J Korean Soc Radiol.  2014 Jan;70(1):35-41. 10.3348/jksr.2014.70.1.35.

Pleural Changes after Talc Pleurodesis in Patients with Underlying Malignancy: Comparison with Recurrent Malignant Pleural Lesions on CT and Fluorodeoxyglucose-Positron Emission Tomography/CT

• Kim BS
• Kang H
• Park JG

• KMID: 1897258
• DOI: http://doi.org/10.3348/jksr.2014.70.1.35

Abstract

PURPOSE
To compare computed tomography (CT) and fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) findings of benign pleural changes with those of recurrent malignant pleural lesions in patients with a history of underlying malignancy after talc pleurodesis.
MATERIALS AND METHODS
Of 194 patients who underwent talc pleurodesis, we retrospectively reviewed 16 patients for whom both follow-up CT and FDG-PET/CT were performed. The morphologic CT findings and maximum standard uptake values (SUVmax) were evaluated and compared between benign pleural changes and recurrent malignant pleural lesions.
RESULTS
Twenty-two lesions were found in 16 patients; six patients had no evidence of active pleural disease (group 1) and 10 patients had recurrent malignant pleural lesions on radiological or clinical follow-up (group 2). Characteristic high-density pleural deposits [mean, 131 Hounsfield unit (HU); range, 28-251 HU] were seen along the pleural thickenings (mean, 13.4 mm; range, 4.9-62.3 mm) in 15 patients. The shape and thickness on CT and the SUVmax on FDG-PET/CT showed no significant differences between the two groups. On CT, the pre-contrast attenuation was higher in group 1 than group 2 (165 HU vs. 101 HU, respectively, p = 0.030), and the degree of enhancement was higher in group 2 than that in group 1 (29 HU vs. 48 HU, respectively, p = 0.048). Pleural effusions (n = 5) and other pleural thickening without high-density foci (n = 4) were observed only in group 2; however, no statistical significance was observed between the two groups.
CONCLUSION
Malignant pleural lesions can be characterized by lower pre-contrast attenuation and higher contrast enhancement, whereas benign pleural changes after talc pleurodesis are characterized by higher pre-contrast attenuation and lower contrast enhancement on CT.

MeSH Terms

Follow-Up Studies
Humans
Pleural Diseases
Pleural Effusion
Pleurodesis*
Retrospective Studies
Talc*
Talc

Figure

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  Fig. 1 A 49-year-old woman who underwent a right lower lobectomy due to lung adenocarcinoma (group 1). A. Pre-contrast CT scan taken 14 months after talc pleurodesis shows nodular pleural thickening with a focal area of high attenuation in the right upper thorax (arrow). B. Contrast-enhanced CT scan shows contrast enhancement (arrow). C. FDG-PET/CT scan shows intense FDG uptake (arrow). Note.-FDG-PET/CT = fluorodeoxyglucose-positron emission tomography/CT

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  Fig. 2 A 53-year-old man who underwent a left lower lobectomy due to lung adenocarcinoma (group 1). A. Pre-contrast CT scan taken 20 months after talc pleurodesis shows a focal area of high attenuation with nodular pleural thickening in the left upper anterior thorax (arrow). B. Diffuse pleural thickening with a linear high attenuation area was seen in the left lower posterior thorax (arrows).

• 

  Fig. 3 A 65-year-old man who underwent right upper wedge resection due to squamous cell lung cancer (group 2). A, B. Pre-contrast (A) and contrast-enhanced (B) CT scans taken 3 months after talc pleurodesis show a high-density pleural thickening with patchy distribution and contrast enhancement in the right upper hemithorax (arrow). C. Contrast-enhanced CT scans taken 10 months after talc pleurodesis show a recurrent mass with pleural involvement in the right upper hemithorax.

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  Fig. 4 A 77-year-old woman with malignant mesothelioma (group 2). A. Contrast-enhanced CT scan taken 3 months after talc pleurodesis shows an area of high density with pleural thickening in the left hemithorax. B. Eighteen months later, enhancing pleural thickening and nodules arose from the previously noted high-density pleural lesion (arrows).

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