Supplementary Material for: Predictive Value of F-18 FDG PET/CT for Malignant Pleural Effusion in Non-Small Cell Lung Cancer Patients

Background: The purpose of this study was to evaluate the accuracy of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) imaging in the detection of malignant pleural effusion and pleural metastasis in patients with non-small cell lung cancer (NSCLC). Materials and Methods: We analyzed F-18 FDG PET/CT images of 33 lung cancer patients with pleural effusion. We used 2 categorical parameters to differentiate malignant from benign pleural effusion: i) quantitative parameters using maximum standardized uptake value (SUVmax of effusion and pleura, and the following ratios: lesion to aorta (L/Ao), to cerebellum (L/Cbl), to liver (L/Liv), to nonlesion (L/NL), and to primary lung cancer (L/Prim)) and ii) various parameters determined by PET and CT scans (uptake at the pleural region, Hounsfield unit, size, and morphology of any solid abnormality). Results: Malignant pleural effusions showed significantly higher L/Prim values than benign pleural effusions. The presence of pleural abnormality on CT and pleural region uptake on PET images were found to be significantly more frequent in cases of malignant pleural disease. These parameters could differentiate malignant and benign pleural effusion according to receiver operating characteristic (ROC) analyses. There were no statistical differences between L/Prim, pleural abnormality on CT, and pleural region uptake on PET images. Abnormal pleural region uptake on PET images was the most accurate parameter identifying malignant pleural effusion by logistic regression analysis. Conclusions: Our results suggest that F-18 FDG PET/CT can be used as a reliable and noninvasive method for the differentiation of malignant and benign pleural disease in patients with NSCLC.研究背景：本研究旨在评估18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-18 FDG PET/CT）成像在检测非小细胞肺癌（non-small cell lung cancer, NSCLC）患者恶性胸腔积液及胸膜转移中的准确性。 材料与方法：本研究分析了33例伴胸腔积液的肺癌患者的F-18 FDG PET/CT影像资料。我们采用两项分类参数鉴别良恶性胸腔积液：① 定量参数：包括积液及胸膜的最大标准化摄取值（maximum standardized uptake value, SUVmax），以及病灶与主动脉（L/Ao）、小脑（L/Cbl）、肝脏（L/Liv）、非病灶区域（L/NL）、原发肺癌（L/Prim）的比值；② 由PET与CT扫描确定的多项参数：胸膜区域的放射性摄取情况、亨氏单位（Hounsfield unit）、实性异常病灶的大小及形态学特征。 结果：恶性胸腔积液的L/Prim值显著高于良性胸腔积液。研究发现，CT检出胸膜异常及PET图像上胸膜区域摄取增高在恶性胸膜疾病患者中更为常见。通过受试者工作特征（receiver operating characteristic, ROC）分析，上述参数可有效区分良恶性胸腔积液。L/Prim值、CT检出胸膜异常与PET图像胸膜区域摄取三者之间无统计学差异。经logistic回归分析，PET图像上异常的胸膜区域摄取是鉴别恶性胸腔积液的最准确参数。 结论：本研究结果表明，F-18 FDG PET/CT可作为一种可靠的无创性方法，用于非小细胞肺癌（NSCLC）患者良恶性胸膜疾病的鉴别诊断。