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Clinical Investigations |
1 Division of Nuclear Medicine, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
2 Division of Thoracic Surgery, Department of Surgery, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
Malignant pleural mesothelioma is an aggressive primary neoplasm for which early detection and accurate staging are known diagnostic challenges. The role of 18F-FDG dual-head gamma-camera coincidence imaging (18F-FDG-CI) is yet to be defined. The purpose of this study was to evaluate the usefulness of 18F-FDG-CI in the assessment of malignant pleural mesothelioma using histopathology as the gold standard. Methods: Fifteen consecutive patients with CT scan evidence of pleural thickening, fluid, plaques, or calcification underwent 18F-FDG imaging 1.5 h after the intravenous administration of 370 MBq 18F-FDG. Imaging was performed with a dual-head gamma camera equipped with 2.54-cm-thick NaI crystals operating in coincidence mode. Using an iterative algorithm, whole-body images were reconstructed as transaxial, sagittal, and coronal images. No attenuation correction was applied. The results of 18F-FDG-CI scans were compared with CT and with histopathologic diagnosis. Results: Eleven of 15 patients had histologically proven malignant mesotheliomas (10 epithelial, 1 sarcomatoid). All 11 primary tumors were detected by 18F-FDG, and absence of disease was confirmed in the 4 patients who were disease free. Thirty-four lesions were biopsied; among these, 29 were found to be positive for tumor. 18F-FDG was true-positive in 28 lesions, true-negative in 4, false-negative in 1 (0.5 cm in diameter), and false-positive in 1 (inflammatory pleuritis). The smallest lesion detected was 0.8 cm. For biopsied lesions, overall sensitivity, specificity, and accuracy for 18F-FDG-CI were 97%, 80%, and 94% respectively, compared with 83%, 80%, and 82% for CT. Twenty-one of 29 positive lesions involved the pleura, lung parenchyma, or chest wall and were all 18F-FDG avid. In the mediastinum, 18F-FDG-CI detected 7 of 8 biopsy-positive lesions (88%), whereas CT was positive in 6 of 8 lesions (75%). 18F-FDG identified extrathoracic metastases in 5 patients, excluding them from surgical therapy. Conclusion: These preliminary results suggest that 18F-FDG-CI appears to be an accurate method to diagnose and to define the extent of disease in patients with diffuse malignant pleural mesothelioma.
Key Words: 18F-FDG • mesothelioma • coincidence imaging • pleural malignancies
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