Korean J Radiol.  2019 Aug;20(8):1293-1299. 10.3348/kjr.2018.0843.

Diagnostic Performance of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/CT for Chronic Empyema-Associated Malignancy

Affiliations
  • 1Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, Korea.
  • 2Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. jynm.choi@samsung.com
  • 3Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 4Department of Medicine, Samsung Medical Center, Division of Pulmonary and Critical Care Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 5Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
The purpose of this study was to evaluate the diagnostic performance of ¹â¸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹â¸F-FDG PET/CT) for chronic empyema-associated malignancy (CEAM).
MATERIALS AND METHODS
We retrospectively reviewed the ¹â¸F-FDG PET/CT images of 33 patients with chronic empyema, and analyzed the following findings: 1) shape of the empyema cavity, 2) presence of fistula, 3) maximum standardized uptake value (SUV) of the empyema cavity, 4) uptake pattern of the empyema cavity, 5) presence of a protruding soft tissue mass within the empyema cavity, and 6) involvement of adjacent structures. Final diagnosis was determined based on histopathology or clinical follow-up for at least 6 months. The abovementioned findings were compared between the ¹â¸F-FDG PET/CT images of CEAM and chronic empyema. A receiver operating characteristic (ROC) analysis was also performed.
RESULTS
Six lesions were histopathologically proven as malignant; there were three cases of diffuse large B-cell lymphoma, two of squamous cell carcinoma, and one of poorly differentiated carcinoma. Maximum SUV within the empyema cavity (p < 0.001) presence of a protruding soft tissue mass (p = 0.002), and involvement of the adjacent structures (p < 0.001) were significantly different between the CEAM and chronic empyema images. The maximum SUV exhibited the highest diagnostic performance, with the highest specificity (96.3%, 26/27), positive predictive value (85.7%, 6/7), and accuracy (97.0%, 32/33) among all criteria. On ROC analysis, the area under the curve of maximum SUV was 0.994.
CONCLUSION
¹â¸F-FDG PET/CT can be useful for diagnosing CEAM in patients with chronic empyema. The maximum SUV within the empyema cavity is the most accurate ¹â¸F-FDG PET/CT diagnostic criterion for CEAM.

Keyword

Chronic empyema-associated malignancy; Chronic empyema; ¹⁸F-FDG; PET/CT

MeSH Terms

Carcinoma, Squamous Cell
Diagnosis
Electrons*
Empyema
Fistula
Follow-Up Studies
Humans
Lymphoma, B-Cell
Positron-Emission Tomography and Computed Tomography
Retrospective Studies
ROC Curve
Sensitivity and Specificity
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