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Romei C, Fanni SC, Volpi F, Milazzo A, D’Amore CA, Colligiani L, Neri E, De Liperi A, Stella GM, Bortolotto C. New Updates of the Imaging Role in Diagnosis, Staging, and Response Treatment of Malignant Pleural Mesothelioma. Cancers (Basel) 2021; 13:cancers13174377. [PMID: 34503186 PMCID: PMC8430786 DOI: 10.3390/cancers13174377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Malignant pleural mesothelioma is a rare neoplasm with poor prognosis. CT is the first imaging technique used for diagnosis, staging, and assessment of therapy response. Although, CT has intrinsic limitations due to low soft tissue contrast and the current staging system as well as criteria for evaluating response, it does not consider the complex growth pattern of this tumor. Computer-based methods have proven their potentiality in diagnosis, staging, prognosis, and assessment of therapy response; moreover, computer-based methods can make feasible tasks like segmentation that would otherwise be impracticable. MRI, thanks to its high soft tissue contrast evaluation of contrast enhancement and through diffusion-weighted-images, could replace CT in many clinical settings.
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Affiliation(s)
- Chiara Romei
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, 56124 Pisa, Italy;
- Correspondence: (C.R.); (S.C.F.)
| | - Salvatore Claudio Fanni
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
- Correspondence: (C.R.); (S.C.F.)
| | - Federica Volpi
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Alessio Milazzo
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Caterina Aida D’Amore
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Leonardo Colligiani
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Emanuele Neri
- Department of Translational Research, Academic Radiology, University of Pisa, 56124 Pisa, Italy; (F.V.); (A.M.); (C.A.D.); (L.C.); (E.N.)
| | - Annalisa De Liperi
- 2nd Radiology Unit, Radiology Department, Pisa University Hospital, 56124 Pisa, Italy;
| | - Giulia Maria Stella
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation, University of Pavia Medical School, 27100 Pavia, Italy;
| | - Chandra Bortolotto
- Unit of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation, University of Pavia Medical School, 27100 Pavia, Italy;
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Song J, Nam BD, Yoon SH, Yoo JY, Jeong YJ, Yeo CD, Lim SY, Lee SY, Kim HK, Kim BH, Jin KN, Yong HS. [Korean Clinical Imaging Guidelines for the Appropriate Use of Chest MRI]. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:562-574. [PMID: 36238776 PMCID: PMC9432450 DOI: 10.3348/jksr.2020.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/15/2021] [Accepted: 02/01/2021] [Indexed: 11/15/2022]
Abstract
MRI has the advantages of having excellent soft-tissue contrast and providing functional information without any harmful ionizing radiation. Although previous technical limitations restricted the use of chest MRI, recent technological advances and expansion of insurance coverage are increasing the demand for chest MRI. Recognizing the need for guidelines on appropriate use of chest MRI in Korean clinical settings, the Korean Society of Radiology has composed a development committee, working committee, and advisory committee to develop Korean chest MRI justification guidelines. Five key questions were selected and recommendations have been made with the evidence-based clinical imaging guideline adaptation methodology. Recommendations are as follows. Chest MRI can be considered in the following circumstances: for patients with incidentally found anterior mediastinal masses to exclude non-neoplastic conditions, for pneumoconiosis patients with lung masses to differentiate progressive massive fibrosis from lung cancer, and when invasion of the chest wall, vertebrae, diaphragm, or major vessels by malignant pleural mesothelioma or non-small cell lung cancer is suspected. Chest MRI without contrast enhancement or with minimal dose low-risk contrast media can be considered for pregnant women with suspected pulmonary embolism. Lastly, chest MRI is recommended for patients with pancoast tumors planned for radical surgery.
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Sinha S, Swift AJ, Kamil MA, Matthews S, Bull MJ, Fisher P, De Fonseka D, Saha S, Edwards JG, Johns CS. The role of imaging in malignant pleural mesothelioma: an update after the 2018 BTS guidelines. Clin Radiol 2020; 75:423-432. [PMID: 32081346 DOI: 10.1016/j.crad.2019.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Malignant pleural mesothelioma (MPM) is a primary malignancy of the pleura and is associated with a poor outcome. The symptoms and signs of malignant mesothelioma present late in the natural history of the disease and are non-specific, making the diagnosis challenging and imaging key. In 2018, the British Thoracic Society (BTS) updated the guideline on diagnosis, staging, and follow-up of patients with MPM. These recommendations are discussed in this review of the current literature on imaging of MPM. It is estimated MPM will continue to cause serious morbidity and mortality in the UK late into the 21st century, and internationally, people continue to be exposed to asbestos. We aim to update the reader on current and future imaging strategies, which could aid early diagnosis of pleural malignancy and provide an update on staging and assessment of tumour response.
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Affiliation(s)
- S Sinha
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - A J Swift
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK; Academic Unit of Radiology, The University of Sheffield, Sheffield, UK
| | - M A Kamil
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Matthews
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - M J Bull
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - P Fisher
- Department of Oncology, Sheffield Teaching Hospitals, Sheffield, UK
| | - D De Fonseka
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, Sheffield, UK
| | - S Saha
- Department of Respiratory Medicine, Sheffield Teaching Hospitals, Sheffield, UK
| | - J G Edwards
- Department of Thoracic Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - C S Johns
- Department of Radiology, Sheffield Teaching Hospitals, Sheffield, UK.
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Harris EJA, Musk A, de Klerk N, Reid A, Franklin P, Brims FJH. Diagnosis of asbestos-related lung diseases. Expert Rev Respir Med 2019; 13:241-249. [DOI: 10.1080/17476348.2019.1568875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Edward J. A. Harris
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Arthur Musk
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Nicholas de Klerk
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Alison Reid
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Peter Franklin
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Fraser J. H. Brims
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
- School of Public Health, Curtin University, Perth, WA, Australia
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Tsim S, Humphreys CA, Cowell GW, Stobo DB, Noble C, Woodward R, Kelly CA, Alexander L, Foster JE, Dick C, Blyth KG. Early Contrast Enhancement: A novel magnetic resonance imaging biomarker of pleural malignancy. Lung Cancer 2018; 118:48-56. [PMID: 29572002 PMCID: PMC5884311 DOI: 10.1016/j.lungcan.2018.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/05/2018] [Accepted: 01/18/2018] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Pleural Malignancy (PM) is often occult on subjective radiological assessment. We sought to define a novel, semi-objective Magnetic Resonance Imaging (MRI) biomarker of PM, targeted to increased tumour microvessel density (MVD) and applicable to minimal pleural thickening. MATERIALS AND METHODS 60 consecutive patients with suspected PM underwent contrast-enhanced 3-T MRI then pleural biopsy. In 58/60, parietal pleura signal intensity (SI) was measured in multiple regions of interest (ROI) at multiple time-points, generating ROI SI/time curves and Mean SI gradient (MSIG: SI increment/time). The diagnostic performance of Early Contrast Enhancement (ECE; which was defined as a SI peak in at least one ROI at or before 4.5 min) was compared with subjective MRI and Computed Tomography (CT) morphology results. MSIG was correlated against tumour MVD (based on Factor VIII immunostain) in 31 patients with Mesothelioma. RESULTS 71% (41/58) patients had PM. Pleural thickening was <10 mm in 49/58 (84%). ECE sensitivity was 83% (95% CI 61-94%), specificity 83% (95% CI 68-91%), positive predictive value 68% (95% CI 47-84%), negative predictive value 92% (78-97%). ECE performance was similar or superior to subjective CT and MRI. MSIG correlated with MVD (r = 0.4258, p = .02). DISCUSSION ECE is a semi-objective, perfusion-based biomarker of PM, measurable in minimal pleural thickening. Further studies are warranted.
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Affiliation(s)
- Selina Tsim
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, UK
| | | | - Gordon W Cowell
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - David B Stobo
- Department of Radiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Colin Noble
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | - Rosemary Woodward
- Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, UK
| | - Caroline A Kelly
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Laura Alexander
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - John E Foster
- Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow, UK
| | - Craig Dick
- Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Infection, Immunity & Inflammmation, University of Glasgow, UK.
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Woolhouse I, Bishop L, Darlison L, De Fonseka D, Edey A, Edwards J, Faivre-Finn C, Fennell DA, Holmes S, Kerr KM, Nakas A, Peel T, Rahman NM, Slade M, Steele J, Tsim S, Maskell NA. British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma. Thorax 2018; 73:i1-i30. [PMID: 29444986 DOI: 10.1136/thoraxjnl-2017-211321] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Ian Woolhouse
- Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Lesley Bishop
- Department of Respiratory Medicine, University Hospitals Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Liz Darlison
- Respiratory Medicine, University Hospitals of Leicester, Leicester, UK
| | | | | | | | | | - Dean A Fennell
- University of Leicester & University Hospitals of Leicester, Leicester, UK
| | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, Somerset, UK
| | | | - Apostolos Nakas
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - Tim Peel
- North Tyneside General Hospital, North Shields, UK
| | - Najib M Rahman
- Oxford NIHR Biomedical Research, University of Oxford, Oxford, UK
| | - Mark Slade
- Papworth Hospital, Thoracic Oncology, Cambridge, UK
| | | | - Selina Tsim
- Respiratory Medicine, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nick A Maskell
- Academic Respiratory Unit, Bristol Medical School, University of Bristol, Bristol, UK
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Lazarus A, Massoumi A, Hostler J, Hostler DC. Asbestos-related pleuropulmonary diseases: benign and malignant. Postgrad Med 2012; 124:116-30. [PMID: 22691906 DOI: 10.3810/pgm.2012.05.2555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Asbestos is known for its desirable properties of thermal and heat resistance along with excellent strength and durability. It was widely used in many industries since the late 19th century, until its adverse effects on health were recognized. The occurrence of pleuropulmonary changes from exposure to asbestos often has a latency period of 20 to 30 years. The use of asbestos has been banned, regulated, and minimized in many countries, but in several developing countries, the use of asbestos in industries is still a common practice. In this article, the benign and malignant clinical manifestations of asbestos exposure are discussed.
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Affiliation(s)
- Angeline Lazarus
- Pulmonary Division, Walter Reed National Military Medical Center, Bethesda, MD 20889-5600, USA.
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[Follow-up of subjects occupationally exposed to asbestos: MRI and PET scans]. Rev Mal Respir 2012; 29:529-36. [PMID: 22542410 DOI: 10.1016/j.rmr.2011.09.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 11/22/2022]
Abstract
MRI and PET scans are not normally used for screening and follow-up of patients following occupational exposure to asbestos. These examinations usually complement the investigation of a parenchymal mass, an effusion or pleural thickening. PET and MRI have an excellent ability to define a parenchymal lesion as malignant (cancer versus rounded atelectasis) or a pleural lesion (mesothelioma versus plaque). MRI distinguishes perfectly the involvement of sub-pleural fat by bronchial carcinoma or mesothelioma. MRI, taking account of its lack of irradiation, could be regarded as suitable for potentially repeated examinations following initial screeing by CT scan. A comparative study of multidetector scanner versus MRI, including diffusion MRI could be, nevertheless, interesting. PET cannot be proposed for the follow up or for screening on account of the irradiation induced and the difficulty of access. Pleural plaques do not take up FDG. There is no specific study of asbestos related fibrosis and there is discordance between studies of other types of pulmonary fibrosis.
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Screening for Malignant Pleural Mesothelioma and Lung Cancer in Individuals with a History of Asbestos Exposure. J Thorac Oncol 2009; 4:620-8. [DOI: 10.1097/jto.0b013e31819f2e0e] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Weber MA, Bock M, Plathow C, Wasser K, Fink C, Zuna I, Schmähl A, Berger I, Kauczor HU, Schoenberg SO. Asbestos-Related Pleural Disease. Invest Radiol 2004; 39:554-64. [PMID: 15308938 DOI: 10.1097/01.rli.0000131888.39636.c5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to compare respiratory-gated high-spatial resolution magnetic resonance imaging (MRI) and radial MRI with ultra-short echo times with computed tomography (CT) in the diagnosis of asbestos-related pleural disease. METHODS Twenty-one patients with confirmed long-term asbestos exposure were examined with a CT and a 1.5-T MR unit. High-resolution respiratory-gated T2w turbo-spin-echo (TSE), breath-hold T1w TSE, and contrast-enhanced fat-suppressed breath-hold T1w TSE images with an inplane resolution of less than 1 mm were acquired. To visualize pleural plaques with a short T2* time, a pulse sequence with radial k-space-sampling was used (TE = 0.5 milliseconds) before and after administration of Gd-DTPA. CT and MR images were assessed by 4 readers for the number and calcification of plaques, extension of pleural fibrosis, extrapleural fat, detection of mesothelioma and its infiltration into adjacent tissues, and detection of pleural effusion. Observer agreement was studied with the use of kappa statistics. RESULTS The MRI protocol allowed for differentiation between normal pleura and pleura with plaques. Interobserver agreement was comparable for MRI and CT in detecting pleural plaques (median kappa = 0.72 for MRI and 0.73 for CT) and significantly higher with CT than with MRI for detection of plaque calcification (median kappa 0.86 for CT and 0.72 for MRI; P = 0.03). Median sensitivity of MRI was 88% for detection of plaque calcification compared with CT. For assessment of pleural thickening, pleural effusion, and extrapleural fat, interobserver agreement with MRI was significantly higher than with CT (median kappa 0.71 and 0.23 for pleural thickening, 0.87 and 0.62 for pleural effusion, and 0.7 and 0.56 for extrapleural fat, respectively; P < 0.05). For detection of mesothelioma, median kappa was 0.63 for MRI and 0.58 for CT. CONCLUSION High-resolution MR sequences and radial MRI achieve a comparable interobserver agreement in detecting pleural plaques and even a higher interobserver agreement in assessing pleural thickening, pleural effusion, and extrapleural fat when compared with CT.
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Affiliation(s)
- Marc-André Weber
- Division of Radiology, German Cancer Research Center, Heidelberg, Germany.
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Stewart DJ, Edwards JG, Smythe WR, Waller DA, O'Byrne KJ. Malignant pleural mesothelioma--an update. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2004; 10:26-39. [PMID: 15070023 DOI: 10.1179/oeh.2004.10.1.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Exposure to asbestos is the most frequent, but not exclusive, cause of malignant mesothelioma. Clinical features include dyspnea, cough, nonspecific chest pain, weight loss and night sweats. Diagnosis may be complicated by histologic difficulties. Thoracoscopic techniques are proving beneficial, but no one method of imaging has proven superior, and disease staging is inconsistent. Conventional treatments such as chemotherapy, surgery, and radiotherapy have had variable impacts, although chemotherapy is useful in palliation and can improve both survival and quality of life. There is hope for new antimetabolite agents. The role of radical surgery is yet to be evaluated in a large trial. New radiotherapeutic techniques to improve local control are promising. Multimodality treatments appear to be the most successful for management of potentially resectable disease. It is likely that biological markers will improve accuracy in staging and prognosis. With new treatments based on better understanding of the biology of the disease, there is cautious optimism for the future for patients with malignant pleural mesothelioma.
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Affiliation(s)
- Duncan J Stewart
- University Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Abstract
Magnetic resonance imaging (MRI) is not routinely used in investigations for patients with suspected malignant pleural mesothelioma but it can be a useful tool in some instances--particularly predicting malignancy in patients with asbestos exposure; differentiating between metastatic pleural disease and malignant pleural mesothelioma (MPM); assessing patients for radical surgery and post treatment evaluation of patients.
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Affiliation(s)
- James Entwisle
- Department of Radiology, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK.
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Abstract
The global incidence of asbestos-related lung diseases is expected to continue to rise. Although much attention is devoted to malignant diseases induced by asbestos, benign asbestos pleural diseases (pleural plaques, benign asbestos-related pleural effusion, diffuse pleural thickening, and rounded atelectasis) are common in clinical practice and often produce diagnostic difficulties. The authors describe the clinical features of benign asbestos-related pleural disease, before focusing on recent advances in radiology and on controversies surrounding the pathogenesis of asbestos-induced pleural injury. Advances in computed tomography have assisted the understanding and diagnosis of these diseases, and increasing evidence suggests radiologic appearances on computed tomography can predict impairment in pulmonary function tests. The pathogenesis of asbestos-induced pleural diseases has also been subject to extensive investigation. Asbestos fibers can provoke pleural inflammation from direct toxicity to mesothelial cells. Inhaled asbestos fibers can also elicit pleural injury indirectly via the release of growth factors and inflammatory cytokines from within the lung. Although progress has been made in the understanding of the mechanisms of asbestos pleural injury, many important questions remain unanswered. The role of genetic factors and possible environmental cofactors (eg, simian virus 40) in the pathogenesis of benign asbestos pleural diseases requires further research.
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Affiliation(s)
- Stephen J Chapman
- Osler Chest Unit, Churchill Hospital, Oxford, UK, and Department of Medicine, University of Western Australia, Perth, Australia
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Hierholzer J, Luo L, Bittner RC, Stroszczynski C, Schröder RJ, Schoenfeld N, Dorow P, Loddenkemper R, Grassot A. MRI and CT in the differential diagnosis of pleural disease. Chest 2000; 118:604-9. [PMID: 10988179 DOI: 10.1378/chest.118.3.604] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To explore the role of MRI in the differential diagnosis of pleural disease. PATIENTS Forty-two patients with pleural disease were included. METHOD Retrospective study. All patients were examined with both CT and MRI. The morphologic features of pleural lesions and magnetic resonance signal intensity on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted images were evaluated. RESULTS Mediastinal pleural involvement, circumferential pleural thickening, nodularity, irregularity of pleural contour, and infiltration of the chest wall and/or diaphragm were most suggestive of a malignant cause both on CT and MRI. Pleural calcification on CT was suggestive of a benign cause. Contrary to what has been previously reported in the literature, neither on CT nor on MRI, pleural thickness >1 cm revealed significant difference between malignant and benign pleural disease (p>0.05, chi(2) test). High signal intensity in relation to intercostal muscles on T2-weighted and/or contrast-enhanced T1-weighted images was significantly suggestive for a malignant disease. Using morphologic features in combination with the signal intensity features, MRI had a sensitivity of 100% and a specificity of 93% in the detection of pleural malignancy. CONCLUSION When signal intensity and morphologic features are assessed, MRI is more useful and therefore superior to CT in differentiation of malignant from benign pleural disease.
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Affiliation(s)
- J Hierholzer
- Klinik und Poliklinik für Strahlenheilkunde, Charité Virchow-Klinikum, Humboldt Universitat zu Berlin, Germany
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