CT of malignant pleural mesothelioma

Our plain-English summary of CT of malignant pleural mesothelioma, by S. Mirvis, J.P. Dutcher, P.J. Haney, et al (AJR. American Journal of Roentgenology, 1983).

The study

• Authors: S. Mirvis, J.P. Dutcher, P.J. Haney, N.O. Whitley, J. Aisner
• Journal: AJR. American Journal of Roentgenology
• Published: 1983;140(4):665-70
• Cited by: 44 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The CT scans, plain films, and clinical courses of nine patients with malignant pleural mesothelioma were reviewed to assess the value of computed tomography (CT) in the initial evaluation and follow-up of this malignancy. The initial pretreatment scans showed a typical lobulated rind of pleural tumor encasing the lung associated with variable amounts of pleural fluid. Local invasion of the mediastinum, pericardium, diaphragm, and contralateral thorax were well depicted on CT; unsuspected abdominal extension of tumor was demonstrated on CT scans of five patients. Serial scans during treatment provided objective evidence of either regression or growth of tumor mass, even when the patients' clinical status and plain films appeared stable.

In plain English

Researchers at the University of Maryland Cancer Center reviewed the hospital charts, chest X-rays and 26 CT scans of the chest and upper abdomen of nine patients with malignant pleural mesothelioma, comparing CT with chest films from the same dates. All nine were men aged 43 to 76, and seven had a known history of asbestos exposure. In seven patients CT showed a thick rind of tumor encasing the lung, and pleural fluid was present in all nine. CT detected tumor invading the pericardium (the sac around the heart) in three patients, confirmed at autopsy in two, and spread to and through the diaphragm in five. Chest films showed neither in any patient. On repeat scans, four patients showed definite tumor growth on CT that was not seen on chest films, and two showed shrinkage on CT while their chest films stayed stable. Median survival from diagnosis was 8 months. The authors concluded that CT was superior to plain films for judging the extent of disease and the response to treatment. They also concluded that CT for suspected pleural mesothelioma should routinely include the upper abdomen.

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: Retrospective review of a small case series, comparing CT scans with chest radiographs taken on corresponding dates
• Who was studied: Nine male patients aged 43-76 years (median 62) with malignant pleural mesothelioma, followed at the University of Maryland Cancer Center; study dates not stated
• Exposure: Seven of the nine patients had a known history of asbestos exposure, with 10-34 years of previous exposures. Fiber types and jobs are not given. The study's focus was CT imaging compared with plain chest radiographs.
• Main results:
  • In seven cases CT showed a thick, lobulated, pleural-based rind of soft tissue encasing the lung.
  • A variable amount of pleural fluid, usually loculated, was present in all cases. Mean attenuation was 7 H for fluid and 44 H for the surrounding tumor tissue.
  • In six cases there was evidence of asbestos exposure in the opposite side of the chest: pleural thickening in all six and calcified plaques in three.
  • CT detected pericardial invasion in three patients, confirmed in two at autopsy. This was not discernible on chest radiographs in any of them.
  • CT showed spread of tumor to and through the diaphragm in five cases, which had not been clinically suspected. Chest radiographs did not show this extension in any case.
  • On serial scans, four cases showed definite progression on CT that was not indicated on chest films in any case. Of these four, three were clinically judged as stable.
  • Two patients with a decrease in tumor bulk on CT had essentially stable chest films.
  • Median survival from diagnosis for all nine patients was 8 months (range 1-41).
• The authors' conclusion: The authors concluded that CT was superior to conventional radiography in assessing the extent of disease and the response to therapy. They also suggested that CT evaluation of suspected pleural mesothelioma should include routine scanning through the upper abdomen.

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, CT Scan, Mediastinum, Pericardium, Diaphragm, Thorax.

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