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Non–Small Cell Lung Cancer: Evaluation of Pleural Abnormalities on CT Scans with ¹⁸F FDG PET¹

¹ From the Departments of Radiology (G.J.S., G.W., H.S., R.G., R.N., R.M.A.), Surgery (A.M., F.M.S.J.), and Pulmonology (G.F.), University Hospital Graz, Auenbruggerplatz 9, A-8036 Graz, Austria; and Department of Pulmonology, County Hospital Hörgas-Enzenbach, Gratwein, Austria (M.W.). Received May 25, 2003; revision requested July 17; final revision received October 29; accepted November 6. Address correspondence to G.J.S. (e-mail: gottfried.schaffler@kfunigraz.ac.at).

View larger version (129K): [in a new window]   Figure 1a. Images obtained after lobectomy of left lower lobe (18 months after surgery) in a 56-year-old man with NSCLC. (a) Transverse CT scan at level of lower lobes shows large left pleural effusion (arrows). (b) Coronal PET scan shows normal FDG uptake in left hemithorax. Intense FDG uptake in heart represents normal variation depending on metabolic status of myocardium. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan at level of lower lobes of lung shows normal pleural FDG uptake (grade 0) (arrows). Thoracentesis revealed transudate within left pleural space.

View larger version (106K): [in a new window]   Figure 1b. Images obtained after lobectomy of left lower lobe (18 months after surgery) in a 56-year-old man with NSCLC. (a) Transverse CT scan at level of lower lobes shows large left pleural effusion (arrows). (b) Coronal PET scan shows normal FDG uptake in left hemithorax. Intense FDG uptake in heart represents normal variation depending on metabolic status of myocardium. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan at level of lower lobes of lung shows normal pleural FDG uptake (grade 0) (arrows). Thoracentesis revealed transudate within left pleural space.

View larger version (96K): [in a new window]   Figure 1c. Images obtained after lobectomy of left lower lobe (18 months after surgery) in a 56-year-old man with NSCLC. (a) Transverse CT scan at level of lower lobes shows large left pleural effusion (arrows). (b) Coronal PET scan shows normal FDG uptake in left hemithorax. Intense FDG uptake in heart represents normal variation depending on metabolic status of myocardium. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan at level of lower lobes of lung shows normal pleural FDG uptake (grade 0) (arrows). Thoracentesis revealed transudate within left pleural space.

View larger version (114K): [in a new window]   Figure 2a. Images in a 63-year-old man with shortness of breath and NSCLC in the right upper lobe. (a) Transverse CT scan at level of upper lobes shows mild thickening of right pleura (indeterminate lesion) (arrow). (b) Coronal PET scan shows mild increased FDG uptake in right upper lobe and marked FDG uptake within mass (arrow) at the right hilum, representing squamous cell cancer. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan shows mild increased pleural FDG uptake (arrow) (grade 1). Histologic examination revealed postinflammatory scar tissue.

View larger version (101K): [in a new window]   Figure 2b. Images in a 63-year-old man with shortness of breath and NSCLC in the right upper lobe. (a) Transverse CT scan at level of upper lobes shows mild thickening of right pleura (indeterminate lesion) (arrow). (b) Coronal PET scan shows mild increased FDG uptake in right upper lobe and marked FDG uptake within mass (arrow) at the right hilum, representing squamous cell cancer. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan shows mild increased pleural FDG uptake (arrow) (grade 1). Histologic examination revealed postinflammatory scar tissue.

View larger version (83K): [in a new window]   Figure 2c. Images in a 63-year-old man with shortness of breath and NSCLC in the right upper lobe. (a) Transverse CT scan at level of upper lobes shows mild thickening of right pleura (indeterminate lesion) (arrow). (b) Coronal PET scan shows mild increased FDG uptake in right upper lobe and marked FDG uptake within mass (arrow) at the right hilum, representing squamous cell cancer. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan shows mild increased pleural FDG uptake (arrow) (grade 1). Histologic examination revealed postinflammatory scar tissue.

View larger version (116K): [in a new window]   Figure 3a. Images obtained after lobectomy of left lower lobe in a 63-year-old man with NSCLC. (a) Transverse CT scan just below carina shows subacute left rib fracture (12 weeks after surgery) with adjacent pleural soft tissue (indeterminate lesion) (arrows). (b) Coronal PET scan shows diffuse increased FDG uptake in left lateral chest wall. Dotted line crosses area with the most FDG-avid uptake of left lateral chest wall and represents level at which a and c were obtained. (c) Transverse PET scan at level just below carina shows increased FDG uptake (arrow) in lateral chest wall (grade 2). US-guided biopsy revealed immature scar tissue without evidence of malignancy.

View larger version (94K): [in a new window]   Figure 3b. Images obtained after lobectomy of left lower lobe in a 63-year-old man with NSCLC. (a) Transverse CT scan just below carina shows subacute left rib fracture (12 weeks after surgery) with adjacent pleural soft tissue (indeterminate lesion) (arrows). (b) Coronal PET scan shows diffuse increased FDG uptake in left lateral chest wall. Dotted line crosses area with the most FDG-avid uptake of left lateral chest wall and represents level at which a and c were obtained. (c) Transverse PET scan at level just below carina shows increased FDG uptake (arrow) in lateral chest wall (grade 2). US-guided biopsy revealed immature scar tissue without evidence of malignancy.

View larger version (81K): [in a new window]   Figure 3c. Images obtained after lobectomy of left lower lobe in a 63-year-old man with NSCLC. (a) Transverse CT scan just below carina shows subacute left rib fracture (12 weeks after surgery) with adjacent pleural soft tissue (indeterminate lesion) (arrows). (b) Coronal PET scan shows diffuse increased FDG uptake in left lateral chest wall. Dotted line crosses area with the most FDG-avid uptake of left lateral chest wall and represents level at which a and c were obtained. (c) Transverse PET scan at level just below carina shows increased FDG uptake (arrow) in lateral chest wall (grade 2). US-guided biopsy revealed immature scar tissue without evidence of malignancy.

View larger version (130K): [in a new window]   Figure 4a. Images obtained after lobectomy of right lower lobe (6 months after surgery) in a 73-year-old man with NSCLC. (a) Transverse CT scan at level of right diaphragm reveals right-sided pleural effusion with subtle pleural enhancement (indeterminate lesion) (arrows). (b) Coronal PET scan shows diffuse increased FDG uptake (arrows) in right hemithorax, with mediastinal shift to the right. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan shows diffuse increased pleural FDG uptake in right hemithorax (grade 2) (arrows). US-guided biopsy revealed empyema, without evidence of malignancy.

View larger version (110K): [in a new window]   Figure 4b. Images obtained after lobectomy of right lower lobe (6 months after surgery) in a 73-year-old man with NSCLC. (a) Transverse CT scan at level of right diaphragm reveals right-sided pleural effusion with subtle pleural enhancement (indeterminate lesion) (arrows). (b) Coronal PET scan shows diffuse increased FDG uptake (arrows) in right hemithorax, with mediastinal shift to the right. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan shows diffuse increased pleural FDG uptake in right hemithorax (grade 2) (arrows). US-guided biopsy revealed empyema, without evidence of malignancy.

View larger version (95K): [in a new window]   Figure 4c. Images obtained after lobectomy of right lower lobe (6 months after surgery) in a 73-year-old man with NSCLC. (a) Transverse CT scan at level of right diaphragm reveals right-sided pleural effusion with subtle pleural enhancement (indeterminate lesion) (arrows). (b) Coronal PET scan shows diffuse increased FDG uptake (arrows) in right hemithorax, with mediastinal shift to the right. Dotted line represents level at which a and c were obtained. (c) Transverse PET scan shows diffuse increased pleural FDG uptake in right hemithorax (grade 2) (arrows). US-guided biopsy revealed empyema, without evidence of malignancy.

View larger version (160K): [in a new window]   Figure 5a. Images obtained after lobectomy of right lower lobe (12 months after surgery) in a 65-year-old man with NSCLC. (a) Transverse CT scan at level of lower lobes shows pleural fluid with pleural thickening (indeterminate lesion) (arrows point to both). (b) Coronal PET scan shows diffuse increased FDG uptake in right chest wall. Dotted line shows level at which c was obtained. (c) Sagittal PET scan shows increased pleural FDG uptake (grade 2) (arrows). US-guided biopsy revealed exudative pleural effusion with histologically proved diffuse pleural malignancy.

View larger version (114K): [in a new window]   Figure 5b. Images obtained after lobectomy of right lower lobe (12 months after surgery) in a 65-year-old man with NSCLC. (a) Transverse CT scan at level of lower lobes shows pleural fluid with pleural thickening (indeterminate lesion) (arrows point to both). (b) Coronal PET scan shows diffuse increased FDG uptake in right chest wall. Dotted line shows level at which c was obtained. (c) Sagittal PET scan shows increased pleural FDG uptake (grade 2) (arrows). US-guided biopsy revealed exudative pleural effusion with histologically proved diffuse pleural malignancy.

View larger version (103K): [in a new window]   Figure 5c. Images obtained after lobectomy of right lower lobe (12 months after surgery) in a 65-year-old man with NSCLC. (a) Transverse CT scan at level of lower lobes shows pleural fluid with pleural thickening (indeterminate lesion) (arrows point to both). (b) Coronal PET scan shows diffuse increased FDG uptake in right chest wall. Dotted line shows level at which c was obtained. (c) Sagittal PET scan shows increased pleural FDG uptake (grade 2) (arrows). US-guided biopsy revealed exudative pleural effusion with histologically proved diffuse pleural malignancy.