Nucl Med Mol Imaging.  2015 Mar;49(1):42-51. 10.1007/s13139-014-0303-3.

Value of 18F-FDG PET/CT in the Detection of Ovarian Malignancy

Affiliations
  • 1Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, South Korea.
  • 2Department of Nuclear Medicine, Korea University Anam Hospital, #73, Inchon-ro, Seoungbuk-gu, Seoul 136-705, South Korea. seiong@korea.ac.kr
  • 3Department of Nuclear Medicine, Korea University Ansan Hospital, Ansan, South Korea.

Abstract

PURPOSE
Ovarian cancer is a leading cause of gynecologic malignancy. As symptoms of ovarian cancer are nonspecific, only 20% of ovarian cancers are diagnosed while they are still limited to the ovaries. Thus, early and accurate detection of disease is important for an improved prognosis. For the accurate and effective diagnosis of ovarian malignancy on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), we analyzed several parameters, including visual assessment. METHOD: A total of 51 peritoneal lesions in 19 patients who showed ovarian masses with diffuse peritoneal infiltration were enrolled. Twelve patients were confirmed to have ovarian malignancy and seven patients with benign disease by pathologic examination. All patients were examined by 18F-FDG PET/CT, and an additional 2-h delayed 18F-FDG PET/CT was also performed for 15 patients with 42 peritoneal lesions. We measured semiquantitative parameters including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on a 1-h initial 18F-FDG PET/CT image (Parameter1) and on a 2-h delayed image (Parameter2). Additionally, retention indices of each parameter were calculated, and each parameter among the malignant and benign lesions was compared byMann-Whitney U test.We also assessed the visual characteristics of each peritoneal lesion, including metabolic extent, intensity, shape, heterogeneity, and total visual score. Associations between visual grades and malignancy were analyzed using linear by linear association methods. Moreover, a receiver operating characteristic (ROC) curve was analyzed to compare the effectiveness of significant parameters. RESULT: In a comparison between the malignant and benign groups in the analysis of 51 total peritoneal lesions, SUVmax1, SUVmean1, and TLG1 showed significant differences. Also, in the analysis of 42 peritoneal lesions that underwent an additional 2-h 18F-FDG PET/CT examination, SUVmax1,2, SUVmean1,2, TLG2, and the RI of TLG showed significant differences between the malignant and benign groups. MTV did not show significant differences in either the analysis of 51 peritoneal lesions or of 42 lesions. Regarding visual assessments, metabolic intensity, shape, heterogeneity, and total visual score showed an association with malignancy. In the ROC analysis, the AUC of the visual score was larger than the AUC of other parameters in both the analyses of 51 peritoneal lesions and of 42 lesions.
CONCLUSION
Although further study with a larger patient population is needed, the visual assessment of 18F-FDG PET/CT imaging has a primary role in the detection of malignancy in ovarian cancer patients with assistance from other semiquantitative parameters.

Keyword

Ovarian cancer; 18F-FDG PET/CT; Visual assessment; Maximal standardized uptake value; Metabolic tumor volume; Total lesion glycolysis; Diagnostic value

MeSH Terms

Area Under Curve
Diagnosis
Electrons
Female
Fluorodeoxyglucose F18*
Glycolysis
Humans
Ovarian Neoplasms
Ovary
Population Characteristics
Positron-Emission Tomography and Computed Tomography*
Prognosis
ROC Curve
Tumor Burden
Fluorodeoxyglucose F18
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