Malignant Pleural Mesothelioma: Visual Assessment by Using Pleural Pointillism at Diffusion-weighted MR Imaging

Abstract

Visual assessment of pleural pointillism on high-b-value DW images is useful to differentiate MPD from benign alterations, performing substantially better than mediastinal pleural thickness and shrinking lung, and might obviate unnecessary invasive procedures for MPM.

The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy

“…As a result, optimal imaging conditions were only achieved in 108/315 (34%) of the patients studied. The development of objective imaging biomarkers of PM may therefore provide a better long-term method of reducing inter-observer disagreement in CT reporting, as has previously been demonstrated in breast cancer [11], [12] Novel objective imaging markers of PM are also under development including Pleural Pointillism [13] and Early Contrast Enhancement [14], both defined using MRI.…”

British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma

“…More recent studies have highlighted potential utility for diffusion-weighted MR imaging (DWI-MRI) in differentiating pleural malignancy from benign pleural disease, with lower Apparent Diffusion Coefficient (ADC) values being demonstrated in pleural malignancy 31 32 . Coolen et al also performed DWI-MRI in a study of pleural malignancy and reported that inhomogeneous restriction in diffusion of the thickened pleura differentiates malignant from benign pleural disease with a sensitivity of 92.5% (95% CI 84% to 97%) and specificity of 79% (95% CI 62% to 89%) 33 . Gill et al demonstrated that patients with epithelioid MPM have a significantly higher ADC value than those with non-epithelioid MPM and an ADC threshold of 1.1 could differentiate epithelioid MPM from sarcomatoid MPM with a sensitivity of 60% and specificity of 94% (95% CIs not reported) 32 .…”

Imaging of malignant pleural mesothelioma: it is possible a screening or early diagnosis program?—a systematic review about the use of screening programs in a population of asbestos exposed workers

“…The features of malignant pleuropathy have been well described in literature and can be summarized as: circumferential pleural thickening (pleural rind); thickened mediastinal pleura; nodular or lobular borders within the internal profile; irregular borders of the external profile (infiltration of the wall); mediastinal and pericardial infiltration, lymph nodes in extra pleural fat tissues (7)(8)(9)(10)(11)(12). Pleural effusion is an unspecific sign and pleural calcific or not calcific plaques are indicative of asbestos exposure but not of neoplastic pathology (8).…”

“…Magnetic resonance imaging (MRI) is not routinely performed in the clinical practice for patients with MPM; there is some evidence in literature that MRI signal could be useful to differentiate malignant pleuropathy from benign pleural fibrous plaque (12,16). MRI is better than CT for detecting invasion of chest wall, mediastinal and nervous structures as brachial plexus, and peritoneum (15) and is generally reserved for those patients eligible for surgical treatment.…”