Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed             tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma.
Malignant pleural mesothelioma (MPM) has a poor prognosis, and conventional imaging modalities do not reflect the prognosis of MPM. In this study, the clinical significance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) was evaluated for the differential diagnosis, staging and prognosis in MPM patients. Ninety patients who underwent 18F-FDG PET/CT scanning due to a clinical diagnosis or suspicion of MPM prior to therapy were reviewed. Of 90 patients, 31 were pathologically diagnosed as MPM. Maximum standardized uptake values (SUVmax) were semi-quantitatively obtained from PET/CT 60 min (early phase) and 120 min (delayed phase) after injection of 18F-FDG, and the clinicopathological correlations with the level of SUVmax obtained from PET/CT were examined. The survival curves of MPM patients were plotted according to the methods of Kaplan-Meier. The prognostic implications of the level of SUVmax were estimated by t-test. PET/CT scan showed intense abnormal FDG uptake (SUVmax>2.0) in the pleural lesions of all 31 MPM patients at delayed phase, while it showed abnormal FDG uptake in 30 (97%) patients at early phase. In all 31 MPM patients, the values of SUVmax at delayed phase were higher than those at the early phase. PET/CT also indicated metastasis in the lymph node in 7 patients (23%) and in the systemic lesions in 8 patients (26%) with MPM. Twenty-three MPM patients with high SUVmax, whose prognosis was apparent, showed significantly poorer prognosis in both early and delayed phase (respectively, p=0.03 and p=0.01, t-test). The results showed that 18F-FDG PET/CT at delayed phase is very useful for the diagnosis of pleural diseases, and SUVmax on PET/CT in the delayed phase is a more reliable prognostic factor than that in the early phase. High uptake of 18F-FDG PET/CT may be a predictive factor of prognosis in MPM patients.
Tokorozawa PET Diagnostic Imaging Clinic, Higashisumiyoshi 7-5, Tokorozawa, Saitama 359-1124, Japan. abe@toko-pet.or.jp
Yoshiyuki
Y
Abe
Katsumi
K
Tamura
Ikuko
I
Sakata
Jiro
J
Ishida
Yuichi
Y
Ozeki
Atsuhisa
A
Tamura
Kazutsugu
K
Uematsu
Hiroshi
H
Sakai
Tomoyuki
T
Goya
Minoru
M
Kanazawa
Kikuo
K
Machida
D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging* / Q000401:mortality; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D049268:Positron-Emission Tomography; D011379:Prognosis; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
D019788:Fluorodeoxyglucose F18