Radiomic analysis will add differential diagnostic value of benign and malignant pulmonary nodules: a hybrid imaging study based on [(18)F]FDG and [(18)F]FLT PET/CT

PURPOSE: To investigate the clinical value of radiomic analysis on [(18)F]FDG and [(18)F]FLT PET on the differentiation of [(18)F]FDG-avid benign and malignant pulmonary nodules (PNs). METHODS: Data of 113 patients with inconclusive PNs based on preoperative [(18)F]FDG PET/CT who underwent additional [(18)F]FLT PET/CT scans within a week were retrospectively analyzed in the present study. Three methods of analysis including visual analysis, radiomic analysis based on [(18)F]FDG PET/CT images alone, and radiomic analysis based on dual-tracer PET/CT images were evaluated for differential diagnostic value of benign and malignant PNs. RESULTS: A total of 678 radiomic features were extracted from volumes of interest (VOIs) of 123 PNs. Fourteen valuable features were thereafter selected. Based on a visual analysis of [(18)F]FDG PET/CT images, the diagnostic accuracy, sensitivity, and specificity were 61.6%, 90%, and 28.8%, respectively. For the test set, the area under the curve (AUC), sensitivity, and specificity of the radiomic models based on [(18)F]FDG PET/CT plus [(18)F]FLT signature were equal or better than radiomics based on [(18)F]FDG PET/CT only (0.838 vs 0.810, 0.778 vs 0.778, 0.750 vs 0.688, respectively). CONCLUSION: Radiomic analysis based on dual-tracer PET/CT images is clinically promising and feasible for the differentiation between benign and malignant PNs. CLINICAL RELEVANCE STATEMENT: Radiomic analysis will add differential diagnostic value of benign and malignant pulmonary nodules: a hybrid imaging study based on [(18)F]FDG and [(18)F]FLT PET/CT. KEY POINTS: • Radiomics brings new insights into the differentiation of benign and malignant pulmonary nodules beyond the naked eyes. • Dual-tracer imaging shows the biological behaviors of cancerous cells from different aspects. • Radiomics helps us get to the histological view in a non-invasive approach. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13244-023-01530-6.