255
Table 1. Summary of CT Features and FDG-PET Findings of Progressive Massive Fibrosis in 11 Patients with Pneumoconiosis Case No. Patient Data Age (year) Sex CT Findings PET Findings Location Size (cm) Peak SUV Mean SUV 01 66 M RUL 3.4 0.5 0.4 02 68 M BUL 3.6 / 1.5 4.6 / 3.9 3.1 / 2.9 03 61 M BUL 3.3 / 4.8 8.1 / 5.8 5.8 / 4.5 04 65 M BUL 3.3 / 4.3 2.0 / 2.3 1.6 / 1.9 05 73 M BUL 3.7 / 3.3 3.7 / 4.6 2.6 / 3.3 06 63 M BUL 6.4 / 1.4 5.8 / 3.9 4.3 / 2.8 07 68 M BUL 3.8 / 1.3 6.0 / 2.3 4.5 / 2.0 08 71 M BUL 5.4 / 2.5 2.3 / 2.2 1.5 / 1.8 09 66 M RUL 3.9 4.1 3.5 10 54 M RUL 2.8 3.8 3.2 11 82 M BUL 6.2 / 2.8 3.7 / 2.5 3.2 / 2.1 Mean 67 3.6 1.4 3.8 1.8 2.9 1.3 Note. SUV = standardized uptake value, M=male, and R(B)UL = right (both) upper lobe. (Right/Left) 256
대한영상의학회지 2008;59:255-260 A B C E D F Fig. 1. Pneumoconiosis with progressive massive fibrosis (PMF) in a 66-year-old male. A. Chest radiograph shows an irregular mass-like lesion in the right upper lobe. Multiple nodules are scattered in the upper lung zone of both lungs. The pleura is irregularly thickened with pleural effusion along the right chest wall. B-D. Transverse contrast-enhanced CT scan (B) shows a heterogeneously enhancing mass in the right upper lobe, with irregular contour and calcifications. Pleural effusion with minimal pleural enhancement is noted in the right hemithorax (C). Small nodules are also seen in both upper lobes (D). E, F. Coronal (E) and axial (F) FDG-PET images show a ring-shaped FDG uptake in PMF and an irregular FDG uptake along the pleura with the mean SUV of 0.4. Biopsy results failed to reveal pulmonary tuberculosis in PMF and the pleura. 257
이상민 외: 진폐증 환자에 동반된 진행성거대섬유화의 F-18 FDG-PET 소견 취계수는 0.5-8.1(평균, 3.8)였고, 평균 표준화섭취계수는 0.4-5.9(평균, 2.9)였다. 진행성거대섬유화 19예 중에서 7예 (36.8%)는 평균 표준화섭취계수가 2.5 이하 이었으며, 12예 (63.2%)는 2.5 보다 초과 되었다(Fig. 2)(Table 1). CT 영상 에서 측정된 진행성거대섬유화의 크기와 FDG-PET 영상에서 측정된 평균 표준화섭취계수 사이에 통계적으로 의미 있는 연 관성은 보이지 않았다(r=0.225)(Fig. 3). 세침 흡입 검사가 진행된 12예에서 현미경 검사상 양성 상 행성거대섬유화는 상엽에 위치하였으며 주변 폐조직에 작은 결절들이 관찰되었다. 8명의 환자에서 종괴는 양측 상엽에 있 었고, 3명의 환자에서는 우상엽에 위치하였다. 병변의 크기는 장경이 1.3~6.4 cm(평균, 3.6 cm)였다. 한 명의 환자는 조영 증강 CT 영상에서 조영 증강을 보이는 흉막 삼출을 보였다 (Fig. 1). 진행성거대섬유화의 FDG 대사 상태는 FDG-PET 영상에 서 다양하게 관찰되었다. FDG-PET 영상에서 최대 표준화섭 A C E B D Fig. 2. Pneumoconiosis with progressive massive fibrosis in a 61-year-old male. A. Chest radiograph shows irregular mass-like shadows in both upper lobes. Multiple nodules are scattered in the upper lung zone of both lungs. B, C. Transverse contrast-enhanced CT scan (B) shows a heterogeneously enhancing mass in both upper lobes, with irregular contour and calcifications. Small satellite nodules are also seen in both upper lobes (C). D, E. Coronal (D) and axial (E) FDG-PET images show strong FDG uptake in PMF with the mean SUV of 5.8 in the right upper lobe and 4.5 in the left upper lobe. Biopsy results show inflammatory cells with many anthracotic pigment-laden macrophages which are consistent with progressive massive fibrosis. 258
Fig. 3. The mean SUV plotted against the sizes of PMF by linear regression. The slope was 0.202, with a correlation coefficient of 0.225, and a p value 0.357 (Y = 2.160 + 0.202 X, r = 0.225). These results show that the size of PMF measured on the CT images does not correlate with the results of the mean SUV of PMF measured on the FDG-PET images. 1. Spencer H. Pathology of the lung 4th ed. Oxford: Pergamon Press, 1985 2. Green FH, Laqueur WA. Coal workers pneumoconiosis. Pathol Annu 1980;15:333-410 3. Worrell JA, Carroll FE Jr., Pendergrass HP, O Donnell D. Coal worker s pneumoconiosis CT assessment in exposed workers in correlation with radiographic findings. Invest Radiol 1992;27:98-100 4. Remy-Jardin M, Degreef JM, Beuscart R, Voisin C, Remy J. Coal worker s pneumoconiosis: CT assessment in exposed workers and correlation with radiographic findings. Radiology 1990;177:363-371 5. Williams JL, Moller GA. Solitary mass in the lungs of coal miners. Am J Roentgenol Radium Ther Nucl Med 1973;117:765-770 6. Bandoh S, Fujita J, Yamamoto Y, Nishiyama Y, Ueda Y, Tojo Y, et al. A case of lung cancer associated with pneumoconiosis diagnosed by fluorine-18 fluorodeoxyglucose positron emission tomography. Ann Nucl Med 2003;17:597-600 7. Kavanagh PV, Stevenson AW, Chen MY, Clark PB. Nonneoplastic diseases in the chest showing increased activity on FDG PET. AJR Am J Roentgenol 2004;183:1133-1141 8. O Connell M, Kennedy M. Progressive massive fibrosis secondary to pulmonary silicosis appearance on F-18 fluorodeoxyglucose PET/CT. Clin Nucl Med 2004;29:754-755 9. Begin R, Bergeron D, Samson L, Boctor M, Cantin A. CT assessment of silicosis in exposed workers. AJR Am J Roentgenol 1987; 259
148:509-514 10. Bergin CJ, Muller NL, Vedal S, Chan-Yeung M. CT in silicosis: correlation with plain films and pulmonary function tests. AJR Am J Roentgenol 1986;146:477-483 11. Hirakata K. Pathologic-HRCT correlation of pneumoconiosis--a study on inflation-fixed lungs. Nippon Igaku Hoshasen Gakkai Zasshi 1992;52:35-51 12. Yang SN, Liang JA, Lin FJ, Kwan AS, Kao CH, Shen YY. Differentiating benign and malignant pulmonary lesions with FDG-PET. Anticancer Res 2001;21:4153-4157 13. Costa DC, Visvikis D, Crosdale I, Pigden I, Townsend C, Bomanji J, et al. Positron emission and computed X-ray tomography: a coming together. Nucl Med Commun 2003;24:351-358 14. Alavi A, Gupta N, Alberini JL, Hickeson M, Adam LE, Bhargava P, et al. Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med 2002;32:293-321 F-18 FDG PET Features of Progressive Massive Fibrosis in Patients with Pneumoconiosis 1 Sang Min Lee, M.D., Tae Hoon Kim, M.D., Jae Hoon Lee, M.D., Young Hoon Ryu, M.D., Sang Jin Kim, M.D. 1 Department of Radiology, Yonsei University College of Medicine Purpose: To evaluate the fluorodeoxyglucose positron emission tomography (FDG-PET) features of progressive massive fibrosis (PMF) in patients with pneumoconiosis. Materials and Methods: FDG-PET and chest CT scans were performed in 11 patients with pneumoconiosis and PMF on chest radiographs. We evaluated the size, location, maximum, and mean of the standardized uptake value (SUV) for the PMF. A fine needle aspiration biopsy was performed in patients with a mean SUV of > 2.5 to exclude lung malignancies or pulmonary tuberculosis. A Pearson s correlation was performed to determine if a correlation exists if between the sizes and the mean SUV of the PMF. Results: A total of 19 masses from 11 patients were located in the upper lobes (bilateral in eight and right in three). The sizes of the lesions ranged from 1.3 to 6.4 cm (mean = 3.6 cm). The maximum SUV was 0.5 to 8.1 (mean = 3.8) and the mean SUV was 0.4 to 5.9 cm (mean = 2.9 cm). Lung malignancies or tuberculosis were not identified in the 12 lesions (63%) with a mean SUV of >2.5. The sizes of the PMF did not correlate well with the mean SUV (r = 0.225). Conclusion: FDG-PET scans can show PMFs as regions of increased metabolic activity (mean SUV, 2.9) without evidence of lung cancer or pulmonary tuberculosis. No correlation between the sizes of PMF and the mean SUV was found. Index words : Pneumoconiosis Pulmonary fibrosis Tomography, X-Ray Computed Fluorodeoxyglucose F18 Positron-emission tomography Lung Address reprint requests to : Tae Hoon Kim, M.D., Ph.D., Department of Radiology, Yongdong Severance Hospital, Yonsei University Health System, 146-95, Dogok-dong, Gangnam-gu, Seoul 135-720, South Korea. Tel. 82-2-2019-3510 Fax. 82-2-3462-5472 E-mail: thkim1@yuhs.ac 260