The Role of FDG PET-CT in Differential Diagnosis of Pleural Pathologies

Rev Esp Med Nucl Imagen Mol. Jul-Aug 2012;31(4):187-91. doi: 10.1016/j.remn.2011.06.002. Epub 2011 Sep 22.

Abstract

Objective: This study has aimed to evaluate the impact of (F18) Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET-CT) in the differential diagnosis of malignant and benign pleural lesions in patients with suspected malignant pleural mesothelioma (MPM).

Material and methods: Fifty patients (32 females, 18 males; age range 24-79 years) with pleural thickening, fluid, plaques or calcification on previous CT scan were examined with FDG PET-CT. PET-CT imaging was obtained 1 h after FDG injection. In 12 patients, delayed imaging from the thoracic region was performed 2 h after injection. FDG uptake was evaluated visually and semiquantitively using standardized uptake value (SUV). FDG PET-CT findings were compared with histopathologic diagnosis.

Results: Thirty-nine patients had increased FDG uptake in pleural lesions but PET-CT results were negative in 11 patients. When compared with histopathological results in FDG positive group, 34 patients had MPM, 5 had benign pathology; in FDG negative group 8 patients had benign pathology, 3 had MPM. Of patients with delayed imaging, 9 showed increased SUV but 3 had a decreased SUV on delayed images. Increased SUV group had 4 MPM, 5 benign pathology (3 chronic granulomatous inflammation, 2 benign asbestotic plaque). Decreased SUV group all had benign pathology (fibrosis, chronic inflammation, myofibrosis).

Discussion: FDG PET-CT is a useful imaging modality in differential diagnosis of malignant and benign pleural lesions. Delayed imaging seems to be useful if there is a decrease in SUV suggesting a benign pathology but does not seem to contribute to the differential diagnosis if the SUV is increased.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Asbestosis / diagnostic imaging
  • Asbestosis / pathology
  • Diagnosis, Differential
  • Female
  • Fluorine Radioisotopes*
  • Fluorodeoxyglucose F18*
  • Granuloma / diagnostic imaging
  • Granuloma / pathology
  • Humans
  • Male
  • Mesothelioma / diagnostic imaging
  • Mesothelioma / pathology
  • Middle Aged
  • Multimodal Imaging
  • Pleural Diseases / diagnostic imaging*
  • Pleural Diseases / pathology
  • Pleural Neoplasms / diagnostic imaging
  • Pleural Neoplasms / pathology
  • Positron-Emission Tomography
  • Radiopharmaceuticals*
  • Retrospective Studies
  • Spain
  • Tomography, X-Ray Computed
  • Young Adult

Substances

  • Fluorine Radioisotopes
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18