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Characteristics of malignant thyroid lesions on [(18)F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT)

OBJECTIVES: To determine the imaging variables that can best differentiate malignant from benign thyroid lesions incidentally found on F-18 FDG PET/CT scans. METHODS: All F-18 FDG PET/CT studies starting from 2011 to end of 2016 were reviewed for incidental thyroid lesions or metabolic abnormalities...

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Autores principales: Nasr, Hatem, Farghaly, Hussein, Alqarni, Abdullah, Al-Salem, Seham, Sayed, Mohamed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379667/
https://www.ncbi.nlm.nih.gov/pubmed/34458507
http://dx.doi.org/10.1016/j.ejro.2021.100373
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author Nasr, Hatem
Farghaly, Hussein
Alqarni, Abdullah
Al-Salem, Seham
Sayed, Mohamed
author_facet Nasr, Hatem
Farghaly, Hussein
Alqarni, Abdullah
Al-Salem, Seham
Sayed, Mohamed
author_sort Nasr, Hatem
collection PubMed
description OBJECTIVES: To determine the imaging variables that can best differentiate malignant from benign thyroid lesions incidentally found on F-18 FDG PET/CT scans. METHODS: All F-18 FDG PET/CT studies starting from 2011 to end of 2016 were reviewed for incidental thyroid lesions or metabolic abnormalities. Only patients who were found to have FNAB or histopathology were included. Patients with known thyroid malignancy were excluded. Patients were analyzed for age, sex, SUVmax, non-enhanced CT tissue density in mean Hounsfield units (HU), uptake pattern (focal or diffuse) and gland morphology (MNG or diffuse). A control group of 15 patients with normal thyroid glands were used to assess the tissue density in HU for normal thyroid tissue. Sensitivity, specificity, PPV, NPV and accuracy to detect malignancy were calculated. Pearson Chi-square test was used to compare categorical variables while unpaired T-test and one way ANOVA test were used to compare means of continuous variables. ROC analysis was used to assess the best cut off points for SUVmax and HU. Regression analysis was used to detect the independent predictors for malignant lesions. RESULTS: Biopsy was unsatisfactory or indeterminate in 4/48 patients (8%). Only 44 patients (mean age 55.2 ± 14.7; 30 females (68 %)) with unequivocal FNAB or histopathology were included for further analysis. MNG was noted in 17/44 patients (38.6 %). Thyroid malignancy was found in 16/44 (36.4 %), benign thyroid lesions in 28/44 (63.6 %). Thyroid malignancies were 12 papillary, 1 follicular, 1 Hurthle cell neoplasm and 2 lymphoma. Benign lesions were 23 benign follicular or colloid nodules and 5 autoimmune thyroiditis. Focal FDG uptake pattern was more frequently associated with malignant lesions compared to benign lesions (75 % vs. 43 %; p = 0.039). The mean SUVmax and tissue density (HU) were both higher in malignant than benign lesions (8.8 ± 8.3 vs. 3.6 ± 1.9, p = 0.024) and (48.9 ± 12.7 vs. 32.9 ± 17.5, p = 0.003) respectively. The mean HU in the control group with normal thyroid tissue was 90 ± 7.4 significantly higher than in both the benign and malignant lesions (p < 0.001). ROC analysis revealed SUVmax cutoff of >4.7 and HU cutoff of >42 to best differentiate malignant from benign lesions. The sensitivity, specificity, PPV, NPV and accuracy to detect malignancy for SUVmax>4.7 were 68.8 %, 78.6 %, 64.8 %, 81.5 & 75.0 % (p = 0.002), for HU > 42 were 81.3.0 %, 75.0 %, 65.0 %, 87.5 & 77.3 % (p = 0.0003) and for both parameters combined were 87.5 %, 60.7 %, 56.0 %, 89.5 % and accuracy of 70.5 % (p = 0.002) respectively. Only HU > 42 and SUVmax>4.7 were independent predictors for malignancy with odd ratios 8.98 and 4.93 respectively. CONCLUSION: A higher tissue density (HU > 42) and SUVmax>4.7 as well as tendency for focal uptake pattern are the most significant characteristics associated with malignant thyroid lesions occasionally detected on PET/CT.
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spelling pubmed-83796672021-08-27 Characteristics of malignant thyroid lesions on [(18)F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT) Nasr, Hatem Farghaly, Hussein Alqarni, Abdullah Al-Salem, Seham Sayed, Mohamed Eur J Radiol Open Article OBJECTIVES: To determine the imaging variables that can best differentiate malignant from benign thyroid lesions incidentally found on F-18 FDG PET/CT scans. METHODS: All F-18 FDG PET/CT studies starting from 2011 to end of 2016 were reviewed for incidental thyroid lesions or metabolic abnormalities. Only patients who were found to have FNAB or histopathology were included. Patients with known thyroid malignancy were excluded. Patients were analyzed for age, sex, SUVmax, non-enhanced CT tissue density in mean Hounsfield units (HU), uptake pattern (focal or diffuse) and gland morphology (MNG or diffuse). A control group of 15 patients with normal thyroid glands were used to assess the tissue density in HU for normal thyroid tissue. Sensitivity, specificity, PPV, NPV and accuracy to detect malignancy were calculated. Pearson Chi-square test was used to compare categorical variables while unpaired T-test and one way ANOVA test were used to compare means of continuous variables. ROC analysis was used to assess the best cut off points for SUVmax and HU. Regression analysis was used to detect the independent predictors for malignant lesions. RESULTS: Biopsy was unsatisfactory or indeterminate in 4/48 patients (8%). Only 44 patients (mean age 55.2 ± 14.7; 30 females (68 %)) with unequivocal FNAB or histopathology were included for further analysis. MNG was noted in 17/44 patients (38.6 %). Thyroid malignancy was found in 16/44 (36.4 %), benign thyroid lesions in 28/44 (63.6 %). Thyroid malignancies were 12 papillary, 1 follicular, 1 Hurthle cell neoplasm and 2 lymphoma. Benign lesions were 23 benign follicular or colloid nodules and 5 autoimmune thyroiditis. Focal FDG uptake pattern was more frequently associated with malignant lesions compared to benign lesions (75 % vs. 43 %; p = 0.039). The mean SUVmax and tissue density (HU) were both higher in malignant than benign lesions (8.8 ± 8.3 vs. 3.6 ± 1.9, p = 0.024) and (48.9 ± 12.7 vs. 32.9 ± 17.5, p = 0.003) respectively. The mean HU in the control group with normal thyroid tissue was 90 ± 7.4 significantly higher than in both the benign and malignant lesions (p < 0.001). ROC analysis revealed SUVmax cutoff of >4.7 and HU cutoff of >42 to best differentiate malignant from benign lesions. The sensitivity, specificity, PPV, NPV and accuracy to detect malignancy for SUVmax>4.7 were 68.8 %, 78.6 %, 64.8 %, 81.5 & 75.0 % (p = 0.002), for HU > 42 were 81.3.0 %, 75.0 %, 65.0 %, 87.5 & 77.3 % (p = 0.0003) and for both parameters combined were 87.5 %, 60.7 %, 56.0 %, 89.5 % and accuracy of 70.5 % (p = 0.002) respectively. Only HU > 42 and SUVmax>4.7 were independent predictors for malignancy with odd ratios 8.98 and 4.93 respectively. CONCLUSION: A higher tissue density (HU > 42) and SUVmax>4.7 as well as tendency for focal uptake pattern are the most significant characteristics associated with malignant thyroid lesions occasionally detected on PET/CT. Elsevier 2021-08-19 /pmc/articles/PMC8379667/ /pubmed/34458507 http://dx.doi.org/10.1016/j.ejro.2021.100373 Text en © 2021 The Authors. Published by Elsevier Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Nasr, Hatem
Farghaly, Hussein
Alqarni, Abdullah
Al-Salem, Seham
Sayed, Mohamed
Characteristics of malignant thyroid lesions on [(18)F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT)
title Characteristics of malignant thyroid lesions on [(18)F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT)
title_full Characteristics of malignant thyroid lesions on [(18)F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT)
title_fullStr Characteristics of malignant thyroid lesions on [(18)F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT)
title_full_unstemmed Characteristics of malignant thyroid lesions on [(18)F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT)
title_short Characteristics of malignant thyroid lesions on [(18)F] fluorodeoxyglucose (FDG)-Positron emission tomography (PET)/Computed tomography (CT)
title_sort characteristics of malignant thyroid lesions on [(18)f] fluorodeoxyglucose (fdg)-positron emission tomography (pet)/computed tomography (ct)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379667/
https://www.ncbi.nlm.nih.gov/pubmed/34458507
http://dx.doi.org/10.1016/j.ejro.2021.100373
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