Metabolic Imaging of Malignant Pleural Mesothelioma With Fluorodeoxyglucose Positron Emission Tomography: Materials and Methods

Patient Selection
The patient population consisted of 28 consecutive patients referred for the evaluation of pleural disease and suspected malignant mesothelioma. The disease was suspected from clinical symptoms and on the basis of chest radiograph or CT scan results: effusion, pleural masses, or pleural thickening. The FDG-PET study was obtained as part of the clinical evaluation to assess the presence of malignant disease and to determine the extent of tumor involvement. Informed consent was obtained in all patients before the procedure. The patients also underwent chest radiograph and CT evaluation, and pleural fluid cytologic examination. The final diagnosis was established by thoracoscopic biopsy specimen in 21 subjects, pleural biopsy specimen in 4, pleural fluid cytology in 1, pleural decortication in 1, and clinical follow-up in 1. Viagra super active plus Reading here Combined emission and transmission scanning was completed in 26 of 28 subjects. In the remaining two subjects, only the emission scan was available.
Positron Emission Tomography
A volume imaging scanner (PENN PET 240H; UGM Medical Systems; Philadelphia, PA) was employed to perform these studies. This instrument operates without septa for both emission and transmission scanning and has an axial field of view of 12.8 cm, a tran saxial field of view of 51.2 cm, and a spatial resolution of 5.5 mm in all three planes. The patients fasted for at least 4 h before the procedure. The capillary blood glucose level was measured in each subject before the administration of the radiopharmaceutical to ensure a euglycemic state for the optimal uptake of FDG in malignant cells. After a period of 60 to 90 min following the injection of 4.25 MBq/kg of FDG, the patients were placed in the scanner in the supine position, with the arms upraised and folded over the head for imaging the thorax. The scans were performed over the entire chest and upper abdomen with sequential scans of 4 to 5 min each. The imaging bed was moved 6.4 cm axially between scans to provide overlapping frames. This provides wbole-body images of uniform sensitivity in the axial direction. A typical study included five to seven of these frames, covering from 38 to 51 cm of the body axial length depending on the patient’s height. Postinjection transmission scans were obtained over the entire chest, according to previously published methods, using either a rotating 6SGe (positron emitter) rod or a lo‘Cs (single photon emitter) point source.

Category: Pulmonary Function

Tags: FDG, malignant mesothelioma, metabolic imaging, positron emission tomography