Mavi Ayse, Basu Sandip, Cermik Tevfik F, Urhan Muammer, Bathaii Mehdi, Thiruvenkatasamy Dhurairaj, Houseni Mohamed, Dadparvar Simin, Alavi Abass
Division of Nuclear Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 110 Donner Bldg., Philadelphia, PA 19104, USA.
Mol Imaging Biol. 2009 Sep-Oct;11(5):369-78. doi: 10.1007/s11307-009-0212-5. Epub 2009 May 27.
The aim of this study was to assess the utility of dual time point 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) imaging in differentiating benign from malignant pleural disease.
Fifty-five consecutive patients of suspected malignant pleural mesothelioma (MPM) and recurrence of MPM who were referred for the evaluation underwent two sequential 18F-FDG-PET scans (dual time point imaging). The average percent change in the maximum standardized uptake values (Delta%SUVmax) of the lesion/lesions between time point 1 (SUV(max1)) and time point 2 (SUV(max2)) was calculated. All PET results were correlated with the histopathological or cytopathology results. Patients were divided into three principal groups (A = newly diagnosed MPM, B = recurrent MPM, and C = benign pleural disease). The parameters of 18F-FDG uptake (SUV(max) values and its changes over time) were compared among groups.
Among the 55 patients who had undergone dual time point 18F-FDG-PET studies, 44 were diagnosed with MPM (28 newly diagnosed and 16 had recurrence). The PET studies demonstrated 229 malignant pleural lesions in these patients. The remaining 11 patients were proven to have benign pleural disease. The mean +/- SD of the SUV(max1), SUV(max2), and the Delta%SUV(max) of the all lesions of each patient in groups A, B, and C were 5.0 +/- 2.2%, 5.8 +/- 2.8%, and 12.8 +/- 8.4%; 4.6 +/- 1.7%, 5.3 +/- 2.0%, 13.8 +/- 9.2%; and 1.6 +/- 0.4%, 1.4 +/- 0.3%, and-9.6 +/- 19.1%, respectively. The mean +/- SD of the SUV(max1), SUV(max2), and Delta%SUV(max) in patients with both newly diagnosed and recurrent MPM were significantly higher than those of benign pleural disease group (p < 0.0001). For each patient, the most intense (hottest) lesion's SUV(max1), SUV(max2), and Delta%SUV(max) were also compared among the aforementioned groups, and these results again confirmed that MPM lesions had significantly higher values than those of benign pleural lesions (p < 0.0001).
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.
本研究旨在评估双时间点18F-氟脱氧葡萄糖正电子发射断层扫描（18F-FDG-PET）成像在鉴别良性与恶性胸膜疾病中的效用。
55例因疑似恶性胸膜间皮瘤（MPM）及MPM复发而转诊接受评估的患者，接受了两次连续的18F-FDG-PET扫描（双时间点成像）。计算病变在时间点1（SUV(max1)）和时间点2（SUV(max2)）之间最大标准化摄取值的平均变化百分比（Delta%SUVmax）。所有PET结果均与组织病理学或细胞病理学结果相关。患者分为三个主要组（A = 新诊断的MPM，B = 复发的MPM，C = 良性胸膜疾病）。比较各组间18F-FDG摄取参数（SUV(max)值及其随时间的变化）。
在接受双时间点18F-FDG-PET研究的55例患者中，44例被诊断为MPM（28例新诊断，16例复发）。PET研究显示这些患者中有229个恶性胸膜病变。其余11例患者被证实患有良性胸膜疾病。A组、B组和C组中每位患者所有病变的SUV(max1)、SUV(max2)和Delta%SUVmax的平均值±标准差分别为5.0±2.2%、5.8±2.8%和12.8±8.4%；4.6±1.7%、5.3±2.0%和13.8±9.2%；以及1.6±0.4%、1.4±0.3%和 -9.6±19.1%。新诊断和复发MPM患者的SUV(max1)、SUV(max2)和Delta%SUVmax的平均值±标准差显著高于良性胸膜疾病组（p < 0.0001）。对于每位患者，还比较了上述组中最强烈（最热）病变的SUV(max1)、SUV(max2)和Delta%SUVmax，这些结果再次证实MPM病变的值显著高于良性胸膜病变（p < 0.0001）。
胸膜恶性肿瘤中18F-FDG的摄取随时间增加，而良性胸膜疾病中的摄取通常随时间保持稳定或减少。因此，双时间点成像似乎是鉴别良性与恶性胸膜疾病的有效方法，可提高敏感性，也有助于指导活检部位以成功诊断。
