Imaging of the pleura

Our plain-English summary of Imaging of the pleura, by E.J. Helm, T.N. Matin, F.V. Gleeson (Journal of Magnetic Resonance Imaging, 2010).

The study

• Authors: E.J. Helm, T.N. Matin, F.V. Gleeson
• Journal: Journal of Magnetic Resonance Imaging
• Published: 2010;32(6):1275-86
• Type of article: Review
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Pleural disease is a problem of global significance which causes significant morbidity and mortality. Pleural disease is usually first suspected on chest x-ray but further imaging, often ultrasound, is usually required as part of the diagnostic work-up. Complex imaging with computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET)-CT are less often performed but are routinely required in patients with mesothelioma and occasionally required in patients with pleural infection and other pleural diseases. Cross-sectional imaging may be used to suggest the diagnosis of pleural disease, quantify disease severity, guide biopsy, and even predict prognosis. This review will focus on the contributions of CT, MRI, and PET to the management of pleural disease with discussion of their relative strengths and weaknesses.

Copyright © 2010 Wiley-Liss, Inc.

In plain English

This was an invited review, not an original study. It described how computed tomography (CT), magnetic resonance imaging (MRI) and PET-CT scans help diagnose and manage cancers and infections of the pleura, the lining around the lungs. The authors stated pleural cancer is usually first suspected from history and chest X-ray, with CT usually the preferred initial scan, and that mesothelioma has a strong causal link to asbestos exposure. They described pleural plaques as almost always due to asbestos exposure, seen in up to 58% of exposed individuals. They cited studies finding no respiratory impairment even with many plaques. Diffuse asbestos-related pleural thickening, they wrote, can cause shortness of breath, chest pain and a restrictive lung defect. In one reviewed PET-CT study (Erasmus and colleagues), nodal status was correctly determined in 6 of 17 (35%) patients who had complete lymph node staging, and unsuspected distant spread was found in 7 of 29 (25%). The authors concluded that MRI will likely keep a relatively limited role in pleural disease. They noted some staging studies predated routine use of multidetector CT.

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 imaging literature
• Who was studied: No study population of its own; the review covered published work on imaging of pleural disease, divided into neoplasia (cancers) and infection
• Exposure: Not an exposure study. The review was about imaging methods (CT, MRI, PET-CT). Asbestos exposure was discussed as a cause of mesothelioma, pleural plaques, diffuse pleural thickening and round atelectasis. No fiber types were named.
• Main results:
  • The authors stated that pleural malignancy is usually first suspected from clinical history and chest X-ray, and that CT is usually the preferred initial investigation for further assessment
  • The authors stated there is a strong causal link between mesothelioma and asbestos exposure
  • The authors described pleural plaques as almost always secondary to prior asbestos exposure
  • The authors stated plaques may be seen in up to 58% of asbestos-exposed individuals, depending on dose and time since exposure
  • The authors stated that, because plaques are so strongly associated with asbestos exposure, they may be used as risk indicators for mesothelioma
  • Radiological and clinical studies cited by the authors showed no consequent respiratory impairment even in patients with many plaques
  • The authors stated that diffuse asbestos-related pleural thickening, unlike plaques, can cause dyspnea, chest pain and a restrictive pulmonary defect
  • In a cited study (Weber et al), MRI had a sensitivity of 98% for detecting plaques, with CT as the gold standard
  • In a cited PET-CT study of 29 patients referred for extrapleural pneumonectomy (Erasmus et al), nodal status was correctly determined in 6 of 17 (35%) patients who underwent complete lymph node staging
  • In the same cited study (Erasmus et al), distant metastatic disease not previously suspected was detected in 7 of 29 (25%) patients
• The authors' conclusion: The authors concluded that MRI is likely to continue to have a relatively limited role in pleural disease. In the same summary they called CT the workhorse of pleural imaging and expected increased use of PET-CT in the initial assessment of malignant mesothelioma.
• Limitations the authors state:
  • The authors noted that the CT and MRI mesothelioma staging studies they reviewed were performed before multidetector CT was in routine use
  • The authors noted that the PET-alone staging studies they reviewed varied widely in accuracy, likely because of small patient numbers and differences in study design

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: Pleura, Chest X-Ray, Ultrasound, Mesothelioma, Biopsy, Prognosis.

Related studies

• Imaging in pleural mesothelioma: A review of the 14th International Conference of the International Mesothelioma Interest Group — S.G. Armato, R.J. Francis, et al. (2019)
• Imaging the pleura — C. Mortensen, R. Bhatnagar, et al. (2012)
• Imaging of the pleura — N.L. Müller (1993)
• Imaging in pleural mesothelioma: a review of the 11th International Conference of the International Mesothelioma Interest Group — S.G. Armato, Z.E. Labby, et al. (2013)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• CT and MR in pleural disease — T.C. McLoud (1998)

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