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@ARTICLE{Flechsig:142023,
      author       = {P. Flechsig and R. Rastgoo and C. Kratochwil and O. Martin
                      and T. Holland-Letz$^*$ and A. Harms and H.-U. Kauczor and
                      U. Haberkorn$^*$ and F. Giesel$^*$},
      title        = {{I}mpact of {C}omputer-{A}ided {CT} and {PET} {A}nalysis on
                      {N}on-invasive {T} {S}taging in {P}atients with {L}ung
                      {C}ancer and {A}telectasis.},
      journal      = {Molecular imaging $\&$ biology},
      volume       = {20},
      number       = {6},
      issn         = {1860-2002},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science58693},
      reportid     = {DKFZ-2018-02253},
      pages        = {1044 - 1052},
      year         = {2018},
      abstract     = {Tumor delineation within an atelectasis in lung cancer
                      patients is not always accurate. When T staging is done by
                      integrated 2-deoxy-2-[18F]fluoro-D-glucose
                      ([18F]FDG)-positron emission tomography (PET)/X-ray computer
                      tomography (CT), tumors of neuroendocrine differentiation
                      and slowly growing tumors can present with reduced FDG
                      uptake, thus aggravating an exact T staging. In order to
                      further exhaust information derived from [18F]FDG-PET/CT, we
                      evaluated the impact of CT density and maximum standardized
                      uptake value (SUVmax) for the classification of different
                      tumor subtypes within a surrounding atelectasis, as well as
                      possible cutoff values for the differentiation between the
                      primary tumor and atelectatic lung tissue.Seventy-two
                      patients with histologically proven lung cancer and adjacent
                      atelectasis were investigated. Non-contrast-enhanced
                      [18F]FDG-PET/CT was performed within 2 weeks before
                      surgery/biopsy. Boundaries of the primary within the
                      atelectasis were determined visually on the basis of
                      [18F]FDG uptake; CT density was quantified manually within
                      each primary and each atelectasis.CT density of the primary
                      (36.4 Hounsfield units (HU) ± 6.2) was significantly
                      higher compared to that of atelectatic lung (24.3
                      HU ± 8.3; p < 0.01), irrespective of the
                      histological subtype. The discrimination between different
                      malignant tumors using density analysis failed. SUVmax was
                      increased in squamous cell carcinomas compared to
                      adenocarcinomas. Irrespective of the malignant subtype, a
                      possible cutoff value of 24 HU may help to exclude the
                      presence of a primary in lesions below 24 HU, whereas a
                      density above a threshold of 40 HU can help to exclude
                      atelectatic lung.Density measurements in patients with lung
                      cancer and surrounding atelectasis may help to delineate the
                      primary tumor, irrespective of the specific lung cancer
                      subtype. This could improve T staging and radiation
                      treatment planning (RTP) without additional application of a
                      contrast agent in CT, or an additional magnetic resonance
                      imaging (MRI), even in cases of lung tumors of
                      neuroendocrine differentiation or in slowly growing tumors
                      with less avidity to [18F]FDG.},
      cin          = {C060 / E060},
      ddc          = {570},
      cid          = {I:(DE-He78)C060-20160331 / I:(DE-He78)E060-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29679299},
      doi          = {10.1007/s11307-018-1196-9},
      url          = {https://inrepo02.dkfz.de/record/142023},
}