Malignant pleural mesothelioma: the spectrum of manifestations on CT in 70 cases.
OBJECTIVE
The aim of this pictorial review is to illustrate the spectrum of manifestations on computed tomography (CT) of malignant pleural mesothelioma. Malignant pleural mesothelioma is the most common primary neoplasm of the pleura, but nevertheless is a rare tumour. It has a strong association with previous occupational exposure to asbestos and has a bleak prognosis.


METHODS
The pre-treatment CT findings of 70 patients at our institution, and the subsequent findings of the 35 patients who had follow-up CT, have been reviewed by three observers by consensus. 16 patients had surgical resections.


RESULTS
The most common pre-treatment findings were pleural thickening (94%) and pleural effusions (76%). Both contraction (27%) and enlargement (10%) of the ipsilateral hemithorax were identified. Extension of disease to the chest wall, mediastinum, thoracic lymph nodes, and below the diaphragm were identified. Concurrent bilateral pleural calcification and plaques indicative of previous asbestos exposure were identified in 16% of patients. CT failed to identify chest wall and mediastinal invasion in a number of patients who underwent surgical resections.


CONCLUSIONS
CT plays an important role in the diagnosis, assessment, and evaluation of treatment response of this tumour, although it has some limitations in specific areas in evaluating patients for surgical resection.
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Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, USA.
Munden
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RF
Libshitz
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HI
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008654:Mesothelioma / Q000150:complications / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010995:Pleural Diseases / Q000000981:diagnostic imaging; D010997:Pleural Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed