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Efficacy of Helical Dynamic CT Versus Integrated PET/CT for Detection of Mediastinal Nodal Metastasis in Non-Small Cell Lung Cancer

¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
² Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

View larger version (91K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —67-year-old man with adenocarcinoma in left upper lobe and metastases in left lower paratracheal and aortopulmonary window nodes, which were predicted by both helical dynamic CT and integrated PET/CT. Transverse conventional (5.0-mm section thickness) enhanced CT scan (A) shows lymph nodes with short-axis diameter of < 10 mm in left lower paratracheal (arrow) and aortopulmonary (arrowhead) areas, representing benignity under size criteria for CT. Integrated PET/CT image (B) shows high 18F-FDG uptake with maximum standardized uptake values of 5.6 in left lower paratracheal (arrow) and 5.5 in aortopulmonary (arrowhead) lymph nodes.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —67-year-old man with adenocarcinoma in left upper lobe and metastases in left lower paratracheal and aortopulmonary window nodes, which were predicted by both helical dynamic CT and integrated PET/CT. Transverse conventional (5.0-mm section thickness) enhanced CT scan (A) shows lymph nodes with short-axis diameter of < 10 mm in left lower paratracheal (arrow) and aortopulmonary (arrowhead) areas, representing benignity under size criteria for CT. Integrated PET/CT image (B) shows high 18F-FDG uptake with maximum standardized uptake values of 5.6 in left lower paratracheal (arrow) and 5.5 in aortopulmonary (arrowhead) lymph nodes.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —67-year-old man with adenocarcinoma in left upper lobe and metastases in left lower paratracheal and aortopulmonary window nodes, which were predicted by both helical dynamic CT and integrated PET/CT. Attenuation measurements of helical dynamic CT through nodule indicate probable mediastinal nodal metastasis with unenhanced nodule attenuation of 71 H (C) and peak enhancement of 120 H (D), thus net enhancement of 49 H. PRE = unenhanced nodule attenuation, PEAK = peak enhancement nodule attenuation.

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —67-year-old man with adenocarcinoma in left upper lobe and metastases in left lower paratracheal and aortopulmonary window nodes, which were predicted by both helical dynamic CT and integrated PET/CT. Attenuation measurements of helical dynamic CT through nodule indicate probable mediastinal nodal metastasis with unenhanced nodule attenuation of 71 H (C) and peak enhancement of 120 H (D), thus net enhancement of 49 H. PRE = unenhanced nodule attenuation, PEAK = peak enhancement nodule attenuation.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —50-year-old woman with adenocarcinoma in right lower lobe and metastases in right lower paratracheal and subcarinal nodes, which were predicted by helical dynamic CT but not by integrated PET/CT. Transverse conventional (5.0-mm section thickness) enhanced CT scan (A) shows lymph nodes with short-axis diameter of < 10 mm in right lower paratracheal (arrow, A) area, representing benignity with CT size criteria for malignant nodes. This node shows no identifiable 18F-FDG uptake on PET image (B).

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —50-year-old woman with adenocarcinoma in right lower lobe and metastases in right lower paratracheal and subcarinal nodes, which were predicted by helical dynamic CT but not by integrated PET/CT. Transverse conventional (5.0-mm section thickness) enhanced CT scan (A) shows lymph nodes with short-axis diameter of < 10 mm in right lower paratracheal (arrow, A) area, representing benignity with CT size criteria for malignant nodes. This node shows no identifiable 18F-FDG uptake on PET image (B).

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —50-year-old woman with adenocarcinoma in right lower lobe and metastases in right lower paratracheal and subcarinal nodes, which were predicted by helical dynamic CT but not by integrated PET/CT. Transverse conventional (5.0-mm section thickness) enhanced CT scan (C) shows lymph nodes with short-axis diameter of < 10 mm in subcarinal (arrow, C) area, representing benignity with CT size criteria for malignant nodes. This node shows no identifiable 18F-FDG uptake on PET image (D).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —50-year-old woman with adenocarcinoma in right lower lobe and metastases in right lower paratracheal and subcarinal nodes, which were predicted by helical dynamic CT but not by integrated PET/CT. Transverse conventional (5.0-mm section thickness) enhanced CT scan (C) shows lymph nodes with short-axis diameter of < 10 mm in subcarinal (arrow, C) area, representing benignity with CT size criteria for malignant nodes. This node shows no identifiable 18F-FDG uptake on PET image (D).

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2E —50-year-old woman with adenocarcinoma in right lower lobe and metastases in right lower paratracheal and subcarinal nodes, which were predicted by helical dynamic CT but not by integrated PET/CT. Attenuation measurements of helical dynamic CT through nodule indicate probable mediastinal nodal metastasis with unenhanced nodule attenuation of 30 H and peak enhancement of 119 H, thus net enhancement of 89 H. PRE = unenhanced nodule attenuation, PEAK = peak enhancement nodule attenuation.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2F —50-year-old woman with adenocarcinoma in right lower lobe and metastases in right lower paratracheal and subcarinal nodes, which were predicted by helical dynamic CT but not by integrated PET/CT. Attenuation measurements of helical dynamic CT through nodule indicate probable mediastinal nodal metastasis with unenhanced nodule attenuation of 30 H and peak enhancement of 119 H, thus net enhancement of 89 H. PRE = unenhanced nodule attenuation, PEAK = peak enhancement nodule attenuation.

View larger version (91K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —46-year-old man with adenocarcinoma in right lower lobe and metastasis in right paratracheal lymph node, which was predicted by integrated PET/CT but not by helical dynamic CT. Transverse conventional (5.0-mm section thickness) enhanced CT scan (A) shows lymph nodes in right paratracheal area (arrow) with short-axis diameter of 7 mm, representing benignity with CT size criteria for malignant nodes. Integrated PET/CT image (B) shows high 18F-FDG uptake with maximum standardized uptake value of 8.0 in right paratracheal lymph node (arrow).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —46-year-old man with adenocarcinoma in right lower lobe and metastasis in right paratracheal lymph node, which was predicted by integrated PET/CT but not by helical dynamic CT. Transverse conventional (5.0-mm section thickness) enhanced CT scan (A) shows lymph nodes in right paratracheal area (arrow) with short-axis diameter of 7 mm, representing benignity with CT size criteria for malignant nodes. Integrated PET/CT image (B) shows high 18F-FDG uptake with maximum standardized uptake value of 8.0 in right paratracheal lymph node (arrow).

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —46-year-old man with adenocarcinoma in right lower lobe and metastasis in right paratracheal lymph node, which was predicted by integrated PET/CT but not by helical dynamic CT. Attenuation measurements of helical dynamic CT through nodule indicate probable absence of mediastinal nodal metastasis with unenhanced nodule attenuation of 40 H and peak enhancement of 77 H, thus net enhancement 37 H. PRE = unenhanced nodule attenuation, PEAK = peak enhancement nodule attenuation.

View larger version (82K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —46-year-old man with adenocarcinoma in right lower lobe and metastasis in right paratracheal lymph node, which was predicted by integrated PET/CT but not by helical dynamic CT. Attenuation measurements of helical dynamic CT through nodule indicate probable absence of mediastinal nodal metastasis with unenhanced nodule attenuation of 40 H and peak enhancement of 77 H, thus net enhancement 37 H. PRE = unenhanced nodule attenuation, PEAK = peak enhancement nodule attenuation.

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