ORIGINAL ARTICLES  ADVANCES IN PET - PART II 

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2008 March;52(1):66-73

Copyright © 2008 EDIZIONI MINERVA MEDICA

language: English

Comparison of two-phase 201Tl SPECT with chest CT to differentiate thoracic malignancies from benign lesions

Yu Y. H. ¹, Hsu W. H. ¹, Hsu N. Y. ², Chang Y. C. ¹, Tsai P. P. ³, Tseng G. C. ⁴, Sun S. S. ⁵, Chiui Y. F. ³

¹ Division of Pulmonary and Critical Care Medicine Department of Medicine China Medical University Hospital Taichung, Taiwan 2 Division of Thoracic Surgery Department of Surgery China Medical University Hospital Taichung, Taiwan 3 Department of Radiology China Medical University Hospital, Taichung, Taiwan 4 Department of Pathology China Medical University Hospital, Taichung, Taiwan 5 Department of Nuclear Medicine China Medical University Hospital, Taichung, Taiwan

Aim. This study was conducted to compare the performance of 201Tl single photon emission computed tomography (201Tl SPECT) with chest computed tomography (CT) in differentiating thoracic malignancies from benign lesions.
Methods. One hundred and seventy patients with confirmed diagnostic thoracic lesions found in chest radiographs were prospectively examined by 201Tl SPECT. The performance of 201Tl SPECT in differentiating thoracic malignancies from benign lesions was evaluated in 161 patients with a measurable retention index (RI), using the region-of-interest method. Chest CT scans were retrospectively collected from 165 patients and were interpreted by two independent observers.
Results. The areas under the receiver operating characteristics curves were 0.85 using the RI value to differentiate thoracic malignancies from benign lesions. The sensitivity, specificity, and accuracy were 71.9%, 83.1%, and 76.4%, respectively, with a cutoff level for the RI set at 20%. Similarly, the sensitivity, specificity and accuracy of chest CT scans to differentiate malignancies from benign lesions were 78.2%, 69.7% and 74.9%, respectively. Focusing on patients with concordant results in both 201Tl SPECT and chest CT scans, we can differentiate thoracic malignancies from benign lesions with a sensitivity of 89.1%, a specificity of 90%, and an accuracy of 89.4%.
Conclusion. Both 201Tl SPECT and chest CT scans are useful imaging tools in differentiating thoracic malignancies from benign lesions, with an accuracy of around 75%. By combining these two image modalities, the accuracy improves to 89.4%, which may circumvent the need for invasive procedures for certain equivocal cases, using either single image alone.