Original ArticleDifferentiation of malignant from benign heart and pericardial lesions using positron emission tomography and computed tomography
Introduction
Computed tomography (CT) can be used to identify morphological alterations associated with disease. Conventional CT images cannot detect differences in metabolic status, and, therefore, are of little use for distinguishing malignant from benign myocardial or pericardial lesions. Positron emission tomography (PET)-CT can convey both anatomical information (lesion structure) and metabolic status,1, 2, 3, 4 However, the role of PET-CT in the differential diagnosis of cardiac and pericardial lesions has not previously been reported. In this study, a total of 23 cardiac or pericardial lesions were retrospectively reviewed to explore whether it was feasible to differentiate the benign vs malignant nature of cardiac or pericardial lesions by PET-CT.
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Patients
The clinical data of patients seen between August 2007 and 2009 that correspond with the following criteria were retrospectively reviewed. The inclusive criteria were: (1) The cardiac or pericardial lesions were histologically proven, and lipoma was confirmed by MRI; (2) the complete clinical data of all patients were collected; and (3) all patients had undergone a PET/CT scan. Finally, a total of 23 patients were included in this study (14 males, 9 females, age range 16-86, mean age 55).
Of the
Criteria for Differentiating Malignant and Benign Cardiac or Pericardial Lesions by PET
- (1)
Lesion SUVmaxand SUVmaxof lesion/blood of cardiac and pericardiallesions (Table 1; Figure 1, 2) The benign lesions had SUVmax values from 0.5 to 7.4 (median 1.5), while the malignant lesions had SUVmax values between 4.1 and 21.2 (median 6.5). The difference in SUVmax between benign and malignant lesions was statistically significant (Z = −3.601, P < .01). The lesion/blood SUVmax values for benign and malignant lesions were 0.9 and 3.4, respectively, and again the difference was also
The Advantages of Fasting
Fasting before 18F-FDG PET is a suitable method to depress normal myocardial FDG uptake. Minimizing myocardial FDG uptake should decrease false-positive results and increase the detection rate because a decrease in the background uptake should facilitate the detection of FDG-avid juxtacardiac masses (Figure 7). In normal myocardium, metabolism is primarily oxidative and utilizes various admixtures of free fatty acids, glucose, and lactate. Under fasting conditions, plasma insulin levels fall,
Limitations
Due to the diversity of cardiac and pericardial lesions and the variability in clinical symptoms, it is difficult to perform a comprehensive analysis and summary of clinical conditions. Additional research with inclusion of larger numbers of patients should be undertaken to elucidate them.
Because it reduces influence of the background and individual difference, SUVmax of lesion/blood was a better indicator in distinguishing benign from malignant lesions compared with SUVmax.
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