Malignant pleural mesothelioma: value of CT and MR imaging in predicting resectability.
OBJECTIVE
Our objective was to determine if CT or MR imaging findings could be used to accurately predict resectability in patients with biopsy-proved malignant pleural mesotheliomas.


METHODS
CT and MR findings in 41 consecutive patients with malignant mesotheliomas who were referred to the thoracic surgery clinic for extrapleural pneumonectomy were studied by thoracic radiologists before surgery. Review of radiologic studies focused on local invasion of three separate regions: the diaphragm, chest wall, and mediastinum. Results of all imaging examinations were carefully correlated with intraoperative, gross, and microscopic pathologic findings.


RESULTS
After radiologic and clinical evaluation, 34 patients (83%) had thoracotomy; 24 of these had tumors that were resectable. The sensitivity was high (> 90%) for both CT and MR in each region. Specificity, however, was low, probably because of the small number of patients with unresectable tumors.


CONCLUSIONS
CT and MR provided similar information on resectability in most cases. Sensitivity was high for both procedures. Because CT is more widely available and used, we suggest it as the initial study when determining resectability. In difficult cases, important complementary anatomic information can be derived from MR images obtained before surgical intervention.
Patz
E F
EF
Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115.
Shaffer
K
K
Piwnica-Worms
D R
DR
Jochelson
M
M
Sarin
M
M
Sugarbaker
D J
DJ
Pugatch
R D
RD
D001194:Asbestos / Q000009:adverse effects; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D001194:Asbestos