18F-Fluorodeoxyglucose positron emission tomography for diagnosis and monitoring of idiopathic retroperitoneal fibrosis associated with mediastinal fibrosis

Abstract

A 68-year-old man was admitted to our hospital with left intermittent claudication. Computed tomography showed soft tissue masses surrounding the left iliac artery and in the bilateral pulmonary hilum, and the first FDG PET showed increased FDG uptake by the lesions. Retroperitoneal fibrosis associated with mediastinal fibrosis was most suspected. An open biopsy of the left peri-iliac masses revealed retroperitoneal fibrosis. Corticosteroid treatment was initiated. The second FDG PET under corticosteroid treatment showed no pathological FDG uptake. The third FDG PET after cessation of corticosteroid treatment showed increased FDG uptake in the mediastinum, and so Sairei-to treatment was initiated. The fourth FDG PET under Sairei-to treatment showed no improvement of the pathological FDG uptake, and so low-dose corticosteroid was re-started in combination with Sairei-to treatment. The fifth FDG PET under Sairei-to and corticosteroid treatment showed no pathological FDG uptake. These FDG PET findings suggest the usefulness of FDG PET for the diagnosis and monitoring of retroperitoneal fibrosis associated with mediastinal fibrosis.

The role of PET scan in monitoring the progression of fibrosing mediastinitis

“…CT angiography may be helpful in the diagnosis of complications. Although PET scanning, which is a functional imaging modality, was initially introduced as a tool to identify malignancies and establish tumor dissemination, it is now well established that a benign disease with a notable inflammatory component may have a high metabolic activity as well [10,11,14,15]. As these radiologic findings are nondiagnostic and mediastinal malignancy is in the differential diagnosis, further histopathological work-up is required.…”

“…Surgical intervention is usually required to decompress the effected mediastinal structures. Disease activity is typically monitored using inflammatory markers such as erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) and by computed tomography (CT) imaging; however, positron emission tomography (PET) scanning has also been reported as an effective monitoring tool [10,11]. Here we present a case of idiopathic fibrosing mediastinitis that was monitored by CT and functional PET scan imaging.…”

Catheter based treatments for fibrosing mediastinitis

“…CT is also preferred for following patients after invasive procedures as vascular stents cause significant metal artifact on MRI which limits visualization of the stented lumen. Increased metabolic activity within the fibroproliferative tissue can be seen using FDG‐PET scans (Figure ) . Ventilation perfusion scanning and transthoracic echocardiography are useful adjunctive imaging techniques which can quantify the functional impact of vascular and airway obstruction and may help guide targeted invasive therapies.…”

Fibrose rétropéritonéale : revue de littérature

“…[33][34][35] Elle a l'avantage d'examiner le corps entier objectivant ainsi d'autres sites inflammatoires (fibrosclérose multifocale, FRP secondaires aux processus néoplasiques ou infectieux). 36,37 Par rapport aux marqueurs biologiques de l'inflammation et à l'imagerie morphologique, le 18F-FDG apparaît comme une modalité plus sensible pour l'évaluation de l'activité métabolique des masses résiduelles et la démonstration de la rechute de la maladie.…”