Value of 18F-FDG PET/CT in the Detection of Ovarian Malignancy

Taegyu Park, Sinae Lee, Soyeon Park, Eunsub Lee, Kisoo Pahk, Seunghong Rhee, Jaehyuk Cho, Chulhan Kim, Jae Seon Eo, Jae-Gol Choe, Sungeun Kim

Research output: Contribution to journalArticle

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Abstract

Purpose: Ovarian cancer is a leading cause of gynecologic malignancy. As symptoms of ovarian cancer are nonspecific, only 20 % of ovarian cancers are diagnosed while they are still limited to the ovaries. Thus, early and accurate detection of disease is important for an improved prognosis. For the accurate and effective diagnosis of ovarian malignancy on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), we analyzed several parameters, including visual assessment. Method: A total of 51 peritoneal lesions in 19 patients who showed ovarian masses with diffuse peritoneal infiltration were enrolled. Twelve patients were confirmed to have ovarian malignancy and seven patients with benign disease by pathologic examination. All patients were examined by 18F-FDG PET/CT, and an additional 2-h delayed 18F-FDG PET/CT was also performed for 15 patients with 42 peritoneal lesions. We measured semiquantitative parameters including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on a 1-h initial 18F-FDG PET/CT image (Parameter1) and on a 2-h delayed image (Parameter2). Additionally, retention indices of each parameter were calculated, and each parameter among the malignant and benign lesions was compared by Mann-Whitney U test. We also assessed the visual characteristics of each peritoneal lesion, including metabolic extent, intensity, shape, heterogeneity, and total visual score. Associations between visual grades and malignancy were analyzed using linear by linear association methods. Moreover, a receiver operating characteristic (ROC) curve was analyzed to compare the effectiveness of significant parameters. Result: In a comparison between the malignant and benign groups in the analysis of 51 total peritoneal lesions, SUVmax1, SUVmean1, and TLG1 showed significant differences. Also, in the analysis of 42 peritoneal lesions that underwent an additional 2-h 18F-FDG PET/CT examination, SUVmax1,2, SUVmean1,2, TLG2, and the RI of TLG showed significant differences between the malignant and benign groups. MTV did not show significant differences in either the analysis of 51 peritoneal lesions or of 42 lesions. Regarding visual assessments, metabolic intensity, shape, heterogeneity, and total visual score showed an association with malignancy. In the ROC analysis, the AUC of the visual score was larger than the AUC of other parameters in both the analyses of 51 peritoneal lesions and of 42 lesions. Conclusion: Although further study with a larger patient population is needed, the visual assessment of 18F-FDG PET/CT imaging has a primary role in the detection of malignancy in ovarian cancer patients with assistance from other semi-quantitative parameters.

Original languageEnglish
Pages (from-to)42-51
Number of pages10
JournalNuclear Medicine and Molecular Imaging
Volume49
Issue number1
DOIs
Publication statusPublished - 2015 Mar 1

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Fluorodeoxyglucose F18
Ovarian Neoplasms
Neoplasms
Glycolysis
Tumor Burden
ROC Curve
Area Under Curve
Nonparametric Statistics
Positron Emission Tomography Computed Tomography
Early Diagnosis
Ovary
Population

Keywords

  • F-FDG PET/CT
  • Diagnostic value
  • Maximal standardized uptake value
  • Metabolic tumor volume
  • Ovarian cancer
  • Total lesion glycolysis
  • Visual assessment

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Value of 18F-FDG PET/CT in the Detection of Ovarian Malignancy. / Park, Taegyu; Lee, Sinae; Park, Soyeon; Lee, Eunsub; Pahk, Kisoo; Rhee, Seunghong; Cho, Jaehyuk; Kim, Chulhan; Eo, Jae Seon; Choe, Jae-Gol; Kim, Sungeun.

In: Nuclear Medicine and Molecular Imaging, Vol. 49, No. 1, 01.03.2015, p. 42-51.

Research output: Contribution to journalArticle

Park, Taegyu ; Lee, Sinae ; Park, Soyeon ; Lee, Eunsub ; Pahk, Kisoo ; Rhee, Seunghong ; Cho, Jaehyuk ; Kim, Chulhan ; Eo, Jae Seon ; Choe, Jae-Gol ; Kim, Sungeun. / Value of 18F-FDG PET/CT in the Detection of Ovarian Malignancy. In: Nuclear Medicine and Molecular Imaging. 2015 ; Vol. 49, No. 1. pp. 42-51.
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AU - Park, Taegyu

AU - Lee, Sinae

AU - Park, Soyeon

AU - Lee, Eunsub

AU - Pahk, Kisoo

AU - Rhee, Seunghong

AU - Cho, Jaehyuk

AU - Kim, Chulhan

AU - Eo, Jae Seon

AU - Choe, Jae-Gol

AU - Kim, Sungeun

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N2 - Purpose: Ovarian cancer is a leading cause of gynecologic malignancy. As symptoms of ovarian cancer are nonspecific, only 20 % of ovarian cancers are diagnosed while they are still limited to the ovaries. Thus, early and accurate detection of disease is important for an improved prognosis. For the accurate and effective diagnosis of ovarian malignancy on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), we analyzed several parameters, including visual assessment. Method: A total of 51 peritoneal lesions in 19 patients who showed ovarian masses with diffuse peritoneal infiltration were enrolled. Twelve patients were confirmed to have ovarian malignancy and seven patients with benign disease by pathologic examination. All patients were examined by 18F-FDG PET/CT, and an additional 2-h delayed 18F-FDG PET/CT was also performed for 15 patients with 42 peritoneal lesions. We measured semiquantitative parameters including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on a 1-h initial 18F-FDG PET/CT image (Parameter1) and on a 2-h delayed image (Parameter2). Additionally, retention indices of each parameter were calculated, and each parameter among the malignant and benign lesions was compared by Mann-Whitney U test. We also assessed the visual characteristics of each peritoneal lesion, including metabolic extent, intensity, shape, heterogeneity, and total visual score. Associations between visual grades and malignancy were analyzed using linear by linear association methods. Moreover, a receiver operating characteristic (ROC) curve was analyzed to compare the effectiveness of significant parameters. Result: In a comparison between the malignant and benign groups in the analysis of 51 total peritoneal lesions, SUVmax1, SUVmean1, and TLG1 showed significant differences. Also, in the analysis of 42 peritoneal lesions that underwent an additional 2-h 18F-FDG PET/CT examination, SUVmax1,2, SUVmean1,2, TLG2, and the RI of TLG showed significant differences between the malignant and benign groups. MTV did not show significant differences in either the analysis of 51 peritoneal lesions or of 42 lesions. Regarding visual assessments, metabolic intensity, shape, heterogeneity, and total visual score showed an association with malignancy. In the ROC analysis, the AUC of the visual score was larger than the AUC of other parameters in both the analyses of 51 peritoneal lesions and of 42 lesions. Conclusion: Although further study with a larger patient population is needed, the visual assessment of 18F-FDG PET/CT imaging has a primary role in the detection of malignancy in ovarian cancer patients with assistance from other semi-quantitative parameters.

AB - Purpose: Ovarian cancer is a leading cause of gynecologic malignancy. As symptoms of ovarian cancer are nonspecific, only 20 % of ovarian cancers are diagnosed while they are still limited to the ovaries. Thus, early and accurate detection of disease is important for an improved prognosis. For the accurate and effective diagnosis of ovarian malignancy on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), we analyzed several parameters, including visual assessment. Method: A total of 51 peritoneal lesions in 19 patients who showed ovarian masses with diffuse peritoneal infiltration were enrolled. Twelve patients were confirmed to have ovarian malignancy and seven patients with benign disease by pathologic examination. All patients were examined by 18F-FDG PET/CT, and an additional 2-h delayed 18F-FDG PET/CT was also performed for 15 patients with 42 peritoneal lesions. We measured semiquantitative parameters including maximum and mean standardized uptake values (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) on a 1-h initial 18F-FDG PET/CT image (Parameter1) and on a 2-h delayed image (Parameter2). Additionally, retention indices of each parameter were calculated, and each parameter among the malignant and benign lesions was compared by Mann-Whitney U test. We also assessed the visual characteristics of each peritoneal lesion, including metabolic extent, intensity, shape, heterogeneity, and total visual score. Associations between visual grades and malignancy were analyzed using linear by linear association methods. Moreover, a receiver operating characteristic (ROC) curve was analyzed to compare the effectiveness of significant parameters. Result: In a comparison between the malignant and benign groups in the analysis of 51 total peritoneal lesions, SUVmax1, SUVmean1, and TLG1 showed significant differences. Also, in the analysis of 42 peritoneal lesions that underwent an additional 2-h 18F-FDG PET/CT examination, SUVmax1,2, SUVmean1,2, TLG2, and the RI of TLG showed significant differences between the malignant and benign groups. MTV did not show significant differences in either the analysis of 51 peritoneal lesions or of 42 lesions. Regarding visual assessments, metabolic intensity, shape, heterogeneity, and total visual score showed an association with malignancy. In the ROC analysis, the AUC of the visual score was larger than the AUC of other parameters in both the analyses of 51 peritoneal lesions and of 42 lesions. Conclusion: Although further study with a larger patient population is needed, the visual assessment of 18F-FDG PET/CT imaging has a primary role in the detection of malignancy in ovarian cancer patients with assistance from other semi-quantitative parameters.

KW - F-FDG PET/CT

KW - Diagnostic value

KW - Maximal standardized uptake value

KW - Metabolic tumor volume

KW - Ovarian cancer

KW - Total lesion glycolysis

KW - Visual assessment

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