Applications of Magnetic Resonance Imaging of the Thorax in Pleural Diseases: A State-of-the-Art Review

Our plain-English summary of Applications of Magnetic Resonance Imaging of the Thorax in Pleural Diseases: A State-of-the-Art Review, by F.M. Pessôa, A.S. de Melo, A.S. Souza, et al (Lung, 2016).

The study

• Authors: F.M. Pessôa, A.S. de Melo, A.S. Souza, L.S. de Souza, B. Hochhegger, G. Zanetti, E. Marchiori
• Journal: Lung
• Published: 2016;194(4):501-9
• Type of article: Review
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The aim of this review was to present the main aspects of pleural diseases seen with conventional and advanced magnetic resonance imaging (MRI) techniques. This modality is considered to be the gold standard for the evaluation of the pleural interface, characterization of complex pleural effusion, and identification of exudate and hemorrhage, as well as in the analysis of superior sulcus tumors, as it enables more accurate staging. The indication for MRI of the thorax in the identification of these conditions is increasing in comparison to computerized tomography, and it can also be used to support the diagnosis of pulmonary illnesses. This literature review describes the morphological and functional aspects of the main benign and malignant pleural diseases assessed with MRI, including mesothelioma, metastasis, lymphoma, fibroma, lipoma, endometriosis, asbestos-related pleural disease, empyema, textiloma, and splenosis.

In plain English

This article was a narrative review of published studies, not new research. It described how benign and malignant pleural diseases, including mesothelioma, metastasis, lymphoma and asbestos-related pleural disease, appear on chest magnetic resonance imaging (MRI). It did not describe how the literature was chosen. The review stated that cumulative exposure to inhaled asbestos particles causes progressive pleural changes, mainly plaques at the lung bases. It stated that MRI detected early-stage plaques better than X-ray and CT. Citing earlier work, it reported that MRI could show round atelectasis missed by conventional studies, and that benign plaques looked dark on T2-weighted images while plaques affected by mesothelioma looked bright, with 100 % agreement with tissue findings in one study. It also cited lower average water-diffusion values for mesothelioma plaques than for benign plaques. Its text and its summary table described plaque signal differently. The authors concluded that MRI is the gold standard for judging whether pleural lesions can be surgically removed, while CT remains more sensitive for pleural calcifications.

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: Narrative (state-of-the-art) literature review; no search method or study selection is described
• Who was studied: No study population of its own; the review draws on published literature, with example images from individual patients (for example a 53-year-old man with pleural mesothelioma)
• Exposure: Asbestos is discussed as the cause of asbestos-related pleural disease and as an association of mesothelioma; no fiber types, jobs or doses are given
• Main results:
  • As background, the review stated that mesothelioma is commonly associated with asbestos exposure, with an approximate latency of 35 to 40 years, and is also related to radiotherapy, tuberculosis and chronic empyema
  • The review described asbestos-related pleural disease as discontinuous pleural thickening in plaques, mainly at the lung bases, with calcified plaques forming over decades
  • The review stated that MRI performs better than conventional radiography and CT in detecting early-stage plaques, and cited the series of Bekkelund et al. for MRI showing round atelectasis not seen in conventional studies
  • Citing Podobnik et al., the review reported that benign plaques are hypointense (dark) on T2-weighted images and plaques affected by mesothelioma are hyperintense (bright), with 100 % correlation between tissue (histopathological) and imaging findings
  • Citing Gill et al., the review reported an average apparent diffusion coefficient (ADC) of approximately 2.6 x 10 to the minus 3 mm2/s for benign plaques and 1.2 x 10 to the minus 3 mm2/s for mesothelioma plaques (the multiplication sign is scanned as '9')
  • The review's text states that plaques appear hyperintense on T1- and T2-weighted images with no contrast enhancement, while its Table 1 lists asbestos-related pleural disease as low signal on both
• The authors' conclusion: The authors concluded that MRI is superior for evaluating invasion of the chest wall and diaphragm and is the gold standard for assessing whether pleural lesions can be resected, but that CT keeps advantages, including greater sensitivity for pleural calcifications

Topics

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

Medical terms in this study, explained in our Lexicon: Thorax, Pleural Effusion, Exudate, Staging, Mesothelioma, Metastasis, Asbestos-Related Pleural Disease, Empyema.

Related studies

• Magnetic resonance imaging of the thorax in the evaluation of asbestosis — S.I. Bekkelund, U. Aasebø, et al. (1998)
• New applications of magnetic resonance imaging for thoracic oncology — Y. Ohno (2014)
• Asbestos-related pleural disease: value of dedicated magnetic resonance imaging techniques — M.A. Weber, M. Bock, et al. (2004)
• Early Contrast Enhancement: A novel magnetic resonance imaging biomarker of pleural malignancy — S. Tsim, C.A. Humphreys, et al. (2018)
• The use of magnetic resonance imaging in malignant mesothelioma — J. Entwisle (2004)
• Asbestos-related pericardial thickening detected by magnetic resonance imaging — N.A. Jarad, S.R. Underwood, et al. (1993)

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