Fluorodeoxyglucose Positron Emission Tomography and CT After Talc Pleurodesis

doi:10.1378/chest.125.6.2356

Chest

Volume 125, Issue 6, June 2004, Pages 2356-2360

https://doi.org/10.1378/chest.125.6.2356 Get rights and content

Background

Talc pleurodesis is widely performed for the management of persistent pneumothorax or pleural effusion, particularly malignant effusions. However, there are very few data characterizing fluorodeoxyglucose (FDG)-positron emission tomography (PET) and CT findings after treatment.

Methods

We retrospectively evaluated the FDG-PET and CT studies of nine patients who underwent talc pleurodesis for the treatment of malignant pleural effusions or persistent air leak.

Results

FDG-PET studies were performed on average 22 months after talc pleurodesis, and the mean CT follow-up period was 25 months. There was moderate-to-intense plaque-like or focal nodular-increased FDG uptake in the pleura on PET with mean standardized uptake value of 5.4 (SEM, 1.2; range, 2.0 to 16.3). The FDG uptake was either diffuse (two patients) or focal (seven patients), and most commonly occurred in the posterior costophrenic angles (five patients), followed by the apical regions (three patients), anterior costophrenic angle (one patient), and the anterior chest wall (one patient). On CT, high-density areas of pleural thickening or nodularity (mean, 230 Hounsfield units [HU]; SEM, 23 HU; range, 140 to 380 HU) corresponded to regions of increased FDG uptake. These pleural foci had an average thickness of 1.2 cm and measured up to 8.2 cm (mean, 7.1 cm) in length. Rounded pleural nodules were as large as 3.1 cm (mean, 1.5 cm). Conclusions: Talc pleurodesis produces increased FDG uptake on PET and high-density areas of pleural thickening on CT that remain unchanged on serial imaging. When PET detects increased uptake in the pleural space, correlation with CT is recommended to detect the presence of pleural thickening of increased attenuation that suggests talc deposits rather than tumor.

Section snippets

MATERIALS AND METHODS

The study was approved by the Human Research Committee of our institution. Over a 3-year period, nine patients who underwent both talc pleurodesis and FDG-PET were identified, and a retrospective review of their clinical and radiologic records was performed. There were eight women and one man in the study group. Their mean age was 58 years (range, 26 to 73 years). All patients had a history of malignancy, five had lung carcinomas (one each in stage IA, IB, IIA, IIB, and IV), and one each had

RESULTS

On average, the patients in our study underwent their first FDG-PET study 22 months after talc pleurodesis (range, 10 days to 71 months) [Table 1]. All the FDG-PET studies showed increased pleural uptake, with the sole exception of a patient who underwent FDG-PET examination 10 days after surgery. For this patient, a subsequent FDG-PET scan obtained 3 months later showed intense increased FDG uptake in the pleura. The area of increased uptake had a mean SUV of 5.4 (SEM, 1.2; range, 2.0 to 16.3).

DISCUSSION

Bethune¹ described the anatomic changes in the pleura following talc pleurodesis in animal studies. He observed that despite uniform scattering of talc powder over the pleura during thoracotomy, the powder subsequently accumulated into well-demarcated nodules.¹ In 1969, Jones⁸ described the postmortem findings in seven patients who received talc pleurodesis: “During the first two weeks the pleura was covered with a hemorrhagic fibrin purulent exudate. By the third week, the response was more

CONCLUSION

Talc deposits in the pleura produce areas of increased uptake on FDG-PET that correspond with areas of high-density pleural thickening on CT. It is important to correlate these PET findings with CT imaging and clinical history to distinguish this benign inflammatory process from malignancy. Alternatively, in patients who have undergone talc pleurodesis, it is important to carefully identify and follow up these associated inflammatory foci in order to detect new pleural metastases.

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Selected ReportsFluorodeoxyglucose Positron Emission Tomography and CT After Talc Pleurodesis

Background

Methods

Results

Section snippets

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

J Thorac Surg

J Thorac Cardiovasc Surg

Chest

Ann Thorac Surg

Respir Med

Chest

Semin Nucl Med

Selected Reports
Fluorodeoxyglucose Positron Emission Tomography and CT After Talc Pleurodesis