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Evaluation of a new visual uptake scoring scale for 18F-fluorothymidine positron emission tomography in the diagnosis of pulmonary lesions

Beauregard, Jean-Mathieua,e; Giraudet, Anne-Laurea,c; Aide, Nicolasa,d; Hofman, Michael S.a; Blum, Robertb; Drummond, Elizabetha; Roselt, Petera; Hicks, Rodney J.a

Nuclear Medicine Communications:
doi: 10.1097/MNM.0b013e3283606669
Original Articles

Purpose: The aim of this analysis was to evaluate a new visual scoring scale developed to facilitate the qualitative appraisal of lesion uptake on 18F-fluorothymidine PET (18F-FLT-PET).

Methods: Sixty-two patients with a pulmonary lesion of unknown aetiology who had undergone an 18F-fluorodeoxyglucose-PET/computed tomography (CT) suspicious for malignancy prospectively underwent an 18F-FLT-PET/CT. Three nuclear medicine physicians independently reviewed each 18F-FLT-PET/CT scan with knowledge of the location of the pulmonary lesion but blinded to the final diagnosis. They scored the lesion 18F-FLT uptake as follows: (0) no visible uptake; (1) <spleen; (2) ≥spleen, but <both liver and marrow; (3) between liver and marrow; (4) >liver and >marrow. Lesion mean (SUVmean) and maximum (SUVmax) standardized uptake values were measured in a separate session.

Results: In all, 35 lesions were malignant and 27 were benign, as assessed on the basis of surgery, biopsy or follow-up of at least 12 months. Visual score, SUVmean and SUVmax were statistically different between benign and malignant lesions. The visual scoring scale showed substantial to almost-perfect interobserver agreement with a weighted κ value of 0.84, 0.67 and 0.65 for each observer pair. The visual score was highly correlated to SUVmean and SUVmax (r=0.83 and 0.87, respectively) and described a logarithmic pattern in relation to SUVmean and SUVmax (r 2=0.67 and 0.72, respectively). The area under the receiver-operating characteristic curve for the visual score was 0.86 and was statistically different from that for SUVmean (0.77; P=0.026) and SUVmax (0.79; P=0.047).

Conclusion: The 18F-FLT scoring scale we propose is easy to use with high interobserver agreement and a significantly better discriminative capacity compared with SUV measurements. It has the potential to harmonize the qualitative interpretation of 18F-FLT-PET/CT in lung cancer diagnosis.

Author Information

aMolecular Imaging, Centre for Cancer Imaging, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne

bMedical Oncology, Bendigo Health, Bendigo, Australia

cNuclear Medicine Service, Hôpital René Huguenin – Institut Curie, Paris

dDepartment of Nuclear Medicine, Centre François Baclesse, Caen, France

eDepartment of Medical Imaging, CHU de Québec, Laval University, Quebec City, Quebec, Canada

Correspondence to Jean-Mathieu Beauregard, MD, MSc, FRCPC, CHU de Québec Research Center, 9 McMahon St., Quebec City, QC, Canada G1R 3S3 Tel: +1 418 525 4444; fax: +1 418 691 2922; e-mail:

Received November 8, 2012

Accepted February 20, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins