An overview on multimodal imaging for the diagnostic workup of pleural mesothelioma

Our plain-English summary of An overview on multimodal imaging for the diagnostic workup of pleural mesothelioma, by M. Gabelloni, L. Faggioni, M.C. Brunese, et al (Japanese Journal of Radiology, 2024).

The study

• Authors: M. Gabelloni, L. Faggioni, M.C. Brunese, C. Picone, R. Fusco, G.D. Aquaro, D. Cioni, E. Neri, N. Gandolfo, A. Giovagnoni, V. Granata
• Journal: Japanese Journal of Radiology
• Published: 2024;42(1):16-27
• Type of article: Review
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Pleural mesothelioma (PM) is an aggressive disease that has a strong causal relationship with asbestos exposure and represents a major challenge from both a diagnostic and therapeutic viewpoint. Despite recent improvements in patient care, PM typically carries a poor outcome, especially in advanced stages. Therefore, a timely and effective diagnosis taking advantage of currently available imaging techniques is essential to perform an accurate staging and dictate the most appropriate treatment strategy. Our aim is to provide a brief, but exhaustive and up-to-date overview of the role of multimodal medical imaging in the management of PM.

© 2023. The Author(s).

In plain English

This article is an invited narrative review of published evidence on how medical imaging is used to diagnose and stage pleural mesothelioma. The authors describe asbestos as a major causal factor for this cancer. The authors did not study any patients themselves. The review described chest X-rays as the first-level test. The most typical finding at presentation was a one-sided build-up of fluid around the lung (pleural effusion), reported in 30 to 80% of patients. CT scanning was described as the mainstay for staging and treatment planning, though its accuracy for judging lymph node spread remains suboptimal. MRI was described as possibly more sensitive than CT for judging local invasion of the chest wall, diaphragm and heart and blood-vessel structures. PET/CT was described as helpful for finding hidden spread to lymph nodes and other sites, and the authors stated it should be done before surgery involving talc pleurodesis. The review also summarized a few published studies of radiomics, a computer-based image analysis. The authors concluded that combining imaging methods is essential for accurate, timely staging and detection of recurrence.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Invited narrative review of published evidence on imaging in pleural mesothelioma
• Who was studied: No patients or animals were studied by the authors. The review drew on published studies, guidelines and expert-panel recommendations about imaging of pleural mesothelioma. The figures show illustrative patient cases.
• Exposure: Not an exposure study. The review covered imaging methods: chest radiography, CT, MRI, PET and radiomics. It discussed asbestos as background, describing it as a major cause of pleural mesothelioma.
• Main results:
  • On chest radiography, the review reported that a one-sided pleural effusion was the most typical finding at presentation in patients with pleural mesothelioma, seen in 30 to 80% of patients.
  • The review described multidetector CT as the mainstay for assessing pleural mesothelioma and for primary staging and treatment planning.
  • The review stated that CT accuracy for lymph node involvement remains suboptimal, because enlarged lymph nodes alone do not prove cancer spread.
  • The review stated that chest MRI can be more sensitive than CT for evaluating local invasion of the chest wall, diaphragm and cardiovascular structures.
  • The review described 18F-FDG PET as helpful for detecting hidden (occult) spread of pleural mesothelioma to lymph nodes and other sites.
  • The review stated that 18F-FDG PET/CT should be performed before surgery involving talc pleurodesis, because talc can cause strong PET uptake from inflammation.
  • The review stated that a few studies have examined radiomics in pleural mesothelioma. One cited study, by Pavic et al., analyzed PET/CT scans of 72 patients later treated with curative surgery. It reported a mean concordance index for predicting progression-free survival of 0.67 in the training cohort and 0.66 in the internal validation cohort. These are that study's results, not results of this review.
• The authors' conclusion: The authors concluded that pleural mesothelioma is likely to remain a relevant healthcare issue despite asbestos bans. They concluded that a multimodal imaging workup is essential to ensure accurate and timely staging and detection of disease recurrence.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Staging.

Related studies

• Diagnostic Imaging and workup of Malignant Pleural Mesothelioma — L. Cardinale, F. Ardissone, et al. (2017)
• Diagnostic Laparoscopy Improves Staging of Malignant Pleural Mesothelioma With Routine Positron Emission Tomography Imaging — R.T. Ripley, N. Palivela, et al. (2021)
• Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma — L.T. Nickell, J.P. Lichtenberger, et al. (2014)
• Whole-Body MRI: Comparison of Its Capability for TNM Staging of Malignant Pleural Mesothelioma With That of Coregistered PET/MRI, Integrated FDG PET/CT, and Conventional Imaging — Y. Ohno, M. Yui, et al. (2019)
• Multimodal therapy of malignant pleural mesothelioma: is the replacement of radical surgery imminent? — J. Lindenmann, V. Matzi, et al. (2013)
• The diagnostic performance of routinely acquired and reported computed tomography imaging in patients presenting with suspected pleural malignancy — S. Tsim, D.B. Stobo, et al. (2017)

Browse more research in Japanese Journal of Radiology, or return to medical research.