Gerbaudo V H, Britz-Cunningham S, Sugarbaker D J, Treves S T
Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Thorax. 2003 Dec;58(12):1077-82. doi: 10.1136/thorax.58.12.1077.
Malignant pleural mesothelioma is an aggressive neoplasm with a highly variable course. This pilot study evaluated the significance of the pattern, intensity and kinetics of 18F-FDG uptake in mesothelioma in the context of histopathology and surgical staging.
Sixteen consecutive patients with pleural disease on CT scan underwent 18F-FDG imaging. Imaging was performed with a dual detector gamma camera operating in coincidence mode. Semiquantitative image analysis was performed by obtaining lesion-to-background ratios (18F-FDG uptake index) and calculating the increment of 18F-FDG lesion uptake over time (malignant metabolic potential index (MMPi)).
Twelve patients had histologically proven malignant mesotheliomas (10 epithelial, two sarcomatoid). Thirty two lesions were positive for tumour. Patterns of uptake matched the extent of pleural and parenchymal involvement observed on CT scanning and surgery. Mean (SD) 18F-FDG uptake index for malignant lesions was 3.99 (1.92), range 1.5-9.46. Extrathoracic spread and metastases had higher 18F-FDG uptake indices (5.17 (2)) than primary (3.42 (1.52)) or nodal lesions (2.99 (1)). No correlation was found between histological grade and stage. The intensity of lesion uptake had poor correlation with histological grade but good correlation with surgical stage. 18F-FDG lesion uptake increased over time at a higher rate in patients with more advanced disease. The MMPi was a better predictor of disease aggressiveness than the histological grade.
This pilot study suggests that the pattern, intensity, and kinetics of 18F-FDG uptake in mesothelioma are good indicators of tumour aggressiveness and are superior to the histological grade in this regard.
恶性胸膜间皮瘤是一种侵袭性肿瘤，病程高度可变。本前瞻性研究在组织病理学和手术分期的背景下，评估了18F-FDG摄取模式、强度和动力学在间皮瘤中的意义。
16例CT扫描显示有胸膜疾病的连续患者接受了18F-FDG成像。成像采用双探测器γ相机以符合模式进行。通过获取病变与背景比值（18F-FDG摄取指数）并计算18F-FDG病变摄取随时间的增量（恶性代谢潜能指数（MMPi））进行半定量图像分析。
12例患者经组织学证实为恶性间皮瘤（10例上皮型，2例肉瘤样型）。32个病变为肿瘤阳性。摄取模式与CT扫描和手术中观察到的胸膜和实质受累范围相符。恶性病变的平均（标准差）18F-FDG摄取指数为3.99（1.92），范围为1.5 - 9.46。胸外扩散和转移的18F-FDG摄取指数（5.17（2））高于原发灶（3.42（1.52））或淋巴结病变（2.99（1））。未发现组织学分级与分期之间存在相关性。病变摄取强度与组织学分级相关性较差，但与手术分期相关性良好。在疾病进展更严重的患者中，18F-FDG病变摄取随时间增加的速率更高。MMPi比组织学分级更能预测疾病的侵袭性。
本前瞻性研究表明，间皮瘤中18F-FDG摄取的模式、强度和动力学是肿瘤侵袭性的良好指标，在这方面优于组织学分级。
