ArticleLife (Basel, Switzerland)2025
18F-FDG PET/CT Findings to Improve Confidence in Distinguishing Lung External Beam Radiotherapy Side Effects.
Article in Life (Basel, Switzerland), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Modern external beam radiotherapy (EBRT) on lung cancer improved dose distribution thanks to advanced dose calculation algorithms, but side effects and relapses can occur in any case onset. Differential diagnosis of relapses and side effects is difficult, and when computed tomography (CT) is uncertain 18-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) can support the diagnosis, even if it can also be difficult to construe. The aim of this retrospective analysis was to evaluate 18F-FDG PET/CT qualitative patterns and semiquantitative parameters, both automatic and preceded by physicians, in interpreting lung lesions in the radiotherapy (RT) lung irradiation field. In total, 94 patients (pts) submitted to EBRT (3 months before) for stage II lung cancer were included (74 men, 20 women, mean age of 68 years old, range of 49-84 years old). CT scans were performed on pts, which showed lung lesions in the RT field. 18F-FDG-PET/CT scans were analyzed qualitatively as negative or positive, and the presence of the lung area with a high 18F-FDG uptake pattern was distinguished as the following: focal/wide, deep/shade, or homogeneous/inhomogeneous. Furthermore, the following semiquantitative parameters were collected: gSUVmax (global standardized uptake value max), MTV (tumor metabolic volume), metabolic spatial distribution (MSD) = proximal SUVmax/distal SUVmax, and intratumoral difference in spatial distribution (IDSD%) = [distal SUVmax/proximal SUVmax] × 100. 18F-FDG PET/CT was related to the pts' outcome (biopsy and/or clinical-instrumental follow-up): positive for lung relapse, negative if the lesions were phlogistic. The following diagnostic performance parameters of 18F-FDG PET/CT were calculated: sensitivity (Sens), specificity (Spec), diagnostic accuracy (DA), positive predictive value (PPV), and negative predictive value (NPV). Qualitative variables were compared by Chi-squared test, while for semiquantitative parameters Student's
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