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Solitary Pulmonary Nodule (SPN)
Case Study #1A
Study Background:
A 94 yr male with a prior history of prostate cancer was evaluated with PET imaging to help characterize a solitary pulmonary nodule seen on CT.
PET Imaging:
Fifty minutes after the injection of 744 MBq of 18F-FDG, images of the neck, chest, abdomen, and pelvis were obtained with a GE Advance tomograph (7 minutes emission, 2 minutes transmission data per bed position). Data were reconstructed using an OSEM algorithm and segmented attenuation correction. The PET study demonstrated an area of increased FDG uptake in the left mid-lung region which corresponds to the 16 mm nodule seen on CT. No other abnormalities were identified on the PET scan.
Discussion:
Solitary pulmonary nodules of indeterminate etiology are frequently encountered in radiologic practice. Of these nodules, 32% or greater are subsequently determined to be benign. PET imaging, because of its unique ability to assess the underlying metabolic function of tissue, is being successfully employed to non-invasively differentiate these benign nodules from malignant tumors, thereby sparing a large portion of the population with SPN from needless biopsy or other tissue-sampling procedures. This is especially important in patients with extrapulmonary neoplasms such as prostate cancer that have a higher pre-test probability of malignancy. PET is also particularly useful in cases in which biopsies are difficult to perform due to patient age, condition, or nodule location.
Reference:
Fletcher JW. PET scanning and the solitary pulmonary nodule. Semin Thorac Cardiovasc Surg. 2000 Jul;14(3):268-74.
Hsu WH, Hsu NY, et al. Differentiating solitary pulmonary metastases in patients with extrapulmonary neoplasms using FDG-PET. Cancer Invest. 2003;21(1):47-52.
Gould MK, Sanders GD, et al. Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules. Ann Intern Med.2003 May 6;138(9):724-35.
Bubendorf L, Schopfer A, et al. Metastatic patterns of prostate cancer: an autopsy study of 1,589 patients. Hum Pathol. 200 May;31(5):578-83.
Images courtesy of:
The Toledo MRI Center
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