Comparative Role of MDCT and FDG-PET/CT in the Diagnostic Evaluation of Mediastinal Mass Lesions: An Institutional Experience

Abstract

Background  Mediastinal mass lesions span a wide histopathological and radiological spectrum. Partition of the mediastinum into specific compartments aids in differential diagnosis of mass lesions, assistance in biopsies, and other surgical procedures. Multidetector row computed tomography (MDCT) is a promising three-dimensional imaging tool allowing substantial anatomical volumes to be routinely covered with isotropic submillimeter spatial resolution to precisely localize lesions and biopsy needles for both benign and malignant disease lesions of the mediastinum.

Objective  The aim of this study was to categorize mass lesions according to the mediastinal compartments to study their MDCT characteristics and to provide a comparative role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the diagnostic evaluation of mediastinal mass lesions.

Materials and Methods  Patients with clinical or radiological suspicion of mediastinal lesions on the basis of an abnormal chest radiograph were referred to the department of radiodiagnosis at a tertiary care center between April 2015 and December 2019 for MDCT evaluation. A total of 80 cases were correlated with the histopathological diagnosis excluding aneurysms. Size, CT density (Hounsfield unit [HU] mean), and maximum standardized uptake value (SUV _max ) of mediastinal and chest wall lesions were determined on FDG-PET/CT.

Results  This study included a total of 102 cases, 72 males and 29 females. Mediastinal mass lesions were most common in the age group 46 to 60 years. Anterior mediastinum ( n  = 43, 42.2%) is the most commonly involved compartment followed by posterior mediastinum ( n  = 37, 35.9%) and middle mediastinum ( n  = 22, 21.8%). Transcompartmental involvement is more commonly seen involving the anterior and middle mediastinum. The SUV _max , HU mean, and size were higher in malignant cases ( p  = 0.001, p  = 0.003, and p  = 0.004, respectively). The current study found a cutoff value of 4.61 for SUV _max to discriminate benign lesions from malignant ones with a sensitivity and specificity of 73.7 and 75.9%, respectively (area under the curve: 0.841, 95% confidence interval: 0.793–0.965, p  = 0.0001). The values of SUV _max and HU mean were higher in solid benign lesions than those of cystic benign lesions ( p  = 0.007 and p  = 0.003, respectively).

Conclusion  In the current study, MDCT has high diagnostic accuracy of ∼94% overall as compared with histopathology, and 97 and 92% for benign and malignant lesions, respectively, in the evaluation of mediastinal mass lesions. FDG-PET/CT may be complementary to conventional imaging methods for the evaluation of mediastinal and chest wall mass lesions. However, confirmatory tissue sampling is required to confirm PET positive findings for the definite diagnosis.