Potential of Dual Time Point FDG-PET Imaging in Differentiating Malignant from Benign Pleural Disease

Abstract

There is an increasing uptake of (18)F-FDG over time in pleural malignancies, whereas the uptake in benign pleural disease generally stays stable or decreases over time. Therefore, dual time point imaging appears to be an effective approach in differentiating benign from malignant pleural disease, which increases the sensitivity and is also helpful in guiding the biopsy site for a successful diagnosis.

Positron Emission Tomography in Mesothelioma Patients

“…In fact, as observed by the authors of the present study [1], some tumour cells of mesothelioma continue to take up glucose longer than 90 min after tracer injection and require several hours to reach maximum level in FDG uptake. Therefore, if the second PET is acquired at 90 min from injection, some lesions could be lost.…”

“…I n the study by Mavi and co-workers from Dr. Alavi's group, published in the present issue of Molecular Imaging & Biology [1], the authors reported their experience with the 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in malignant pleural mesothelioma patients (MPM). In particular, they have focused their attention on the diagnostic phase of this disease that is still a challenge in all its aspects: diagnosis, staging and therapy [2].…”

“…This new study [1] published in the present issue of Molecular Imaging & Biology together with the previous preliminary study published in The Journal of Nuclear Medicine [9], at our knowledge, are the unique studies that evaluate the role of the dual-time FDG-PET acquisition technique in the diagnosis of MPM. Some other studies on MPM that were reported in the literature described the value of FDG-PET with the usual technique, which consists on the acquisition of images only at 60 min after the injection of tracer and with the semi-quantitative analysis based on the evaluation of the unique SUV measurement available: These studies place the cutoff of SUV around the number 2.0/2.5 [2,[10][11][12] and, to diagnose the mesothelioma, found a sensitivity of more than 90% [2,11,13,14].…”

“…Nevertheless, relatively low specificity values have been reported, around 80% [2,[11][12][13][14][15] mainly related to inflammatory conditions, especially in patients with asbestos exposure history, who develop FDG-avid lesions (pleuritis, benign plaques, parapneumonic effusion, tuberculosis and talc pleurodesis) [2, 8, 11-13, 16, 17]. These conditions are difficult to distinguish from malignant lesions; in these cases, before recurring to invasive diagnostics methods, it may be helpful to utilise the FDG/PET dual-time protocol proposed by Mavi and co-workers [1].…”

Pet Applications For Staging And Restaging In Thoracic Malignancies

“…MPM olgularında FDG PET-BT ile geç görüntüleme esnasında azalan Standardize Tutulum Değerleri'nin (SUV) saptanmasının benign karakterdeki lezyonlar açısından anlamlı olabileceği konusunda görüş birliği olmakla birlikte, artan ya da sebat eden SUV değerle-rinin ayırıcı tanıya katkısı ise tartışmalıdır (43)(44)(45).…”