Loco-regional staging of malignant pleural mesothelioma by integrated 18F-FDG PET/MRI. Issue 115 (June 2019)

• Record Type: Journal Article
• Authors: Murphy, D.J.; Mak, S.M.; Mallia, A.; Jeljeli, S.; Stirling, J.J.; Goh, V.; Bille, A.; Cook, G.J.R.
• Is Part Of: European journal of radiology. Issue 115(2019)
• Page Start: 46
• Page End: 52
• Publication Date: 2019-06
• Subjects: ADC apparent diffusion coefficient -- AJCC American Joint Committee on Cancer -- CT computed tomography -- DWI diffusion-weighted imaging -- FDG 2-deoxy-2-[18F]fluoro-D-glucose -- HASTE=half Fourier acquired single shot turbo spin echo -- IMIG International Mesothelioma Interest Group -- IASLC International Association for the Study of Lung Cancer -- IV intravenous -- MRI magnetic resonance imaging -- MPM malignant pleural mesothelioma -- MPR multiplanar reformats -- PET positron emission tomography -- ROI region of interest -- SD standard deviation -- SUVmax maximum standardised uptake value -- TGV total glycolytic volume -- TNM tumour, nodes and metastasis -- VIBE volume-interpolated breath-hold examination; Mesothelioma -- Staging -- Neoplasm -- Positron emission tomography computed tomography -- Fluorodeoxyglucose F18 -- Magnetic resonance imaging; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2019.04.003
• Languages: English
• ISSNs: 0720-048X

Abstract

Abstract: Aim: To examine the performance of 18 F-FDG PET/MRI in the loco-regional staging of malignant pleural mesothelioma (MPM). Methods: Consecutive subjects with MPM undergoing pre-operative staging with 18 F-FDG PET/CT who underwent a same day integrated 18 F-FDG PET/MRI were prospectively studied. Clinical TNM staging (AJCC 7 th edition) was performed separately and in consensus by two readers on the 18 F-FDG PET/MRI studies, and compared with staging by 18 F-FDG PET/CT, and with final pathological stage, determined by a combination of intra-operative and histological findings. Results: 10 subjects (9 male, mean age 68 years) with biopsy-proven MPM (9 epithelioid tumours, 1 biphasic) were included. One subject underwent neo-adjuvant chemotherapy between imaging and surgery and was excluded from the clinical versus pathological stage analysis. Pathological staging was concordant with staging by 18 F-FDG PET/MRI in 67% (n = 6) of subjects, and with 18 F-FDG PET/CT staging in 33% (n = 3). Pathological T stage was concordant with 18 F-FDG PET/MRI in 78% (n = 7), and with 18 F-FDG PET/CT in 33% (n = 3) of subjects. Pathological N stage was concordant with both 18 F-FDG PET/MRI and 18 F-FDG PET/CT in 78% (n = 7) of cases. No subject had metastatic disease. There was good inter-observer agreement for overall PET/MRI staging (weighted kappa 0.63) with moderate inter-reader agreement for T staging (weighted kappa 0.59). All 6 subjects with prior talc pleurodesis demonstrated mismatch between elevated FDG uptake and restricted diffusion in areas of visible talc deposition. Conclusion: Clinical MPM staging by 18 F-FDG PET/MRI is feasible, and potentially provides more accurate loco-regional staging than PET/CT, particularly in T staging.