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Eur J Cardiothorac Surg 2007;31:731-736. doi:10.1016/j.ejcts.2007.01.024
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Role of flourine-18 fluorodeoxyglucose positron emission tomography in thymic pathology

Hatem El-Bawaba,*, Abdul Aziz Al-Sugaira, Mohammed Rafaya, Wassem Hajjarb, Mohammed Mahdya, Khaled Al-Kattana,b

a King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
b King Khaled University Hospital, Riyadh, Saudi Arabia

Received 30 August 2006; received in revised form 21 December 2006; accepted 15 January 2007.

* Corresponding author. Address: King Faisal Specialist Hospital & Research Centre, Department of Surgery (MBC 40), P.O. Box 3354, Riyadh 11211, Kingdom of Saudi Arabia. Tel.: +966 1 442 7776; fax: +966 1 442 7772. (Email: hysahmed{at}gmail.com).

Objective: To evaluate the utilization of positron emission tomography (PET) scan with fluorine-18 fluorodeoxyglucose (FDG) in thymic pathology. Methods: Twenty-five consecutive patients with thymic pathology underwent FDG–PET after being evaluated by computed tomography (CT). The indication for CT was myasthenia gravis in 10, anterior mediastinal mass in 7, and recurrent thymic tumor after surgical excision in 8 patients. The results of PET were compared with results obtained by CT, and histopathologic examination of the surgical specimens. Results: All mediastinal abnormal thymic tissue showed FDG uptakes. FDG–PET managed to differentiate between thymic hyperplasia and thymoma in myasthenia gravis group (n = 10) in which CT images were questionable in two patients. There was one case of ectopic thymic tissue which was not diagnosed preoperatively. There were no false-negative results for both CT and FDG–PET in seven patients with thymoma presented as anterior mediastinal mass. However, PET scan predicted thymic carcinoma in one patient. PET was superior to CT scan in localization of recurrent thymoma in two patients, and equal to CT in detecting metastatic lesions in six patients during the follow-up after thymoma excision. Conclusions: In myasthenia gravis, selective use of FDG–PET is useful in differentiating thymoma from hyperplasia, especially when CT scan is controversial, but fails to recognize ectopic thymic tissue. FDG–PET may differentiate thymoma from thymic carcinoma. FDG–PET is also useful in follow-up patients, who underwent thymoma excision, when there is suspicion of recurrence or metastasis.

Key Words: Thymoma • Thymic hyperplasia • Thymic carcinoma • Positron emission tomography • Computed tomography






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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.