Potential advantage of magnetic resonance imaging in detecting thoracic wall infiltration in pleural mesothelioma: A retrospective single-center analysis

Our plain-English summary of Potential advantage of magnetic resonance imaging in detecting thoracic wall infiltration in pleural mesothelioma: A retrospective single-center analysis, by I. Barreto, S. Franckenberg, T. Frauenfelder, et al (JTCVS Open, 2025).

The study

• Authors: I. Barreto, S. Franckenberg, T. Frauenfelder, I. Opitz, O. Lauk
• Journal: JTCVS Open
• Published: 2025;23:318-325
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Thoracic wall infiltration in pleural mesothelioma determines the extent of resection and can be an important prognostic factor. Currently, standardized imaging for restaging after neoadjuvant systemic therapy comprises contrast-enhanced computed tomography or positron emission tomography. Additional thoracic magnetic resonance imaging could better discriminate chest wall infiltration preoperatively and increase staging accuracy. For this reason, the added benefit of magnetic resonance imaging was evaluated at our center.

Methods: A retrospective analysis of the extended imaging protocol was performed from July 2018 to March 2024, including a descriptive analysis for the patient's sex, age, tobacco consumption, asbestos exposure, histological subtype, TNM stage, Modified Response Evaluation Criteria for Solid Tumors in solid tumors, and number of neoadjuvant therapy cycles. Preoperative restaging included routine imaging and magnetic resonance imaging. After histological diagnosis of pleural mesothelioma, neoadjuvant therapy was conducted, followed by intended macroscopic complete resection, with intraoperative biopsies of suspicious chest wall lesions. Computed tomography and magnetic resonance imaging results were compared with intraoperative biopsies.

Results: Twenty-six patients (mean age, 65.50 years, 11.50% female) with operable pleural mesothelioma were included. Of the 11 patients with histologically proven chest wall infiltration, 10 (90.91%) had a cT-stage 3 or greater and 4 (36.36%) underwent surgery that resulted in an R2 resection. Thoracic magnetic resonance imaging showed a high sensitivity (90.91%) for the detection of chest wall infiltration, especially when compared with the computed tomography scan (9.09%).

Conclusions: With the adjunctive use of magnetic resonance imaging, we demonstrated a higher sensitivity for detection of chest wall infiltration compared with conventional imaging before surgery. This may improve patient selection for surgery. Nevertheless, larger studies are required to confirm these results.

© 2024 The Author(s).

In plain English

This retrospective study from the University Hospital Zurich, Switzerland, looked at whether adding thoracic MRI before surgery helped detect pleural mesothelioma growing into the chest wall. Of 35 patients with pleural mesothelioma treated there from July 2018 to March 2024, 26 were included. All had completed chemotherapy before surgery and had tumors judged operable. Most (96%) had confirmed or possible asbestos exposure; exposure was described for patients with and without chest wall infiltration, but no link to infiltration was tested. Scan findings were compared with biopsies taken during surgery, which showed chest wall infiltration in 11 patients. MRI picked up chest wall infiltration with a sensitivity of 90.91%, compared with 9.09% for CT. CT had the higher specificity, 100% versus 75.00% for MRI. When MRI found infiltration, its reported location matched the surgical finding in 9 of 10 cases. Four of the 11 patients with chest wall infiltration had an R2 resection. The authors concluded that MRI's higher sensitivity might help select patients for surgery. They added that their small cohort limits statistical power and larger studies are needed.

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 single-center analysis comparing preoperative thoracic MRI and CT against biopsies taken during surgery
• Who was studied: 26 of 35 patients with pleural mesothelioma treated at University Hospital Zurich, Switzerland, July 2018 to March 2024. Patients were included if they completed neoadjuvant therapy and were operable. Mean age was 65.50 years and 3 (11.54%) were female.
• Exposure: The study compared imaging methods (thoracic MRI added to CT or PET/CT). Asbestos exposure was recorded descriptively only, with no test of association. Overall: yes in 19 (73.08%), possible in 6 (23.08%), no in 1 (3.84%). In the 11 patients with chest wall infiltration: yes 7 (63.63%), possible 3 (27.27%), no 1 (9.09%). In the 15 without: yes 12 (80.00%), possible 3 (20.00%), no 0 (0.00%). No fiber types were reported.
• Main results:
  • For detecting chest wall infiltration (confirmed at surgery in 11 patients), MRI had a sensitivity of 90.91% and CT a sensitivity of 9.09%.
  • CT had higher specificity than MRI: 100% versus 75.00% (Table 2).
  • When MRI showed chest wall infiltration, the reported location matched the location found at surgery in 9 of 10 cases.
  • Among the 11 patients with chest wall infiltration, 4 (36.36%) had an R2 resection. Three of these were due to multilevel chest wall invasion.
  • In the 5 partial pleurectomy cases, MRI had 100% sensitivity and 0% specificity, with 1 false-positive result.
  • In the 21 extended pleurectomy and decortication cases, MRI had a sensitivity of 75% and a specificity of 69.23%.
  • Mean overall survival was 20.27 months for all patients and 19.55 months in the subgroup with chest wall infiltration.
• The authors' conclusion: The authors concluded that MRI's higher sensitivity for chest wall infiltration might facilitate better selection of patients for surgery and planning of the extent of resection, but that larger studies are required to confirm this.
• Limitations the authors state:
  • The small cohort does not allow conclusions with high statistical power.
  • MRI specificity was not entirely satisfactory, especially in partial pleurectomy cases, possibly because of the small sample size.
  • Because MRI specificity was lower, the authors advised caution when interpreting positive MRI results, especially for high tumor volumes.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Systemic Therapy, Staging, Asbestos Exposure, Histological Subtype, Neoadjuvant Therapy.

Related studies

• 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)
• Applications of Magnetic Resonance Imaging of the Thorax in Pleural Diseases: A State-of-the-Art Review — F.M. Pessôa, A.S. de Melo, et al. (2016)
• The use of magnetic resonance imaging in malignant mesothelioma — J. Entwisle (2004)
• Magnetic resonance imaging of the thorax in the evaluation of asbestosis — S.I. Bekkelund, U. Aasebø, et al. (1998)

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