J Korean Soc Magn Reson Med.  2013 Sep;17(3):232-238. 10.13104/jksmrm.2013.17.3.232.

Added Value of Magnetic Resonance Imaging in Staging of Malignant Pleural Mesothelioma

• Lee E
• Chae EJ
• Kang S
• Yeom YK
• Lee HJ
• Park JC
• Shin SY
• Choi YY
• Choi JH
• Do KH

• KMID: 2206922
• DOI: http://doi.org/10.13104/jksmrm.2013.17.3.232

Abstract

PURPOSE
We investigated the possible added value of magnetic resonance imaging (MR) in staging of malignant pleural mesothelioma (MPM) compared to computed tomography (CT).
MATERIALS AND METHODS
We retrospectively enrolled 20 patients (M;F = 14:6; mean age, 53.5 yrs) who diagnosed as MPM by histology and underwent CT and MR at initial evaluation from Jan 1997 to Dec 2012. Two radiologists performed clinical staging by using CT alone or MR alone in consensus. In patients underwent surgery (n = 13), we evaluated the diagnostic accuracy of CT and MR in terms of staging compared to surgical staging. In all patients, we compared clinical staging of CT only and CT with MR.
RESULTS
The diagnostic accuracy for T staging of CT only was 23.1% (3/13) and that of combined CT and MR was 38.5% (5/13), respectively. Among 13 patients underwent surgery, surgical stage was higher than combined CT and MR stage in 5 patients, but lower in 3 patients. CT only and combined CT and MR agreed in 85.0% (17/20). In cases of disagree (15.0%, 3/20), combined CT and MR showed higher stage than CT only.
CONCLUSION
Combined CT and MR increases the diagnostic accuracy in staging of MPM compared to CT only and is important in determining the appropriate treatment in patients being considered for surgery.

Keyword

Malignant pleural mesothelioma; Magnetic resonance imaging (MR); TNM staging

MeSH Terms

Consensus
Humans
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Magnetics
Magnets
Mesothelioma
Neoplasm Staging
Retrospective Studies

Figure

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  Fig. 1 Differences between clinical T stage and corrected surgical T stage in patients with available surgical stage.

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  Fig. 2 A representative case of upstaging by MR compared to surgical stage. a. A CT image shows circumferential pleural thickening involving visceral and parietal pleura. Areas of obliteration of extrapleural fat probably over the expected line of endothoracic fascia suggest chest wall invasion (T4) (arrows). b. Gadolinium-enhanced T1-weighted MR image shows some indentation of chest wall by the pleural mass suggesting chest wall invasion (T4) (arrows). However, patient underwent pleuropneumonectomy and surgical and histologic findings revealed no evidence of chest wall invasion (T2).

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  Fig. 3 Differences between clinical stage by CT only and CT and MR.

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  Fig. 4 A representative case of upstaging by MR compared to CT. a. A CT image shows pleural effusion with diffuse pleural thickening. Soft tissue density lesions are suspicious in intercostal spaces in the lower portion of hemithorax, however chest wall invasion is not clear. b. Gadolinium-enhanced, 3-dimensional, gradient recalled echo sequence MR image clearly shows enhancing soft tissue lesions in the intercostal spaces suggesting diffuse chest wall invasion (T4) (arrow).

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