Improving the imaging diagnostic strategy for pulmonary artery masses based on 18 F-FDG PET/CT integrated with CTPA

Objective To evaluate the diagnostic accuracy of computed tomography pulmonary angiography (CTPA) and 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) for pulmonary artery (PA) masses. Methods Of 2889 patients with PA filling defects of PA on CTPA, 79 consecutive patients suspicious for PA malignancy who subsequently underwent 18 F-FDG PET/CT were enrolled. All masses were diagnosed on the basis of pathological findings or clinical imaging follow-up. For each mass, morphological CT signs, standardized uptake value ( SUVmax and SUVmean ), metabolic tumor volume ( MTV ), and total lesion glycolysis ( TLG ) on 18 F-FDG PET/CT were used as diagnostic markers. Results Expansive growth, irregular margin, invasion, CT contrast uptake, and wall eclipse sign were strongly associated with the malignant nature of masses. The coexistence of at least 5 CT signs perfectly identified malignant masses, whereas the detection of no more than 4 CT signs did not accurately discriminate between the natures of masses. Mean SUVmax , SUVmean , MTV , and TLG values were significantly higher in malignant masses compared to those in benign masses. The diagnostic accuracy of 18 F-FDG PET/CT parameters ( SUV , MTV , and TLG ) was excellent in detecting malignant masses. Among patients with 3 or 4 pathological CT signs, SUVmax > 3.4 significantly increased the identification of malignancies. Conclusions CTPA is a useful imaging modality for diagnosing PA masses, especially when at least 5 abnormal CT signs are identified. Similarly, 18 F-FDG PET/CT accurately identified malignant masses and provided additional valuable information on diagnostic uncertainties after CTPA.