J Nucl Med 2002 Sep;43(9):1144-9 (ISSN: 0161-5505) Gerbaudo VH;
Sugarbaker DJ; Britz-Cunningham S; Di Carli MF; Mauceri C; Treves ST
Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and
Harvard Medical School, Boston, Massachusetts 02115, USA. vgerbaudo@bics.bwh.harvard.edu.
Malignant pleural mesothelioma is an aggressive primary neoplasm for
which early detection and accurate staging are known diagnostic challenges. The role of
(18)F-FDG dual-head gamma-camera coincidence imaging ((18)F-FDG-CI) is yet to be defined.
The purpose of this study was to evaluate the usefulness of (18)F-FDG-CI in the assessment
of malignant pleural mesothelioma using histopathology as the gold standard.
METHODS: Fifteen consecutive patients with CT scan
evidence of pleural thickening, fluid, plaques, or calcification underwent (18)F-FDG
imaging 1.5 h after the intravenous administration of 370 MBq (18)F-FDG. Imaging was
performed with a dual-head gamma camera equipped with 2.54-cm-thick NaI crystals operating
in coincidence mode. Using an iterative algorithm, whole-body images were reconstructed as
transaxial, sagittal, and coronal images. No attenuation correction was applied. The
results of (18)F-FDG-CI scans were compared with CT and with histopathologic diagnosis.
RESULTS: Eleven of 15 patients had histologically
proven malignant mesotheliomas (10 epithelial, 1 sarcomatoid). All 11 primary tumors were
detected by (18)F-FDG, and absence of disease was confirmed in the 4 patients who were
disease free. Thirty-four lesions were biopsied; among these, 29 were found to be positive
for tumor. (18)F-FDG was true-positive in 28 lesions, true-negative in 4, false-negative
in 1 (0.5 cm in diameter), and false-positive in 1 (inflammatory pleuritis). The smallest
lesion detected was 0.8 cm. For biopsied lesions, overall sensitivity, specificity, and
accuracy for (18)F-FDG-CI were 97%, 80%, and 94% respectively, compared with 83%, 80%, and
82% for CT. Twenty-one of 29 positive lesions involved the pleura, lung parenchyma, or
chest wall and were all (18)F-FDG avid. In the mediastinum, (18)F-FDG-CI detected 7 of 8
biopsy-positive lesions (88%), whereas CT was positive in 6 of 8 lesions (75%). (18)F-FDG
identified extrathoracic metastases in 5 patients, excluding them from surgical therapy.
CONCLUSION: These preliminary results suggest that
(18)F-FDG-CI appears to be an accurate method to diagnose and to define the extent of
disease in patients with diffuse malignant pleural mesothelioma.
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