11C-Acetate Positron Emission Tomography Imaging for Lung Adenocarcinoma 1 to 3 cm in Size With Ground-Glass Opacity Images on Computed Tomography

Background Positron-emission tomography (PET) with 18F-fluorodeoxy-glucose (FDG) frequently gives false-negative results for well-differentiated adenocarcinomas of the lung, especially, those with ground-glass opacity images. Recently, PET with 11C-acetate (AC) has been reported to detect slow-growing tumors that have failed to be identified by FDG-PET, such as well-differentiated hepatocellular carcinomas and prostate cancers. To determine the usefulness of AC-PET in detecting well-differentiated adenocarcinomas of the lung, we performed both AC-PET and FDG-PET on pulmonary nodules with ground-glass opacity images on computed tomography (CT). Methods Fifty-four pulmonary nodules 1 to 3 cm in size, which showed ground-glass opacity images over their whole or peripheral area on CT, were examined by both AC-PET and FDG-PET. Results Thirty-seven nodules were adenocarcinoma of the lung, while 17 were inflammatory. Of the 37 adenocarcinomas, 19 (51%) were positively identified by AC-PET and 14 (38%) by FDG-PET. Of the 23 adenocarcinomas which were not identified by FDG-PET, 8 (35%) were positively identified by AC-PET; all were well-differentiated adenocarcinomas. Of the 17 inflammatory nodules, 8 were chronic and 9 were acute ones. While none of the 8 chronic inflammatory nodules were identified by either technique, 9 acute ones showed a variety of the results with AC- and FDG-PET. Conclusions AC-PET detected approximately one third of well-differentiated adenocarcinomas of the lung which were not identified by FDG-PET. AC-PET could be useful to diagnose pulmonary nodules with ground-glass opacity images which were not identified by FDG-PET.