C. On an integrated PET/CT image, the uptake (arrow) falls on the liver, thus enabling a correct interpretation as negative uptake in the right adrenal gland.

• 

  Fig. 2 A false-positive interpretation by the use of both PET and PET/CT in a 33-year-old woman with an adrenal adenoma that was confirmed by surgical excision. The patient also had an adenocarcinoma in the left lower lobe of the lung. A. PET demonstrates increased uptake (arrow) in the left adrenal gland lesion with a maximum standardized uptake value of 4.6. B. An unenhanced CT scan shows a 14 mm sized nodule (arrow) in the left adrenal gland. C. Integrated PET/CT shows high uptake (arrow) in the nodule of the left adrenal gland.

• 

  Fig. 3 A false-positive interpretation by the use of both PET and PET/CT in a 56-year-old woman with an endothelial cyst that was confirmed by surgical excision. The patient also had a squamous cell carcinoma in the left lower lobe of the lung. A. PET demonstrates increased uptake (arrow) in the left adrenal gland lesion with a maximum standardized uptake value of 4.3. B. An unenhanced CT scan shows a 7 mm sized nodule (arrow) in the left adrenal gland. C. Integrated FDG PET/CT shows high uptake (arrow) in the nodule of the left adrenal gland.

• 

  Fig. 4 A false-negative interpretation with the use of PET only, but a true positive interpretation with the use of integrated PET/CT in a 33-year-old woman with an adrenal metastasis confirmed by clinical follow-up. The patient also had adenocarcinoma in the right lower lobe of the lung. A. PET demonstrates increased uptake (arrow) in the left adrenal gland area with a maximum SUV of 3.5. Uptake was regarded as benign by PET alone because the uptake was interpreted as left kidney uptake. B. An unenhanced CT scan shows an 11-mm-sized nodule (arrow) in the left adrenal gland. C. On an integrated PET/CT image, the uptake (arrow) falls on the left adrenal gland, thus enabling a correct interpretation as positive uptake (uptake extent is equal to that of liver). D. The nodule (arrow) in the left adrenal gland shows an increase in size at a 7-month follow-up CT. Hepatic metastasis is also noted (arrowhead).

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