Differentiation of malignant from benign heart and pericardial lesions using positron emission tomography and...

To assess the feasibility of (18)F-FDG PET-CT for the differentiation of malignancy from benign lesions of the heart and the pericardium.

A total of 23 cases (malignancy:benign = 13:10) with cardiac and pericardial lesions, confirmed by pathology or on clinical grounds, were analyzed in this study. All lesions were evaluated semi-quantitatively using maximum standard uptake values (SUV(max)) and SUV(max) lesion/blood, and the density of the heart and pericardium lesions and the relation with surrounding tissues were evaluated. The differences of SUV(max) and SUV(max) lesion/blood between benign and malignant lesions were analyzed by the Mann-Whitney test. Subsequently, the diagnostic sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated for CT and PET-CT, respectively.

The maximum SUV showed significant difference between malignancy (avg ± SD 6.5) and benign (avg ± SD 1.5) (Z = -3.601, P < .01), the SUV(max) lesion/blood of malignancy and benign were avg ± SD 3.4 and avg ± SD 0.9, respectively, also with a significant difference (Z = -3.600, P < .01). In this pilot study, the optimal cutoff value to separate benign vs malignant lesions of SUV(max) was 3.5-4.0 and the cutoff for SUV(max) lesion/blood was 1.3-2.0. The sensitivity, specificity, accuracy, PPV, and NPV of CT and PET-CT were 76.9%(10/13), 100.0%(10/10), 87.0%(20/23), 100.0%(10/10), 76.9%(10/13) and 100.0%(13/13), 90.0%(9/10), 95.7%(22/23), 92.9%(13/14), 100.0%(9/9), respectively.

(18)F-FDG PET-CT appears promising for correctly differentiating benign vs malignant cardiac and pericardial lesions.