Skip to main content
SpringerLink
Log in

Value of 18F-FDG PET/CT in differentiating malignancy of pulmonary artery from pulmonary thromboembolism: a cohort study and literature review

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

To determine the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in differentiating malignancy of pulmonary artery (PA) from pulmonary thromboembolism (PTE) based on a larger number of cases by pooling our cases and those from the literature. Consecutive patients with a PA lesion who had undergone 18F-FDG PET/CT in our hospital were retrospectively reviewed. Moreover, PubMed, Embase, and Medline were searched for literature reporting individual maximum standardised uptake value (SUVmax) of the malignant PA lesion and/or PTE. 18F-FDG activity was compared between PA malignancy and PTE by pooling the data from literature and our patients. Receiver operating characteristic curve analysis was performed to determine the ability of SUVmax to differentiate PA malignancy from PTE. From our database, we identified 11 patients with pulmonary artery sarcoma (PAS), and nine cases of PTE. Fifty patients with a malignant PA lesion (40 cases of PAS and 10 cases of tumor embolism) and 22 subjects with PTE were extracted from the literature. In our cases, the SUVmax of PAS (11.1 ± 4.9, range: 5.5–19.9) was significantly higher than that of PTE (1.9 ± 0.6, range: 1.1–3.2; P < 0.001). There was no significant difference in the SUVmax between the literature data and our cases in malignant lesions or in PTE. Based on the pooled analysis of the literature data and our cases (61 cases of malignant lesions and 31 cases of PTE), the area under the curve for SUVmax to differentiate PA malignancy from PTE was 0.996 (95% CI: 0.989–1.000). At a cutoff value of 3.3, the sensitivity, specificity, and accuracy were 98.4%, 96.8%, and 97.8%, respectively. The 18F-FDG uptake value is an accurate index for determining PA malignancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

AUC:

Area under the curve

CT:

Computed tomography

CTPA:

CT pulmonary angiography

FDG:

Fluorodeoxyglucose

MRI:

Magnetic resonance imaging

MRPA:

Magnetic resonance pulmonary angiography

PA:

Pulmonary artery

PAS:

Pulmonary artery sarcoma

PET:

Positron emission tomography

PTE:

Pulmonary thromboembolism

ROC:

Receiver operating characteristic

ROI:

Region of interest

SUVmax :

Maximum standardised uptake value

References

  1. Coli A, Parente P, Bigotti G (2007) Pulmonary artery sarcoma: an insidious tumor still diagnosed too late. Analysis of the literature and report of a case. J Exp Clin Cancer Res 26:151–156

    CAS  PubMed  Google Scholar 

  2. Levy E, Korach A, Amir G, Milgalter E (2006) Undifferentiated sarcoma of the pulmonary artery mimicking pulmonary thromboembolic disease. Heart Lung Circ 15:62–63

    Article  PubMed  Google Scholar 

  3. Sandhu A, Yates TJ, Kuriakose P (2008) Pulmonary artery sarcoma mimicking a pulmonary embolism. Indian J cancer 45:27–29

    Article  CAS  PubMed  Google Scholar 

  4. Ito K, Kubota K, Morooka M, Shida Y, Hasuo K, Endo H et al (2009) Diagnostic usefulness of 18F-FDG PET/CT in the differentiation of pulmonary artery sarcoma and pulmonary embolism. Ann Nucl Med 23:671–676

    Article  PubMed  Google Scholar 

  5. Attina D, Niro F, Tchouante P, Mineo G, Russo V, Palazzini M et al (2013) Pulmonary artery intimal sarcoma. Problems in the differential diagnosis. Radiol Med 118:1259–1268

    Article  PubMed  Google Scholar 

  6. Chong S, Kim TS, Kim B-T, Cho EY, Kim J (2007) Pulmonary artery sarcoma mimicking pulmonary thromboembolism: integrated FDG PET/CT. Am J Roentgenol 188:1691–1693

    Article  Google Scholar 

  7. Ishiguro T, Kasahara K, Matsumoto I, Waseda R, Minato H, Kimura H et al (2007) Primary pulmonary artery sarcoma detected with a pulmonary infarction. Intern Med 46:601–604

    Article  PubMed  Google Scholar 

  8. Lee EJ, Moon SH, Choi JY, Lee KS, Choi YS, Choe YS et al (2013) Usefulness of fluorodeoxyglucose positron emission tomography in malignancy of pulmonary artery mimicking pulmonary embolism. ANZ J Surg 83:342–347

    Article  PubMed  Google Scholar 

  9. Wittram C, Scott JA (2007) 18F-FDG PET of pulmonary embolism. Am J Roentgenol 189:171–176

    Article  Google Scholar 

  10. Guo Y, Wang T, Yang M (2015) Pulmonary artery sarcoma detected on 18F-FDG PET/CT with unusual findings. Clin Nucl Med 40:e530–e531

    Article  PubMed  Google Scholar 

  11. Çelik G, Çiledaǧ A, Yüksel C, Yenigün BM, Kutlay H, Yazicioǧlu L et al (2011) Pulmonary artery sarcoma mimicking pulmonary thromboembolism. Tuberk Toraks 59:369–373

    Article  PubMed  Google Scholar 

  12. Chun IK, Eo JS, Paeng JC, Kim DW, Chung JK, Lee DS (2011) Pulmonary artery sarcoma detected on F-18 FDG PET/CT as origin of multiple spinal metastases. Clin Nucl Med 36:e87–e89

    Article  PubMed  Google Scholar 

  13. Desmarais P, Laskine M, Caporuscio C (2016) Primary pulmonary artery angiosarcoma mimicking pulmonary embolism in a 66-year-old man with dyspnea. CMAJ 188:E509–E512

    Article  PubMed  PubMed Central  Google Scholar 

  14. Dias OM, Lombardi EM, Canzian M, Soares Junior J, Vieira Lde O, Terra Filho M (2011) 18F-fluorodeoxyglucose positron emission tomography as a noninvasive method for the diagnosis of primary pulmonary artery sarcoma. J Bras Pneumol 37:817–822

    Article  PubMed  Google Scholar 

  15. Evison M, Crosbie P, Chaturvedi A, Shah R, Booton R (2015) Pulmonary artery sarcoma: a rare thoracic tumor frequently misdiagnosed at presentation. Thorac Cancer 6:797–799

    Article  PubMed  Google Scholar 

  16. Girard N, Triby-Moreau C, Benabidallah S, Tronc F, Revel D, Giammarile F et al (2009) Pulmonary artery sarcoma, a paradigm of orphan thoracic oncology. Presse Med 38:1167–1170

    Article  PubMed  Google Scholar 

  17. Hajsadeghi S, Kooranifar S, Ansarinejad N, Sadeghipour A, Iranpour A, Aziz Ahari A (2017) Metastatic pulmonary artery sarcoma presented with tamponade: a case report. Clin Case Rep 5:1007–1010

    Article  PubMed  PubMed Central  Google Scholar 

  18. Halank M, Jakob C, Kolditz M, Hoeffken G, Kappert U, Ehninger G et al (2010) Intimal pulmonary artery sarcoma presenting as severe dyspnea and right heart insufficiency. Onkologie 33:313–316

    Article  PubMed  Google Scholar 

  19. Hmelik S, Dobrenić M, Huić D (2018) F-18 FDG PET/CT in pulmonary artery sarcoma: clinical vignette. Nucl Med Rev 21:48–49

    Article  Google Scholar 

  20. Inoue Y, Izumi Y, Sakaki K, Abe K, Oka T, Tamaru JI et al (2014) A case of pulmonary sarcoma with significant extension into the right lung. Case Rep Med 2014:279374

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kaira K, Imai H, Yamada M (2015) Recurrent intimal sarcoma mimicking pulmonary embolism. Jpn J Clin Oncol 45:695–696

    Article  PubMed  Google Scholar 

  22. Kamaleshwaran KK, Pattabiraman VR, Mehta S, Mohanan V, Shinto AS (2014) Spindle cell sarcoma of pulmonary artery mimicking thromboembolism with lung metastasis detected in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Nucl Med 29:249–251

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kessler A, Son H (2015) Pulmonary artery angiosarcoma on 18F-FDG PET/CT masquerading as pulmonary embolism. Clin Nucl Med 40:82–84

    Article  PubMed  Google Scholar 

  24. Li J, Zhao Q, He L, Zhuang X, Li F (2016) Primary pulmonary artery sarcoma on dual-time point FDG PET/CT imaging. Clin Nucl Med 41:656–658

    Article  PubMed  Google Scholar 

  25. Liu X, Hou J, Wang X, Chen Z (2017) An intimal sarcoma of pulmonary artery mimicking pulmonary embolism: a case report and literature review. Respirol Case Rep 5:e00248

    PubMed  PubMed Central  Google Scholar 

  26. Min D, Lee JH, Jeong HC, Kim JH, Shin SP, Kim HM et al (2014) A case of pulmonary artery sarcoma presented as cavitary pulmonary lesions. Tuberc Respir Dis 76:136–140

    Article  Google Scholar 

  27. Mori S, Uehara H, Motoi N, Okumura S (2017) Pulmonary artery sarcoma presenting as an isolated lung mass. Gener Thorac Cardiovasc Surg 65:171–174

    Article  Google Scholar 

  28. Nakamura Y, Shimizu T, Fukumoto Y, Sugimura K, Ito S, Fujishima F et al (2012) A case of angiosarcoma arising in trunk of the right pulmonary artery clinically simulating pulmonary thromboembolism. World J Oncol 3:119–123

    PubMed  PubMed Central  Google Scholar 

  29. Oberson M, Sophie Pawelczak C, Meincke F (2010) Paraneoplastic thrombus or relapse of a pulmonary artery sarcoma? Thorax 65:941–942

    Article  PubMed  Google Scholar 

  30. Ote EL, Oriuchi N, Miyashita G, Paudyal B, Ishikita T, Arisaka Y et al (2011) Pulmonary artery intimal sarcoma: the role of 18F-fluorodeoxyglucose positron emission tomography in monitoring response to treatment. Jpn J Radiol 29:279–282

    Article  PubMed  Google Scholar 

  31. Park JS, Chung JH, Jheon S, Choi DJ, Yoon HI, Lee JH et al (2011) EBUS-TBNA in the differential diagnosis of pulmonary artery sarcoma and thromboembolism. Eur Respir J 38:1480–1482

    Article  CAS  PubMed  Google Scholar 

  32. Shingyoji M, Ikebe D, Itakura M, Nakajima T, Itami M, Kimura H et al (2013) Pulmonary artery sarcoma diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. Ann Thorac Surg 96:e33–e35

    Article  PubMed  Google Scholar 

  33. Strobel K, Bode B, Lardinois D, Exner U (2007) PET-positive fibrous dysplasia—a potentially misleading incidental finding in a patient with intimal sarcoma of the pulmonary artery. Skeletal Radiol 36(Suppl 1):S24–S28

    Article  PubMed  Google Scholar 

  34. Tueller C, Fischer Biner R, Minder S, Gugger M, Stoupis C, Krause TM et al (2010) FDG-PET in diagnostic work-up of pulmonary artery sarcomas. Eur Respir J 35:444–446

    Article  CAS  PubMed  Google Scholar 

  35. Yamasaki M, Sumi Y, Sakakibara Y, Tamaoka M, Miyazaki Y, Arai H et al (2011) Pulmonary artery leiomyosarcoma diagnosed without delay. Case Rep Oncol 4:287–298

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kumagai H, Nio K, Okumura Y, Komoda M, Shirakawa T, Kusaba H et al (2014) Successful chemoradiotherapy for undifferentiated malignant neoplasm arising from the left pulmonary artery. Case Rep Oncol 7:484–490

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hibino M, Akazawa K, Hikino K, Oe M (2012) Pulmonary tumor embolism secondary to uterine corpus carcinosarcoma mimicking pulmonary thromboembolism. Intern Med 51:2603–2607

    Article  PubMed  Google Scholar 

  38. Leuzzi G, Melis E, Forcella D, Facciolo F (2015) Pulmonary tumor embolus with high (18) FDG uptake mimicking lung metastasis from renal-cell cancer. Rev Esp Med Nucl Imagen Mol 34:325–326

    PubMed  Google Scholar 

  39. Purandare NC, Dua SG, Rangarajan V, Shah S, Sharma AR (2010) Pulmonary artery and femoral vein tumour thromboembolism in a patient with osteogenic sarcoma demonstrated by FDG PET/CT. Eur J Nucl Med Mol Imaging 37:653

    Article  PubMed  Google Scholar 

  40. Sone T, Yoshikawa K, Fukunaga M (2008) Pulmonary tumor embolism from choriocarcinoma: detection with F-18 FDG positron emission tomography. Clin Nucl Med 33:773–774

    Article  PubMed  Google Scholar 

  41. Vial MR, Sarkiss M, Lazarus DR, Eapen G (2015) Endobronchial ultrasound-guided diagnosis of pulmonary artery tumor embolus. Ann Thorac Surg 99:1816–1819

    Article  PubMed  Google Scholar 

  42. Zaheer S, Osmany S, Lai HK, Eng DNC (2009) Usefulness of F-18 fluorodeoxyglucose positron emission tomography/computed tomography in a case of choriocarcinoma presenting as pulmonary embolism. Clin Nucl Med 34:343–345

    Article  PubMed  Google Scholar 

  43. Flavell RR, Behr SC, Brunsing RL, Naeger DM, Pampaloni MH (2014) The incidence of pulmonary embolism and associated FDG-PET findings in IV contrast-enhanced PET/CT. Acad Radiol 21:718–725

    Article  PubMed  Google Scholar 

  44. Manoharan P, Cronin PP, Brown RK (2007) Metastatic head and neck cancer conflated with pulmonary embolism and infarct on PET/CT. Radiol Case Rep 2:62

    Article  PubMed  Google Scholar 

  45. Restrepo CS, Betancourt SL, Martinez-Jimenez S, Gutierrez FR (2012) Tumors of the pulmonary artery and veins. Semin Ultrasound CT MR 33:580–590

    Article  PubMed  Google Scholar 

  46. Hoiczyk M, Iliodromitis K, Bauer S, Konorza T, Philipp S, Bankfalvi A et al (2012) Intimal sarcoma of the pulmonary artery with unusual findings: a case report. Clin Res Cardiol 101:397–401

    Article  PubMed  Google Scholar 

  47. Lee DH, Jung TE, Lee JH, Shin DG, Park WJ, Choi JH (2013) Pulmonary artery intimal sarcoma: poor 18F-fluorodeoxyglucose uptake in positron emission computed tomography. J Cardiothorac Surg 8:40

    Article  PubMed  PubMed Central  Google Scholar 

  48. Watanabe K, Shinkai M, Kaneko T (2016) Autopsy case of pulmonary artery sarcoma forming aneurysm without FDG uptake. Arch Bronconeumol 52:535–536

    Article  PubMed  Google Scholar 

  49. Kishimoto N, Ikuta T, Fujii H, Sumiya A, Kimura E, Shimizu Y (2018) Pyogenic granuloma originating in the pulmonary artery. Gen Thorac Cardiovasc Surg. https://doi.org/10.1007/s11748-018-0930-1

    Article  PubMed  Google Scholar 

  50. Tanaka I, Masuda R, Inoue M, Kasahara D, Furuhata Y, Shimizu S et al (1994) Primary pulmonary-artery sarcoma. Report of a case with complete resection and graft replacement, and review of 47 surgically treated cases reported in the literature. Thorac Cardiovasc Surg 42:64–68

    Article  CAS  PubMed  Google Scholar 

  51. Fernandes T, Planquette B, Sanchez O, Morris T (2016) From acute to chronic thromboembolic disease. Ann Am Thorac Soc 13(Suppl 3):S207–S214

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Xiao-Ying Xi and Wei Gao have contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Nuclear Medicine, Beijing Chaoyang Hospital, Capital Medical University, 8th Gongtinanlu Rd, Chaoyang District, Beijing, 100020, China

    Xiao-Ying Xi, Jiao-Yan Wu & Min-Fu Yang

  2. Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Wei Gao

  3. Department of Respiratory and Critical Care, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Juan-Ni Gong & Yuan-Hua Yang

  4. Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Xiao-Juan Guo

Authors
  1. Xiao-Ying Xi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juan-Ni Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiao-Juan Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jiao-Yan Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuan-Hua Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Min-Fu Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Min-Fu Yang.

Ethics declarations

Conflict of interest

All authors declared that they have no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xi, XY., Gao, W., Gong, JN. et al. Value of 18F-FDG PET/CT in differentiating malignancy of pulmonary artery from pulmonary thromboembolism: a cohort study and literature review. Int J Cardiovasc Imaging 35, 1395–1403 (2019). https://doi.org/10.1007/s10554-019-01553-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-019-01553-5

Keywords

Search

Navigation