FDG uptake heterogeneity evaluated by fractal analysis improves the differential diagnosis of pulmonary nodules

Kenta Miwa, Masayuki Inubushi, Kei Wagatsuma, Michinobu Nagao, Taisuke Murata, Masamichi Koyama, Mitsuru Koizumi, Masayuki Sasaki

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Abstract

Purpose The present study aimed to determine whether fractal analysis of morphological complexity and intratumoral heterogeneity of FDG uptake can help to differentiate malignant from benign pulmonary nodules. Materials and methods We retrospectively analyzed data from 54 patients with suspected non-small cell lung cancer (NSCLC) who were examined by FDG PET/CT. Pathological assessments of biopsy specimens confirmed 35 and 19 nodules as NSCLC and inflammatory lesions, respectively. The morphological fractal dimension (m-FD), maximum standardized uptake value (SUVmax) and density fractal dimension (d-FD) of target nodules were calculated from CT and PET images. Fractal dimension is a quantitative index of morphological complexity and tracer uptake heterogeneity; higher values indicate increased complexity and heterogeneity. Results The m-FD, SUVmax and d-FD significantly differed between malignant and benign pulmonary nodules (p < 0.05). Although the diagnostic ability was better for d-FD than m-FD and SUVmax, the difference did not reach statistical significance. Tumor size correlated significantly with SUVmax (r = 0.51, p < 0.05), but not with either m-FD or d-FD. Furthermore, m-FD combined with either SUVmax or d-FD improved diagnostic accuracy to 92.6% and 94.4%, respectively. Conclusion The d-FD of intratumoral heterogeneity of FDG uptake can help to differentially diagnose malignant and benign pulmonary nodules. The SUVmax and d-FD obtained from FDG-PET images provide different types of information that are equally useful for differential diagnoses. Furthermore, the morphological complexity determined by CT combined with heterogeneous FDG uptake determined by PET improved diagnostic accuracy.

Original languageEnglish
Pages (from-to)715-719
Number of pages5
JournalEuropean Journal of Radiology
Volume83
Issue number4
DOIs
Publication statusPublished - Jan 1 2014

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Fractals
Differential Diagnosis
Lung
Non-Small Cell Lung Carcinoma
Systems Analysis

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

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FDG uptake heterogeneity evaluated by fractal analysis improves the differential diagnosis of pulmonary nodules. / Miwa, Kenta; Inubushi, Masayuki; Wagatsuma, Kei; Nagao, Michinobu; Murata, Taisuke; Koyama, Masamichi; Koizumi, Mitsuru; Sasaki, Masayuki.

In: European Journal of Radiology, Vol. 83, No. 4, 01.01.2014, p. 715-719.

Research output: Contribution to journalArticle

Miwa, Kenta ; Inubushi, Masayuki ; Wagatsuma, Kei ; Nagao, Michinobu ; Murata, Taisuke ; Koyama, Masamichi ; Koizumi, Mitsuru ; Sasaki, Masayuki. / FDG uptake heterogeneity evaluated by fractal analysis improves the differential diagnosis of pulmonary nodules. In: European Journal of Radiology. 2014 ; Vol. 83, No. 4. pp. 715-719.
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abstract = "Purpose The present study aimed to determine whether fractal analysis of morphological complexity and intratumoral heterogeneity of FDG uptake can help to differentiate malignant from benign pulmonary nodules. Materials and methods We retrospectively analyzed data from 54 patients with suspected non-small cell lung cancer (NSCLC) who were examined by FDG PET/CT. Pathological assessments of biopsy specimens confirmed 35 and 19 nodules as NSCLC and inflammatory lesions, respectively. The morphological fractal dimension (m-FD), maximum standardized uptake value (SUVmax) and density fractal dimension (d-FD) of target nodules were calculated from CT and PET images. Fractal dimension is a quantitative index of morphological complexity and tracer uptake heterogeneity; higher values indicate increased complexity and heterogeneity. Results The m-FD, SUVmax and d-FD significantly differed between malignant and benign pulmonary nodules (p < 0.05). Although the diagnostic ability was better for d-FD than m-FD and SUVmax, the difference did not reach statistical significance. Tumor size correlated significantly with SUVmax (r = 0.51, p < 0.05), but not with either m-FD or d-FD. Furthermore, m-FD combined with either SUVmax or d-FD improved diagnostic accuracy to 92.6{\%} and 94.4{\%}, respectively. Conclusion The d-FD of intratumoral heterogeneity of FDG uptake can help to differentially diagnose malignant and benign pulmonary nodules. The SUVmax and d-FD obtained from FDG-PET images provide different types of information that are equally useful for differential diagnoses. Furthermore, the morphological complexity determined by CT combined with heterogeneous FDG uptake determined by PET improved diagnostic accuracy.",
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AU - Murata, Taisuke

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AU - Koizumi, Mitsuru

AU - Sasaki, Masayuki

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N2 - Purpose The present study aimed to determine whether fractal analysis of morphological complexity and intratumoral heterogeneity of FDG uptake can help to differentiate malignant from benign pulmonary nodules. Materials and methods We retrospectively analyzed data from 54 patients with suspected non-small cell lung cancer (NSCLC) who were examined by FDG PET/CT. Pathological assessments of biopsy specimens confirmed 35 and 19 nodules as NSCLC and inflammatory lesions, respectively. The morphological fractal dimension (m-FD), maximum standardized uptake value (SUVmax) and density fractal dimension (d-FD) of target nodules were calculated from CT and PET images. Fractal dimension is a quantitative index of morphological complexity and tracer uptake heterogeneity; higher values indicate increased complexity and heterogeneity. Results The m-FD, SUVmax and d-FD significantly differed between malignant and benign pulmonary nodules (p < 0.05). Although the diagnostic ability was better for d-FD than m-FD and SUVmax, the difference did not reach statistical significance. Tumor size correlated significantly with SUVmax (r = 0.51, p < 0.05), but not with either m-FD or d-FD. Furthermore, m-FD combined with either SUVmax or d-FD improved diagnostic accuracy to 92.6% and 94.4%, respectively. Conclusion The d-FD of intratumoral heterogeneity of FDG uptake can help to differentially diagnose malignant and benign pulmonary nodules. The SUVmax and d-FD obtained from FDG-PET images provide different types of information that are equally useful for differential diagnoses. Furthermore, the morphological complexity determined by CT combined with heterogeneous FDG uptake determined by PET improved diagnostic accuracy.

AB - Purpose The present study aimed to determine whether fractal analysis of morphological complexity and intratumoral heterogeneity of FDG uptake can help to differentiate malignant from benign pulmonary nodules. Materials and methods We retrospectively analyzed data from 54 patients with suspected non-small cell lung cancer (NSCLC) who were examined by FDG PET/CT. Pathological assessments of biopsy specimens confirmed 35 and 19 nodules as NSCLC and inflammatory lesions, respectively. The morphological fractal dimension (m-FD), maximum standardized uptake value (SUVmax) and density fractal dimension (d-FD) of target nodules were calculated from CT and PET images. Fractal dimension is a quantitative index of morphological complexity and tracer uptake heterogeneity; higher values indicate increased complexity and heterogeneity. Results The m-FD, SUVmax and d-FD significantly differed between malignant and benign pulmonary nodules (p < 0.05). Although the diagnostic ability was better for d-FD than m-FD and SUVmax, the difference did not reach statistical significance. Tumor size correlated significantly with SUVmax (r = 0.51, p < 0.05), but not with either m-FD or d-FD. Furthermore, m-FD combined with either SUVmax or d-FD improved diagnostic accuracy to 92.6% and 94.4%, respectively. Conclusion The d-FD of intratumoral heterogeneity of FDG uptake can help to differentially diagnose malignant and benign pulmonary nodules. The SUVmax and d-FD obtained from FDG-PET images provide different types of information that are equally useful for differential diagnoses. Furthermore, the morphological complexity determined by CT combined with heterogeneous FDG uptake determined by PET improved diagnostic accuracy.

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