Imaging in pleural mesothelioma: A review of Imaging Research Presented at the 9th International Meeting of the International Mesothelioma Interest Group

Nowak, Anna K.; Armato, Samuel G.; Ceresoli, Giovanni Luca; Yildirim, Huseyin; Francis, Roslyn J.

doi:10.1016/j.lungcan.2010.05.016

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Volume 70, Issue 1 , Pages 1-6, October 2010

Imaging in pleural mesothelioma: A review of Imaging Research Presented at the 9th International Meeting of the International Mesothelioma Interest Group

Anna K. Nowak
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Corresponding author at: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. Tel.: +61 8 9346 2098; fax: +61 8 9346 2816.
Samuel G. Armato III
- Department of Radiology, The University of Chicago, Chicago, IL, USA
Giovanni Luca Ceresoli
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas IRCCS, Rozzano (Milan), Italy
Huseyin Yildirim
- Eskisehir Osmangazi University, Medical Faculty, Department of Chest Disease, Meselik, 26480, Eskisehir, Turkey
Roslyn J. Francis
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
- Department of Nuclear Medicine and WA PET Service, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia

Received 30 October 2009; received in revised form 29 April 2010; accepted 17 May 2010. published online 14 June 2010.

Abstract

Imaging of malignant pleural mesothelioma (MPM) poses many challenges for imaging specialists and clinicians due to the anatomic location and unique growth pattern of this tumor. Nevertheless, imaging in MPM plays a critical role in diagnosis, prognostication, prediction or measurement of response to therapy, and monitoring of disease recurrence after aggressive surgical management. Imaging-based studies presented at the 9th International Conference of the International Mesothelioma Interest Group (IMIG) in October 2008 sought to further define the current practice and future potential of imaging for the mesothelioma patient. The Imaging Session was dominated by presentations that addressed the use of fluorodeoxyglucose positron emission tomography (FDG-PET), a clear indication of the expanding role of this modality. These uses included FDG-PET imaging at the point of diagnosis, in prognostication, and in the assessment of response to chemotherapy. Often FDG-PET studies were combined with computed tomography (CT) scans in an attempt to overcome limitations associated with either imaging modality alone. At diagnosis, FDG-PET parameters had a high sensitivity and specificity for differentiation of benign from malignant pleural disease. The use of FDG-PET to extract quantitative features from metabolically active tumor volume was shown to be a significant factor in the prediction of patient survival. The prognostic value of FDG-PET was not confounded by prior talc pleurodesis, despite the inflammatory response associated with the procedure. Metabolic response based on FDG-PET was found to be significantly correlated with progression-free survival. CT-based assessment of mesothelioma was determined to be inconsistent with spherical-model-based criteria so that changes in tumor area, a presumably more complete assessment of tumor burden, exhibited a 46% concordance rate with changes in linear measurements.

Keywords: Mesothelioma, Tumor response assessment, PET/CT, Tumor staging, Total glycolytic volume