Abstract
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Objectives “A misty mesentery” is a term describing CT appearance of mesenteric fat with increased attenuation that often exists along with multiple mesenteric lymph nodes. The differential diagnoses involve a wide spectrum of pathosis: neoplastic infiltration, e.g. lymphoma, mesenteric panniculitis, edema, lymphedema, idiopathic, etc. The aim of this study was to evaluate the ability of FDG PET/CT to detect viable malignancy in a misty mesentery.
Methods We studied 18 patients who underwent FDG PET/CT for evaluating a misty mesentery. Among them, 13 patients had a history of malignancy, including 6 lymphoma patients, while the remaining 5 patients had no history of malignancy. Patients with a bulky mass in a mesentery or those who were under chemotherapy at the scanning were not included. FDG uptake higher than surrounding tissue was regarded as positive, and the diagnostic ability for differentiation between viable malignancy and stable lesions was assessed, based on the final diagnoses obtained by histological confirmation or by clinical follow-up for at least 6 months.
Results Viable malignancy was confirmed in 7 patients, for whom mesenteric lesions were positive on PET/CT. All these tumors were lymphoma, including 5 cases of follicular lymphoma. Relapse of lymphoma was confirmed in 3 of the 6 patients with a history of lymphoma. Moreover, PET/CT could detect 4 more fresh lymphoma cases. On the other hand, 7 patients had stable lesions, only one of whom had positive mesenteric uptake. Hence, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for these cases were 100%, 86%, 88%, 100%, and 93%, respectively. The final diagnoses of the remaining 4 patients could not be established.
Conclusions Our preliminary data indicate that FDG PET/CT is feasible for identifying viable malignancy in a misty mesentery. Lymphoma may be a major constituent of positive mesenteric uptake
Results of FDG PET/CT to detect viable malignancy in a misty mesentery
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