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Imaging in Mesothelioma

Imaging occupies a vital role in the diagnosis and treatment of malignant pleural mesothelioma (MPM). In this respect the conventional chest x-ray, although limited in its scope, still remains an important modality. It can suggest or render a diagnosis of exist- ing disease or at least recognise abnormalities affecting the lungs and/or the pleura.
More recently, additional imaging modalities such as computed tomography (CT), high resolution tomography and magnetic resonance imaging (MRI) have proven to be not only important adjuncts but more efficient in outlining the features of both asbestosis and mesothelioma. These techniques more readily distinguish pleural disease from normal pleura, accurately stage and determine tumour extent, and easily identify the optimal site for biopsy as well as aid in the biopsy procedure itself. High resolution tomography has been shown to be well in advance in demonstrating fine interstitial disease and plays an important role in distinguishing emphysematous destruction from the interstitial changes of asbestosis.
However, it does not appear to be of any greater use in the evaluation of mesothelioma.
Because of the partial volume effect on curved surfaces, the platelike growth of mesothelioma is poorly demonstrated on CT.
MRI has been shown to be a more sensitive detector and may prove vital in predicting surgical resectability.
The plaques are located predominantly in the basilar portions of the chest wall, diaphragm, and mediastinum and appear as smooth lesions that rarely exceed 1 cm in thickness . Until the fibrous component becomes sufficiently thickened, noncalcified plaques may be difficult to see on conventional chest x-ray.

Asbestosis. Chest shows multiple calcific plaques involving the chest wall bilaterally. The lungs are emphysematous and minimally fibrotic.

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