A prospective study to determine the real value of mesenteric 18F-FDG uptake in cancer patients – Inflammatory or tumoral mesenteric paniculitis?

Abstract Aim To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in 18 F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. Materials and methods A total of 2666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the 18 F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients), SUVmax Results No signs of mesenteric tumor involvement were demonstrated during a mean follow-up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. Conclusions The presence of radiological signs suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumor process, would have a high likelihood of being indicative of intense inflammatory activity.