Loco-regional staging of malignant pleural mesothelioma by integrated 18F-FDG PET/MRI

• Published in: European journal of radiology Vol. 115; pp. 46 - 52
• Main Authors: Murphy, D.J., Mak, S.M., Mallia, A., Jeljeli, S., Stirling, J.J., Goh, V., Bille, A., Cook, G.J.R.
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.06.2019
• Subjects: Fluorodeoxyglucose F18; Magnetic resonance imaging; Mesothelioma; Neoplasm; Positron emission tomography computed tomography; Staging; ADC; TGV; MRI; Staging; FDG; SUVmax; Mesothelioma; MPM; MPR; IASLC; SD; TNM; AJCC; DWI; VIBE; IMIG; Positron emission tomography computed tomography; IV; ROI; Neoplasm; CT; Magnetic resonance imaging; Fluorodeoxyglucose F18; HASTE=half Fourier; PET
• DOI: 10.1016/j.ejrad.2019.04.003
• ISSN: 0720-048X; 1872-7727

To examine the performance of 18F-FDG PET/MRI in the loco-regional staging of malignant pleural mesothelioma (MPM). Consecutive subjects with MPM undergoing pre-operative staging with 18F-FDG PET/CT who underwent a same day integrated 18F-FDG PET/MRI were prospectively studied. Clinical TNM staging (AJCC 7th edition) was performed separately and in consensus by two readers on the 18F-FDG PET/MRI studies, and compared with staging by 18F-FDG PET/CT, and with final pathological stage, determined by a combination of intra-operative and histological findings. 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 18F-FDG PET/MRI in 67% (n = 6) of subjects, and with 18F-FDG PET/CT staging in 33% (n = 3). Pathological T stage was concordant with 18F-FDG PET/MRI in 78% (n = 7), and with 18F-FDG PET/CT in 33% (n = 3) of subjects. Pathological N stage was concordant with both 18F-FDG PET/MRI and 18F-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. Clinical MPM staging by 18F-FDG PET/MRI is feasible, and potentially provides more accurate loco-regional staging than PET/CT, particularly in T staging.