Kitajima Kazuhiro, Nakamichi Toru, Hasegawa Seiki, Kuribayashi Kozo, Yamakado Koichiro
Radiology, Hyogo College of Medicine, Nishinomiya, JPN.
Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, JPN.
Cureus. 2018 Nov 28;10(11):e3654. doi: 10.7759/cureus.3654.
Talc pleurodesis has been reported to increase fluorodeoxyglucose (FDG) uptake in the high attenuation areas of pleural thickening, making it difficult to distinguish between benign granulomatous inflammatory processes and malignancies, which may therefore interfere with the post-chemotherapy disease evaluation on FDG-positron emission tomography/computed tomography (PET/CT). We present two cases of malignant pleural mesothelioma treated with talc pleurodesis and neoadjuvant chemotherapy (NAC) before pleurectomy/decortication in which post-NAC FDG-PET/CT showed intense FDG uptakes in the high attenuation areas of pleural thickening with false positive result, whereas post-NAC C-choline PET/CT showed mild choline uptake of pleural talc deposit, which did not interfere with the post-chemotherapy disease evaluation. Thus we suggest choline-PET/CT may show little choline uptake to granulomatous inflammation and evaluate treatment response in malignant pleural mesothelioma patients treated with talc pleurodesis and NAC.
据报道，滑石粉胸膜固定术会增加胸膜增厚高衰减区域的氟脱氧葡萄糖（FDG）摄取，使得难以区分良性肉芽肿性炎症过程和恶性肿瘤，因此这可能会干扰氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）对化疗后疾病的评估。我们报告了两例恶性胸膜间皮瘤患者，在胸膜切除术/剥脱术前接受了滑石粉胸膜固定术和新辅助化疗（NAC），其中新辅助化疗后的FDG-PET/CT显示胸膜增厚高衰减区域有强烈的FDG摄取，结果为假阳性，而新辅助化疗后的C-胆碱PET/CT显示胸膜滑石粉沉积处胆碱摄取轻微，这并未干扰化疗后疾病评估。因此，我们建议胆碱-PET/CT对肉芽肿性炎症可能显示很少的胆碱摄取，并可评估接受滑石粉胸膜固定术和NAC治疗的恶性胸膜间皮瘤患者的治疗反应。
