Prediction of Acute Exacerbation of Interstitial Pneumonia Using Visual Evaluation of PET

Background. Acute exacerbation (AE) of interstitial pneumonia (IP) is a fatal complication after lung resection. We aimed to investigate whether the visual accumulation of [18F]-fluoro-2-deoxy-D-glucose (FDG) in the field of IP on preoperative FDG-positron emission tomography-computed tomography is useful for predicting AE of IP. Methods. This study included 193 patients with IP findings on preoperative computed tomography who underwent curative intent lung resection for primary lung cancer at Hiroshima University Hospital between April 2007 and March 2019. If the uptake of IP area was higher than the background normal lung, the patients were considered to have positive FDG accumulation. The relationship of the accumulation of FDG in the IP area and the incidence of AE of IP and short-term mortality was analyzed. Results. Among the included patients, accumulation of FDG in the IP area was detected in 130 (67.4%) patients. The incidence of AE of IP was significantly different between patients with (10.0%) and without (0%) FDG accumulation in the IP area (P = .001). The 90-day mortality rate was also significantly different between patients with (6.9%) and without (0%) accumulation of FDG in the IP area (P = .007). In the multivariable analysis, the accumulation of FDG in the IP area was a significant risk factor of AE of IP (P = .005). Conclusions. The visual evaluation of accumulation of FDG in the IP area was useful to predict the AE of IP and short-term mortality after lung resection. (Ann Thorac Surg 2021;112:264-70) (c) 2021 by The Society of Thoracic Surgeons