- Email: [email protected]
Re: CT appearances of talc pleurodesis
Clinical Radiology (2007) 62, 914e915
CORRESPONDENCE Re: CT appearances of talc pleurodesis SirdWe read with interest the recently published article by Narayanaswamy et al.1 and would like the opportunity to draw readers’ attention to a recent case of ours where positron-emission tomography computed tomography (PET-CT) was markedly abnormal following a talc pleurodesis. The patient had a high-grade B-cell lymphoma of the pleura diagnosed at video-assisted thoroscopic biopsy during which a talc pleurodesis was performed. Six cycles of chemotherapy was followed by targeted radiotherapy to the left para-vertebral area. One year after the completion of treatment, PET-CT was performed (Fig. 1). This showed many of the CT features described in the article by Narayanaswamy et al., in addition to intense fluorodeoxyglucose (FDG) uptake in the areas of pleural thickening. One focus in the left paravertebral area was of initial concern for disease relapse (Fig. 1). This had been a site of disease at staging
and resolved on CT during treatment. Following the PET-CT, sampling was recommended, but it had almost resolved on attendance for CT-guided biopsy and is not apparent on follow up PET-CT (Fig. 2b). PET-CT 18 months after the completion of therapy remains abnormal (Fig. 2), but increased glucose uptake is confined to the pleura with no evidence of local progression or extrapleural disease. The patient remains well off treatment with no clinical or biochemical features of disease relapse. Kwek et al.2 described intense FDG uptake in areas of pleural thickening in all nine patients who had separate CT and FDG-PET examinations following a talc pleurodesis. The PET and CT abnormalities persist for at least months, and probably years, after the inflammatory insult. Therefore, the complimentary imaging data from PET and CT is most useful, particularly in cases where the primary malignant disease is pleural, and if no extra-pleural marker of disease is available, careful
Figure 1 PET-CT 12 months post-treatment. (a) Sagittal image from movie. (b) Fused axial image. Note (arrow both images) area of thickening and FDG uptake at the previous site of disease. 0009-9260/$ - see front matter ª 2007 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2007.04.005
Correspondence
915
Figure 2 PET-CT 18 months post-treatment. (a) Sagittal image from movie. (b) Fused axial image. Note there has been little change since the previous study except for resolution of one area of thickening and uptake arrowed in Fig. 1.
clinical correlation and biopsy or follow-up may be required.
References 1. Narayanaswamy S, Kamath S, Williams M. CT appearances of talc pleurodesis. Clin Radiol 2007;62:233e7.
2. Kwek BH, Aquino SL, Fischman AJ. Fluorodeoxyglucose positron emission tomography and CT after talc pleurodesis. Chest 2004;125:2356e60.
G.J.C. Burkill, K.A. Miles), S. Dizdarevic) )Brighton and Sussex University Hospital and Brighton and Sussex Medical School Brighton, UK E-mail address: [email protected]
CORRESPONDENCE Re: CT appearances of talc pleurodesis SirdWe read with interest the recently published article by Narayanaswamy et al.1 and would like the opportunity to draw readers’ attention to a recent case of ours where positron-emission tomography computed tomography (PET-CT) was markedly abnormal following a talc pleurodesis. The patient had a high-grade B-cell lymphoma of the pleura diagnosed at video-assisted thoroscopic biopsy during which a talc pleurodesis was performed. Six cycles of chemotherapy was followed by targeted radiotherapy to the left para-vertebral area. One year after the completion of treatment, PET-CT was performed (Fig. 1). This showed many of the CT features described in the article by Narayanaswamy et al., in addition to intense fluorodeoxyglucose (FDG) uptake in the areas of pleural thickening. One focus in the left paravertebral area was of initial concern for disease relapse (Fig. 1). This had been a site of disease at staging
and resolved on CT during treatment. Following the PET-CT, sampling was recommended, but it had almost resolved on attendance for CT-guided biopsy and is not apparent on follow up PET-CT (Fig. 2b). PET-CT 18 months after the completion of therapy remains abnormal (Fig. 2), but increased glucose uptake is confined to the pleura with no evidence of local progression or extrapleural disease. The patient remains well off treatment with no clinical or biochemical features of disease relapse. Kwek et al.2 described intense FDG uptake in areas of pleural thickening in all nine patients who had separate CT and FDG-PET examinations following a talc pleurodesis. The PET and CT abnormalities persist for at least months, and probably years, after the inflammatory insult. Therefore, the complimentary imaging data from PET and CT is most useful, particularly in cases where the primary malignant disease is pleural, and if no extra-pleural marker of disease is available, careful
Figure 1 PET-CT 12 months post-treatment. (a) Sagittal image from movie. (b) Fused axial image. Note (arrow both images) area of thickening and FDG uptake at the previous site of disease. 0009-9260/$ - see front matter ª 2007 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.crad.2007.04.005
Correspondence
915
Figure 2 PET-CT 18 months post-treatment. (a) Sagittal image from movie. (b) Fused axial image. Note there has been little change since the previous study except for resolution of one area of thickening and uptake arrowed in Fig. 1.
clinical correlation and biopsy or follow-up may be required.
References 1. Narayanaswamy S, Kamath S, Williams M. CT appearances of talc pleurodesis. Clin Radiol 2007;62:233e7.
2. Kwek BH, Aquino SL, Fischman AJ. Fluorodeoxyglucose positron emission tomography and CT after talc pleurodesis. Chest 2004;125:2356e60.
G.J.C. Burkill, K.A. Miles), S. Dizdarevic) )Brighton and Sussex University Hospital and Brighton and Sussex Medical School Brighton, UK E-mail address: [email protected]