Diagnostic Ability of [F]FDG PET/CT for Distinguishing Benign from Malignant Spleen Lesions

Overview

Journal Eur Radiol

Specialty Radiology

Date 2024 Jul 18

PMID 39026061

Authors

Dong Yun Lee

Yong-Il Kim

Jin-Sook Ryu

Affiliations

Soon will be listed here.

Abstract

Objectives: [F]Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is a non-invasive imaging modality used in the differential diagnosis of splenic lesions, although ideal parameters and thresholds remain unclear. The present study evaluated the ability of [F]FDG PET/CT, including its visual and quantitative parameters, to differentiate between benign and malignant splenic lesions.

Methods: Patients who underwent [F]FDG PET/CT following the detection of splenic lesions on contrast-enhanced CT were retrospectively analysed. Visual parameters assessed on [F]FDG PET/CT included whole spleen uptake intensity, lesion multiplicity, and lesion uptake, and quantitative parameters included maximum standardised uptake value (SUVmax), lesion-to-background ratio (LBR), metabolic tumour volume (MTV), total lesion glycolysis (TLG), and lesion size. Parameters differentiating between benign and malignant lesions were evaluated by Pearson's chi-square test, Mann-Whitney U-test, and receiver operating characteristics (ROC) curve analysis.

Results: Splenic lesion uptake (p = 0.001) was the only visual parameter significantly distinguishing between benign and malignant lesions. ROC curve analysis demonstrated that SUVmax had the largest area under the ROC, 0.91 (p < 0.001), with an optimal cut-off > 5.3 having a sensitivity of 90.3% and a specificity of 80.6%. Subgroup analysis of malignant lesions showed that SUVmax (p = 0.013), LBR (p = 0.012), and TLG (p = 0.034) were significantly higher in splenic lymphomas than in splenic metastases.

Conclusion: Of the [F]FDG PET/CT parameters investigated, SUVmax had the highest accuracy in diagnosing malignant splenic lesions and was significantly higher in splenic lymphomas than in splenic metastases. Visual determination of [F]FDG uptake by splenic lesions may be an easily evaluated parameter.

Clinical Relevance Statement: SUVmax and visual grade of [F]FDG PET/CT help to differentiate spleen lesions. [F]FDG PET/CT is useful for discriminating between benign and malignant spleen lesions.

Key Points: Many splenic lesions are difficult to diagnose on anatomical imaging, with histopathologic analyses are required. SUVmax of PET/CT provided the diagnostic ability to differentiate between benign and malignant splenic lesions. More than normal spleen uptake can be a convenient parameter to diagnose malignant spleen lesions.

References

Skandalakis P, Colborn G, Skandalakis L, Richardson D, Mitchell Jr W, SKANDALAKIS J . The surgical anatomy of the spleen. Surg Clin North Am. 1993; 73(4):747-68. DOI: 10.1016/s0039-6109(16)46083-4. View

Kim N, Auerbach A, Manning M . Algorithmic Approach to the Splenic Lesion Based on Radiologic-Pathologic Correlation. Radiographics. 2022; 42(3):683-701. DOI: 10.1148/rg.210071. View

Thipphavong S, Duigenan S, Schindera S, Gee M, Philips S . Nonneoplastic, benign, and malignant splenic diseases: cross-sectional imaging findings and rare disease entities. AJR Am J Roentgenol. 2014; 203(2):315-22. DOI: 10.2214/AJR.13.11777. View

Venkataramu N, Gupta S, Sood B, Gulati M, Rajawanshi A, Gupta S . Ultrasound guided fine needle aspiration biopsy of splenic lesions. Br J Radiol. 2000; 72(862):953-6. DOI: 10.1259/bjr.72.862.10673946. View

Keogan M, Freed K, Paulson E, Nelson R, Dodd L . Imaging-guided percutaneous biopsy of focal splenic lesions: update on safety and effectiveness. AJR Am J Roentgenol. 1999; 172(4):933-7. DOI: 10.2214/ajr.172.4.10587123. View

Lindgren P, Hagberg H, Eriksson B, Glimelius B, Magnusson A, Sundstrom C . Excision biopsy of the spleen by ultrasonic guidance. Br J Radiol. 1985; 58(693):853-7. DOI: 10.1259/0007-1285-58-693-853. View

Metser U, Even-Sapir E . The role of 18F-FDG PET/CT in the evaluation of solid splenic masses. Semin Ultrasound CT MR. 2006; 27(5):420-5. DOI: 10.1053/j.sult.2006.06.005. View

Barat M, Hoeffel C, Aissaoui M, Dohan A, Oudjit A, Dautry R . Focal splenic lesions: Imaging spectrum of diseases on CT, MRI and PET/CT. Diagn Interv Imaging. 2021; 102(9):501-513. DOI: 10.1016/j.diii.2021.03.006. View

Van de Wiele C, Verstraete K, Bourgeois S, Maes A . Negative F-FDG PET and positive CT and MRI findings in multifocal splenic hamartoma. Hell J Nucl Med. 2017; 20(2):182-183. DOI: 10.1967/s002449910563. View

10.

Metser U, Miller E, Kessler A, Lerman H, Lievshitz G, Oren R . Solid splenic masses: evaluation with 18F-FDG PET/CT. J Nucl Med. 2005; 46(1):52-9. View

11.

Kim H, Kim K, Yu E, Byun J, Lee S, Kim J . Sclerosing angiomatoid nodular transformation of the spleen: clinical and radiologic characteristics. Acta Radiol. 2012; 53(7):701-6. DOI: 10.1258/ar.2012.120180. View

12.

Okada H, Ouchi K, Saito T, Takahashi Y, Yamada M, Negami N . Splenic sarcoid reaction mimicking metachronous metastasis in patients after distal gastrectomy for gastric cancer: a case report and literature review. Surg Case Rep. 2020; 6(1):185. PMC: 7391455. DOI: 10.1186/s40792-020-00955-1. View

13.

Karunanithi S, Sharma P, Roy S, Vettiyil B, Sharma A, Thulkar S . Use of 18F-FDG PET/CT imaging for evaluation of patients with primary splenic lymphoma. Clin Nucl Med. 2014; 39(9):772-6. DOI: 10.1097/RLU.0000000000000523. View

14.

Zhuang H, Alavi A . 18-fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation. Semin Nucl Med. 2002; 32(1):47-59. DOI: 10.1053/snuc.2002.29278. View

15.

Paik J, Lee K, Choe Y, Choi Y, Kim B . Augmented 18F-FDG uptake in activated monocytes occurs during the priming process and involves tyrosine kinases and protein kinase C. J Nucl Med. 2004; 45(1):124-8. View

16.

Mainenti P, Iodice D, Cozzolino I, Segreto S, Capece S, Sica G . Tomographic imaging of the spleen: the role of morphological and metabolic features in differentiating benign from malignant diseases. Clin Imaging. 2012; 36(5):559-67. DOI: 10.1016/j.clinimag.2012.01.015. View

17.

Xu T, Cen B, Liu L, Wang Y, Chen Y . 18F-FDG PET/CT Findings of an Isolated Splenic Metastasis From Endometrial Adenocarcinoma. Clin Nucl Med. 2020; 45(12):1018-1019. DOI: 10.1097/RLU.0000000000003280. View

18.

Lee D, Yoon J, Lee S, Jo K, Yoon S, An Y . Isolated splenic metastasis of ovarian cancer detected with 18F-FDG PET/CT. Clin Nucl Med. 2013; 39(4):349-51. DOI: 10.1097/RLU.0b013e31828e9894. View

19.

Cao F, Qian W, Ma Y, Wu Y, Zhong J . Contrast-enhanced imaging features and differentiation of benign and malignant focal splenic lesions. Clin Imaging. 2017; 49:58-64. DOI: 10.1016/j.clinimag.2017.10.020. View

20.

Reinert C, Hinterleitner C, Fritz J, Nikolaou K, Horger M . Diagnosis of diffuse spleen involvement in haematological malignancies using a spleen-to-liver attenuation ratio on contrast-enhanced CT images. Eur Radiol. 2018; 29(1):450-457. DOI: 10.1007/s00330-018-5556-2. View