CT and MR in pleural disease

Our plain-English summary of CT and MR in pleural disease, by T.C. McLoud (Clinics in Chest Medicine, 1998).

The study

• Author: T.C. McLoud
• Journal: Clinics in Chest Medicine
• Published: 1998;19(2):261-76
• Type of article: Review
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A number of different imaging modalities can be used in the assessment of pleural disease. Although ultrasound has been the more traditional method, CT has found increasing utility for the assessment of the empyema and loculated pleural fluid collections prior to drainage and the evaluation of benign and malignant pleural tumors. MRI has a limited but important role particularly in the evaluation of focal pleural tumors such as lipomas and in determining the extent of malignant mesothelioma prior to therapy.

In plain English

This article is a narrative review by a radiologist at Massachusetts General Hospital. It describes how computed tomography (CT) and magnetic resonance (MR) imaging are used to examine pleural disease, drawing on published studies. It reports no new patients or data of its own. On asbestos, the author wrote that studies have shown high resolution CT is better than chest radiography and conventional CT at detecting pleural plaques. The author also wrote that the demand for and cost of CT make it an unrealistic choice for screening people exposed to asbestos. The review stated that about 80% of malignant mesotheliomas occur in people exposed to asbestos, and that localized fibrous tumors of the pleura are not related to asbestos exposure. It summarized a cited study of 20 patients with malignant mesothelioma in which CT underestimated chest wall invasion in seven. The author described MR as having a limited, although occasionally important, role, and wrote that MR may be better than CT at showing how far mesothelioma has spread.

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 review of imaging (CT and MR) in pleural disease, based on published literature; no original study data
• Who was studied: No study population; the article reviews published imaging studies of pleural disease, including asbestos-related pleural disease and malignant mesothelioma
• Exposure: Imaging methods (CT, high resolution CT, MR) for pleural disease; asbestos exposure is discussed as a cause of pleural plaques, diffuse pleural thickening, rounded atelectasis and malignant mesothelioma (no fiber types named)
• Main results:
  • The author stated that studies have shown high resolution CT is superior to chest radiography and conventional CT for detecting pleural plaques
  • The author stated that the demand for and cost of CT make it an unrealistic screening examination for people exposed to asbestos
  • The author stated that CT or high resolution CT helps distinguish restrictive lung function abnormalities caused by diffuse pleural thickening from those caused by asbestosis
  • The review described a CT definition (from a cited source) of asbestos-related diffuse pleural thickening: thickening extending more than 8 cm from top to bottom and 5 cm sideways, with a thickness of more than 3 mm
  • The author stated that pleural thickening following benign asbestos pleurisy usually shows abnormalities on both sides, whereas other causes usually affect one side
  • The review stated, citing another source, that approximately 80% of malignant mesotheliomas occur in individuals exposed to asbestos
  • The author stated that localized fibrous tumors of the pleura (previously called benign fibrous mesotheliomas) are not related to asbestos exposure
  • In a cited study by Rusch and associates of 20 patients with malignant mesothelioma, CT correctly assessed the pleural extent of disease. However, it underestimated mediastinal lymph node involvement in two cases, chest wall invasion in seven and diaphragmatic invasion in four (20%)
  • The author stated that MR may be superior to CT in determining the extent of malignant mesothelioma
• The authors' conclusion: The author's view was that chest radiography remains the first examination for pleural disease, that CT has many uses, and that MR imaging currently plays a limited, although occasionally important, role

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Ultrasound, Empyema, Malignant Mesothelioma.

Related studies

• Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases — M. Metintas, I. Ucgun, et al. (2002)
• Asbestos-related pleural disease: value of dedicated magnetic resonance imaging techniques — M.A. Weber, M. Bock, et al. (2004)
• Evaluation of pleural disease using MR and CT. With special reference to malignant pleural mesothelioma — A. Knuuttila, L. Kivisaari, et al. (2001)
• Imaging of the pleura — E.J. Helm, T.N. Matin, et al. (2010)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• Imaging of the pleura — N.L. Müller (1993)

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