Current and Future Perspective of PET/CT in Response Assessment of Malignant Pleural Mesothelioma

Seminars in Nuclear Medicine 2025 March [Link]

Manar Badarna, Zohar Keidar, Elite Arnon-Sheleg

Abstract

Malignant pleural mesothelioma (MPM) is a rare but aggressive cancer characterized by its unique growth patterns, presenting substantial diagnostic challenges. With the shift toward immunotherapy for MPM treatment, assessing therapeutic responses has become increasingly complex. Recent studies indicate that FDG PET/CT may provide more effective response criteria compared to traditional CT-based methods. This review emphasizes the important role of PET/CT in offering deep insights into the disease state and monitoring treatment responses. It also addresses the challenges associated with current imaging criteria, particularly the nonspecificity of FDG uptake that may represent inflammatory responses following treatments or procedures rather than tumor activity. Furthermore, the review discusses the potential of emerging radiopharmaceuticals and advanced volumetric assessments, discussing their implications for improving diagnostic accuracy and treatment evaluation in MPM.