MR Imaging of Pleural Neoplasms

Our plain-English summary of MR Imaging of Pleural Neoplasms, by B.W. Carter, S.L. Betancourt, G.S. Shroff, et al (Topics in Magnetic Resonance Imaging, 2018).

The study

• Authors: B.W. Carter, S.L. Betancourt, G.S. Shroff, J.P. Lichtenberger
• Journal: Topics in Magnetic Resonance Imaging
• Published: 2018;27(2):73-82
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The pleura may be affected by primary tumors or metastatic spread of intrathoracic or extrathoracic neoplasms. Primary pleural neoplasms represent ∼10% of all pleural tumors, and malignant lesions are more common than benign lesions. The most common primary tumors include malignant pleural mesothelioma and solitary fibrous tumor. Although pleural neoplasms may initially be evaluated with computed tomography (CT) and/or fluorodeoxyglucose positron emission tomography (PET)/CT, magnetic resonance (MR) imaging is complementary to these other imaging modalities for disease staging and evaluation of patients. In this article, we discuss the etiology, clinical presentation, and imaging of pleural neoplasms, with specific attention given to the role of MR imaging.

In plain English

This was a review article by radiologists, not a new study. It described the causes, symptoms and imaging of tumors of the pleura (the lining around the lungs), with a focus on magnetic resonance (MR) scanning. Its MR images came from individual patients. For malignant pleural mesothelioma, the review stated, citing earlier work, that the disease is associated with asbestos exposure in 40% to 80% of patients. It added that risk rises with the duration and intensity of exposure and that a latency of 35 to 40 years has been described. It said chrysotile accounted for 80% of commercially used asbestos. It noted that cigarette smoking and asbestos act together (are synergistic) in causing lung cancer, but said there is no evidence of a similar role for tobacco in malignant pleural mesothelioma. It gave median survival after diagnosis as 9 to 17 months. It stated that pleural disease alongside pleural plaques suggests mesothelioma and asbestos-related pleural disease. The authors concluded that MR imaging complements CT for staging and evaluating patients and is particularly useful for showing tumor invasion of the chest wall, mediastinum and diaphragm.

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 article (no new patient data; illustrated with MR images of individual patients)
• Who was studied: No study population. The article reviewed published literature on primary and secondary pleural tumors, including malignant pleural mesothelioma, solitary fibrous tumor, other mesenchymal tumors, pleural metastases and lymphoma. Figures show MR images of individual patients.
• Exposure: Asbestos is discussed as a risk factor for malignant pleural mesothelioma. The review names chrysotile, crocidolite, amosite, tremolite, actinolite and anthophyllite, and mentions shipyards, construction and insulation. Other risk factors mentioned are prior irradiation, chronic inflammation such as tuberculosis, and simian virus SV40, whose role the article calls controversial.
• Main results:
  • Citing earlier work, the review stated that malignant pleural mesothelioma is associated with asbestos exposure in 40% to 80% of patients.
  • The review stated that the risk of malignant pleural mesothelioma increases with the duration and intensity of asbestos exposure.
  • The review stated that a latency period of 35 to 40 years from exposure to the development of malignant pleural mesothelioma has been described.
  • The review stated that the disease is more common in men than in women (ratio 4:1) and attributed this largely to men's greater likelihood of occupational asbestos exposure.
  • The review stated that chrysotile (serpentine) fibers account for 80% of the asbestos used commercially.
  • The review stated that all asbestos fibers are classified by the WHO as human carcinogens and that higher fiber aspect ratios (length to width) confer higher tumorigenicity.
  • The review stated that cigarette smoking and asbestos are synergistic in causing lung cancer, but that there is no evidence of a similar role for tobacco in causing malignant pleural mesothelioma.
  • The review stated that MR imaging is more sensitive than CT in detecting tumor invasion of structures such as the chest wall.
  • The review stated that pleural disease together with pleural plaques is suggestive of malignant pleural mesothelioma and asbestos-related pleural disease rather than metastases.
  • The review stated that median survival after diagnosis of malignant pleural mesothelioma is 9 to 17 months.
• The authors' conclusion: The authors concluded that, although CT is the primary imaging method, MR imaging is complementary for staging and evaluating patients with pleural tumors. They said it is particularly useful for identifying invasion of the chest wall, mediastinum and diaphragm, and that it adds value in certain scenarios even though it is not routinely used for all mesothelioma patients.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Pleura, Intrathoracic, Pleural Mesothelioma, Solitary Fibrous Tumor, Staging, Etiology.

Related studies

• 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)
• New applications of magnetic resonance imaging for thoracic oncology — Y. Ohno (2014)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• 18F-Fluorodeoxyglucose PET/CT and dynamic contrast-enhanced MRI as imaging biomarkers in malignant pleural mesothelioma — D.O. Hall, C.E. Hooper, et al. (2018)
• Malignant pleural mesothelioma: role of CT, MRI, and PET/CT in staging evaluation and treatment considerations — M.T. Truong, C. Viswanathan, et al. (2013)
• Cardiac masses: assessment by MR imaging — J.T. Lund, R.L. Ehman, et al. (1989)

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