By Partha Ghosh, MD, Siemens Healthineers Molecular Imaging, Hoffman Estates, Illinois, USA
Data and images courtesy of Rigshospitalet, Copenhagen, Denmark
History
An elderly woman with history of asbestos exposure and pleural mesothelioma that was treated with left-sided pleurodesis presented with chest pain and respiratory distress. Clinical examination and X-ray revealed gross left-sided pleural effusion along with enlargement of the cardiac silhouette.
One hour following a 3.8 mCi (144 MBq) intravenous (IV) injection of Fludeoxyglucose F 18 (18F-FDG) Injection, the patient underwent a 5-minute, whole-body, single-bed PET/CT performed on Biograph Vision Quadra™.
Findings
Figures 1 to 6 show multiple nodular peritoneal recurrences around the heart with extension into the left hilar region in a case of previously diagnosed pleural mesothelioma in the left upper lobar pleura treated with pleurodesis. PET/CT helped define the extent and degree of hypermetabolism within the lesions along with delineation of associated peritoneal thickening and pleural effusion.
Discussion
Peritoneal recurrence is a rare manifestation of pleural mesothelioma. 18F-FDG PET/CT has been widely used for imaging of pleural mesothelioma both for staging and chemotherapy response assessment. PET-guided radiation therapy also has been evaluated.1 In this patient with an established diagnosis of pleural mesothelioma involving the left upper lobar pleura treated with pleurodesis, 18F-FDG PET/CT revealed mild hypermetabolism in the primary pleural involvement in the left upper lobar pleura with associated severe pleural effusion as well as regions of fibrosis. Multiple nodular hypermetabolic pericardial lesions were visualized around the ventricles, the right lateral margin of the right atria extending along the vena caval margins, as well as in the anterior and inferior aspect of the right and left ventricles and in the posterobasal aspect just lateral to the descending aorta. The left hilar region also shows focal malignant lesions. Substantial pericardial thickening was seen apart from the focal pericardial lesions without severe pericardial effusion or calcification. The study clearly suggested pericardial recurrence with left hilar extension from primary pleural mesothelioma with the disease burden indicating need for chemotherapy.
PET/CT imaging of pleural and pericardial malignancies requires high resolution and high lesion contrast for PET as well as high-quality thin-slice CT for delineation of the true extent of pleural and pericardial involvement along with associated findings such as pleural and pericardial thickening and effusion. Long axial field of view (FOV) PET/CT systems like Biograph Vision Quadra provide high sensitivity enabling high-quality PET acquisition at short scan times in order to improve patient convenience and reduce motion, which in such patients with chest pain and respiratory distress, may be often problematic.
Conclusion
This case demonstrates how Biograph Vision Quadra achieves 5-minute, low-dose, single-bed, whole-body 18F-FDG PET/CT to help delineate predominantly pericardial involvement in recurrent pleural mesothelioma. The 106-cm axial FOV along with the ultra-fast time of flight (TOF) performance of the system was instrumental in delivering a fast, high image quality PET acquisition in 5 minutes. Furthermore, the 128-slice CT provided high-quality contrast CT for visualization of pleural and pericardial malignant deposits, thickening, and effusions.
Examination protocol
Scanner: Biograph Vision Quadra PET/CT
Prescribing information
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