A Review of the Role of FDG-PET/CT and PET/MRI in Malignant Pleural Mesothelioma

Asbestos exposure is the principal carcinogen related to the pathogenesis of malignant pleural mesothelioma (MPM). MPM has a peak incidence of 35-45 years after asbestos exposure. Despite the ban of asbestos in many countries, the world wide incidence is increasing given the long latency between exposure and disease onset, with a peak incidence expected in 10-20 years. Although MPM is managed by multimodality treatment, including surgical debulking or decortication, chemotherapy, radiotherapy, and immunotherapy,the median survival of patients after diagnosis of MPM ranges from 7-17 months. Early diagnosis and accurate staging of MPM is critical for optimized patient management. Several imaging modalities have been used in the evaluation of this disease: Contrast-enhanced CT of the chest is limited in its ability to evaluate the degree of local invasion and to differentiate benign from malignant soft-tissue abnormalities. MRI has superior soft tissue contrast resolution and helps to identify the extent of primary tumor; however, it has limitations for indentification of early locoregional or distant metastases. A large amount of data from literature suggests that FDG-PET/CT has a promising role in the overall management of this serious malignancy. Also, new but limited data accumulating from the use of FDG-PET/MRI are also available insubjects with MPM. The objectives of this educational abstract are to: I. Review the diagnostic performance of FDG-PET/CT and PET/MRI to differentiate benign form malignant pleural disease, and to evaluate the role of FDG-PET/CT in biopsy guidance of patients with suspected MPM. II. Compare the role of FDG-PET/CT and PET/MRI in the initial staging of MPM, including preoperative assessment of tumor resectability. III. Review the current literature on the diagnostic performance of FDG-PET/CT and PET/MRI in therapy planning, treatment response assessment, and post-treatment disease surveillance of patients with MPM. IV. Describe and explain the potential pitfalls of FDG-PET/CT, including false positive and false negative findings, in patients with suspected MPM.