PET scans and pleurodesis - 1258238

jmpchic,

I don't think it's so much that doctors don't like PETs at all, it's just that as a follow-up tool it puts doctors and patients in the position you're in - a very small increase in uptake over time, without any other evidence of progression. Most docs don't think that's enough reason to make changes, so why do a PET? And when you think of what happens in a pleurodesis, in which the natural system of lubrication between the lung and chest wall is altered and talc is introduced, it's not surprising that some inflammation occurs and persists (and shows up on PET).

In your husband's case, there may be very good reasons to prefer PET follow-up, given the kidney damage, but as far as judging progression elsewhere, the usual caution about jumping to conclusions applies.

JimC
Forum moderator

I don't think that you should see the SUV rise as a benign finding, but as Jim said, the objection many of us have to PET scans is that too often it leads people to make bad decisions because they overinterpret clinically insignificant changes. Nothing about those numbers seems particularly suggestive of a worrisome trend.

-Dr. West

That's a question to ask the radiologists.

-Dr. West

I just received this email reply from Dr. Kristin Manning a radiologist in reply to your concerns, I hope this helps.

"Contrast induced nephropathy (CIN) from intravenous contrast for exams
such as CT, cardiac catherization or angiography is defined as an
acute deterioration in renal function after exposure to, and as a
result of, contrast media. While several risk factors for CIN have
been identified (such as preexisting abnormal renal function,
diabetes, dehydration), the development of an effective prophylaxis
strategy for CIN has been limited by poor understanding of the
pathophysiology. The effectiveness of prophylaxis regimens such as
N-aceylcysteine (Mucomyst) or sodium bicarbonate to prevent CIN in
high-risk patients remains uncertain. Some studies suggest benefit
while others suggest neutral results. Some studies suggest use of NAC
in higher-risk patients undergoing contrast enhanced procedures is
probably reasonable as the drug is inexpensive, safe, and well
tolerated by patients. However, the most important strategy to prevent
contrast induced nephropathy is to avoid or minimize the use of
intravenous contrast in high risk patients."