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Positron Emission Tomography in the Evaluation of Pulmonary Nodules Among Patients Living in a Coccidioidal Endemic Region

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Abstract

Background

Within a coccidioidal endemic region, pulmonary nodules due to coccidioidomycosis are common. Uptake of 18fluorodeoxyglucose (18FDG) by positron emission tomography with computed axial tomography (PET/CT) has been used to assess whether pulmonary nodules are malignant but inflammatory lesions can be positive. The purpose of this study was to compare by PET/CT the 18FDG uptake in pulmonary nodules likely due to coccidioidomycosis to that of nodules shown to be malignant among patients living in a coccidioidal endemic region.

Methods

We retrospectively reviewed patients who underwent a PET/CT at the Southern Arizona Veterans Affairs Health Care System between January 2008 and March 2012 who were subsequently found on biopsy to have pulmonary nodules that were coccidioidal or granulomatous or were due to malignancy.

Results

Among 245 diagnostic biopsies where the subject had a previous PET/CT, 15 (6.1 %) were either coccidioidal (n = 12) or granulomatous without an identified organism (n = 3). The median maximum standard unit of uptake (SUVmax) on PET/CT of coccidioidal or granulomatous lesions was 2.0 compared to 9.8 for malignant lesions (P < 0.001). The maximum diameter of the coccidioidal or granulomatous nodules was 2.1 cm compared to 3.0 cm for the malignant lesions (P = 0.009). On multivariable analysis, an elevated SUVmax was the only distinguishing feature between the malignant and the granulomatous lesions (OR 1.28, 95 % CI 1.05–1.55; P = 0.013).

Conclusions

Coccidioidal pulmonary nodules take up significantly less 18FDG than those due to malignancies, but there is considerable overlap between granulomatous and malignant lesions at lower SUVmax.

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Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Pulmonary and Critical Care Division, University of Arizona, Tucson, AZ, USA

    Nathaniel Reyes, Oluwole O. Onadeko, Maria Del Carmen Luraschi-Monjagatta & Kenneth S. Knox

  2. Department of Laboratory and Diagnostics, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ, USA

    Margaret A. Rennels & Travis Kent Walsh

  3. Infectious Diseases Section, Medicine and Subspecialties (1-111), University of Arizona and the Southern Arizona Veterans Affairs Health Care System, 3601 S. 6th Avenue, Tucson, AZ, 85723, USA

    Neil M. Ampel

Authors
  1. Nathaniel Reyes
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  2. Oluwole O. Onadeko
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  3. Maria Del Carmen Luraschi-Monjagatta
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  4. Kenneth S. Knox
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  5. Margaret A. Rennels
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  6. Travis Kent Walsh
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  7. Neil M. Ampel
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Correspondence to Neil M. Ampel.

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Reyes, N., Onadeko, O.O., Luraschi-Monjagatta, M.D.C. et al. Positron Emission Tomography in the Evaluation of Pulmonary Nodules Among Patients Living in a Coccidioidal Endemic Region. Lung 192, 589–593 (2014). https://doi.org/10.1007/s00408-014-9589-2

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  • DOI: https://doi.org/10.1007/s00408-014-9589-2

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