Multimodality Imaging for Characterization, Classification, and Staging of Malignant Pleural Mesothelioma

Abstract

Malignant pleural mesothelioma (MPM) is the most common primary malignancy of the pleura and is associated with asbestos exposure in approximately 80% of patients. The patient prognosis is poor, with a median survival of 9-17 months after diagnosis. However, improved survival and decreased morbidity and mortality have been demonstrated when the diagnosis is made in the early stages of disease and specific treatment strategies are implemented. A staging system that focuses on the extent of primary tumor (T), lymph node involvement (N), and metastatic disease (M) has been devised by the International Mesothelioma Interest Group and emphasizes factors related to overall survival. Radiologists should recognize the manifestations of MPM across multiple imaging modalities, translate these findings into the updated staging system, and understand the effects of appropriate staging on treatment and survival. Computed tomography (CT) remains the primary imaging modality used to evaluate MPM and efficiently demonstrates the extent of primary tumor, intrathoracic lymphadenopathy, and extrathoracic spread. However, additional imaging modalities, such as magnetic resonance (MR) imaging of the thorax and positron emission tomography (PET)/CT with fluorodeoxyglucose, have emerged in recent years and are complementary to CT for disease staging and evaluation of patients with MPM. Thoracic MR imaging is particularly useful for identifying invasion of the chest wall, mediastinum, and diaphragm, and PET/CT can accurately demonstrate intrathoracic and extrathoracic lymphadenopathy and metastatic disease.

Evaluation of a tuberculous abscess on the right side of the diaphragm with contrast-enhanced computed tomography: A case report

“…Malignant pleural mesothelioma may involve the diaphragm, and trans-diaphragmatic extension may be detected on CT examination (15). A rind-like pleura, with a thickness of >10 mm is crucial for the diagnosis of malignant pleural mesothelioma (16).…”

Positron Emission Tomography/Computed Tomography for the Pleural Staging of Malignant Pleural Mesothelioma: How Accurate Is It?

“…Consequently, approximately 20-30% of patients undergoing thoracoscopy for MPM are found to be suitable candidates for resection due to discrepancy between preoperative radiological and operative findings [11,12,13,14]. More recently, several studies aimed to define the role of PET/CT in pretherapeutic MPM staging and showed good accuracy for mediastinal lymph nodes assessment as well as extra thoracic metastases, but with comparatively poor evaluation of the pleural cavity [15,16,17,18,19]. …”

Clinical diagnosis of malignant pleural mesothelioma

“…A A B C D recent review of diagnostic performance of CT reported a sensitivity and specificity of 68% and 78%, respectively, for pleural malignancy (21). CT cannot differentiate MPM from metastatic pleural malignancy, although circumferential pleural thickening and mediastinal pleural involvement are more frequent in MPM.…”