Korean J Radiol.  2019 Aug;20(8):1293-1299. 10.3348/kjr.2018.0843.

Diagnostic Performance of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/CT for Chronic Empyema-Associated Malignancy

• Cheon M
• Yoo J
• Hyun SH
• Lee KS
• Kim H
• Kim J
• Zo JI
• Shim YM
• Choi JY

• KMID: 2453079
• DOI: http://doi.org/10.3348/kjr.2018.0843

Abstract

OBJECTIVE
The purpose of this study was to evaluate the diagnostic performance of ¹â¸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹â¸F-FDG PET/CT) for chronic empyema-associated malignancy (CEAM).
MATERIALS AND METHODS
We retrospectively reviewed the ¹â¸F-FDG PET/CT images of 33 patients with chronic empyema, and analyzed the following findings: 1) shape of the empyema cavity, 2) presence of fistula, 3) maximum standardized uptake value (SUV) of the empyema cavity, 4) uptake pattern of the empyema cavity, 5) presence of a protruding soft tissue mass within the empyema cavity, and 6) involvement of adjacent structures. Final diagnosis was determined based on histopathology or clinical follow-up for at least 6 months. The abovementioned findings were compared between the ¹â¸F-FDG PET/CT images of CEAM and chronic empyema. A receiver operating characteristic (ROC) analysis was also performed.
RESULTS
Six lesions were histopathologically proven as malignant; there were three cases of diffuse large B-cell lymphoma, two of squamous cell carcinoma, and one of poorly differentiated carcinoma. Maximum SUV within the empyema cavity (p < 0.001) presence of a protruding soft tissue mass (p = 0.002), and involvement of the adjacent structures (p < 0.001) were significantly different between the CEAM and chronic empyema images. The maximum SUV exhibited the highest diagnostic performance, with the highest specificity (96.3%, 26/27), positive predictive value (85.7%, 6/7), and accuracy (97.0%, 32/33) among all criteria. On ROC analysis, the area under the curve of maximum SUV was 0.994.
CONCLUSION
¹â¸F-FDG PET/CT can be useful for diagnosing CEAM in patients with chronic empyema. The maximum SUV within the empyema cavity is the most accurate ¹â¸F-FDG PET/CT diagnostic criterion for CEAM.

Keyword

Chronic empyema-associated malignancy; Chronic empyema; ¹⁸F-FDG; PET/CT

MeSH Terms

Carcinoma, Squamous Cell
Diagnosis
Electrons*
Empyema
Fistula
Follow-Up Studies
Humans
Lymphoma, B-Cell
Positron-Emission Tomography and Computed Tomography
Retrospective Studies
ROC Curve
Sensitivity and Specificity

Figure

• 

  Fig. 1 Receiver operating characteristic curve of maximum standardized uptake value for diagnosing chronic empyema-associated malignancy in patients with chronic empyema.AUC was 0.994 ± 0.010 (p < 0.001). AUC = area under curve

• 

  Fig. 2 Non-contrast CT and fused PET/CT images of 68-year-old man with 40-year history of chronic tuberculous empyema.Highly hypermetabolic lesion (maximum SUV = 29.6) involving adjacent chest wall is present within empyema cavity. Lesion was histopathologically proven as diffuse large B-cell lymphoma. CT = computed tomography, PET = positron emission tomography, SUV = standardized uptake value

• 

  Fig. 3 Non-contrast CT and fused PET/CT images of 69-year-old man with chronic empyema.Moderately hypermetabolic lesion (maximum SUV = 7.0) involving adjacent rib is seen. Lesion was histopathologically proven as chronic active inflammation.

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