Assessment of pulmonary nodules using [¹⁸F]-FDG PET/CT in deep inspiration breath-hold

The characterization of pulmonary nodules (PN) is a primary indication for [¹⁸F]-FDG PET/CT. However, respiratory movements hinder this characterization, especially for PN located in the lower lobes. Various methods have been developed to improve image resolution.

Our objective was to compare the diagnostic efficacy of [¹⁸F]-FDG PET/CT in deep inspiration breath-hold (DIBH) versus free-breathing corrected by software, in the evaluation of PN.

We prospectively analyzed 51 patients to assess PN using [¹⁸F]-FDG PET/CT in DIBH and free-breathing corrected by software. A total of 84 nodules with an average size of 10 mm were analyzed, with pathological anatomy or medical treatment decide by a multidisciplinary tumor board used as reference.

A total of 84 PN were evaluated, comparing those in DIBH versus free-breathing, finding statistically significant differences in SUVmax values P(< 0.05) (mean SUVmax 3.7 in free-breathing vs. 5.33 in DIBH). When analyzed by location in lobes, we did not find statistically significant differences, though there was a trend towards higher SUVmax values in the lower lobes. [¹⁸F]-FDG PET/CT in DIBH showed high sensitivity (95%) and negative predictive value (NPV) (92%), indicating it may be a promising tool for PN characterization.

The acquisition of [¹⁸F]-FDG PET/CT in DIBH significantly improves the sensitivity and diagnostic efficacy in the assessment of PN. Although no statistically significant differences were found based on location, there is a potential benefit for the lower lobes. These findings could support its use in clinical practice.