Role of Metabolic Imaging in Mesothelioma

Abstract

Early diagnosis and clinical staging in patients affected by malignant pleural mesothelioma (MPM) is necessary to manage individual therapy strategies. Computed tomography (CT) and magnetic resonance imaging (MRI) are routinely used for non-invasive clinical staging. Because of the complex growth pattern of MPM, it is difficult to make a clinical judgement only with morphological imaging, so 18F-FDG PET-CT represent an important adjunctive imaging tool in these patients. 18F-FDG PET-CT can be useful in detecting malignant pleural mesothelioma in patients exposed to asbestos and distinguish asbestos-related benign lesions. Combined PET-CT is essential for selecting patients with resectable disease, increasing the detection of locally advanced tumour and improve the accuracy of preoperative staging. 18F-FDG PET-CT could be useful also in risk stratification, to avoid radical surgery in cases characterized by the worst prognosis. PET-CT is gradually becoming essential in assessment of tumour response in patients undergoing chemotherapy. Metabolic imaging analysis permits the early identification of non-responders to chemotherapy, avoiding unsuccessful treatment, characterized by important toxicities and high mortality risk.