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Assessment of Malignant Pleural Mesothelioma with ¹⁸F-FDG Dual-Head Gamma-Camera Coincidence Imaging: Comparison with Histopathology

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

View larger version (56K): [in a new window]   FIGURE 1. 18F-FDG-CI and MRI images of patient with biopsy-confirmed epithelial-type malignant mesothelioma of right pleura. 18F-FDG images show diffusely increased uptake of tracer along pleural space encasing right lung. Transaxial and sagittal images suggest involvement of anterior chest wall, with pleural uptake extending to right paracardiac mediastinum. 18F-FDG-CI findings are in close agreement with extensive soft-tissue pleural mass seen on MRI. Ant = anterior; Post = posterior; R = right.

View larger version (79K): [in a new window]   FIGURE 2. (A) Axial CT slices of thorax show circumferential pleural nodularity encasing left hemithorax with volume loss. There is medial loculation of pleural fluid, and pleural effusion is also seen in dependent location at left lung base. There is no evidence of right pleural thickening. RT = right. (B) Axial 18F-FDG-CI shows 18F-FDG hypermetabolism in left pleural cavity (arrow). In addition, there is distinct focus of increased uptake in anterior right costophrenic sulcus suggesting contralateral disease (arrowhead). Histology confirmed bilateral pleural mesothelioma of epithelial type.

View larger version (61K): [in a new window]   FIGURE 3. 18F-FDG-CI study of patient who had undergone right pleurectomy and chemotherapy for diffuse malignant mesothelioma 18 mo earlier. There is increased 18F-FDG uptake in middle mediastinum extending to posterior mediastinum and to upper-posterior abdomen. In addition, there is abnormal 18F-FDG uptake in superior anterior abdominal wall. Ant = anterior; Post = posterior; R = right.