DOI: 10.1007/s00259-017-3795-0Pages: 102-109

Added diagnostic value of respiratory-gated 4D 18F–FDG PET/CT in the detection of liver lesions: a multicenter study

1. San Gerardo Hospital, Nuclear Medicine

2. University of Milan-Bicocca

3. San Gerardo Hospital, Medical Physics

4. IRCCS San Raffaele Scientific Institute, Nuclear Medicine

5. Santa Maria Nuova Hospital IRCCS, Nuclear Medicine

6. Santa Maria Nuova Hospital IRCCS, Medical Physics

7. Military Institute of Medicine

8. Hôpital Pierre Beregovoy, Service de Médecine Nucléaire

9. University of Milan-Bicocca, Tecnomed Foundation

Correspondence to:
Cinzia Crivellaro
Tel: +39.039.2339145




The aim of the present study was to evaluate the added diagnostic value of respiratory-gated 4D18F–FDG PET/CT in liver lesion detection and characterization in a European multicenter retrospective study.


Fifty-six oncological patients (29 males and 27 females, mean age, 61.2 ± 11.2 years) from five European centers, submitted to standard 3D–PET/CT and liver 4D–PET/CT were retrospectively evaluated. Based on visual analysis, liver PET/CT findings were scored as positive, negative, or equivocal both in 3D and 4D PET/CT. The impact of 4D–PET/CT on the confidence in classifying liver lesions was assessed. PET/CT findings were compared to histology and clinical follow-up as standard reference and diagnostic accuracy was calculated for both techniques. At semi-quantitative analysis, SUVmax was calculated for each detected lesion in 3D and 4D–PET/CT.


Overall, 72 liver lesions were considered for the analysis. Based on visual analysis in 3D–PET/CT, 32/72 (44.4%) lesions were considered positive, 21/72 (29.2%) negative, and 19/72 (26.4%) equivocal, while in 4D–PET/CT 48/72 (66.7%) lesions were defined positive, 23/72 (31.9%) negative, and 1/72 (1.4%) equivocal. 4D–PET/CT findings increased the confidence in lesion definition in 37/72 lesions (51.4%). Considering 3D equivocal lesions as positive, sensitivity, specificity, and accuracy were 88.9, 70.0, and 83.1%, respectively, while the same figures were 67.7, 90.0, and 73.8% if 3D equivocal findings were included as negative. 4D–PET/CT sensitivity, specificity, and accuracy were 97.8, 90.0, and 95.4%, respectively, considering equivocal lesions as positive and 95.6, 90.0, and 93.8% considering equivocal lesions as negative. The SUVmax of the liver lesions in 4D–PET (mean ± SD, 6.9 ± 3.2) was significantly higher (p < 0.001) than SUVmax in 3D–PET (mean ± SD, 5.2 ± 2.3).


Respiratory-gated PET/CT technique is a valuable clinical tool in diagnosing liver lesions, reducing 3D undetermined findings, improving diagnostic accuracy, and confidence in reporting. 4D–PET/CT also improved the quantification of SUVmax of liver lesions.

To access the full text, please Sign in

If you have institutional access, please click here

  • Accepted: Jul 26, 2017
  • Online: Aug 19, 2017

Article Tools