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Lee, Chae, Kang, Yeom, Lee, Park, Shin, Choi, Choi, and Do: Added Value of Magnetic Resonance Imaging in Staging of Malignant Pleural Mesothelioma
Original Article

Journal of the Korean Society of Magnetic Resonance in Medicine 2013; 17(3): 232-238.

Published online: 30 September 2013

DOI: https://doi.org/10.13104/jksmrm.2013.17.3.232

Added Value of Magnetic Resonance Imaging in Staging of Malignant Pleural Mesothelioma

Eunsol Lee, Eun Jin Chae, Sunji Kang, Yoo Kyeong Yeom, Hyun Joo Lee, Jong Chun Park, So Youn Shin, Yoon Young Choi, Joon Ho Choi, Kyung-Hyun Do

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Korea.

Corresponding author: Eun Jin Chae, M.D. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel. 82-2-3010-4355, Fax. 82-2-476-0090, ejinchae@gmail.com

Received 20 August 2013       Revised 9 September 2013       Accepted 17 September 2013

Copyright © 2013 Journal of the Korean Society of Magnetic Resonance in Medicine

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We investigated the possible added value of magnetic resonance imaging (MR) in staging of malignant pleural mesothelioma (MPM) compared to computed tomography (CT).

Materials and Methods

We retrospectively enrolled 20 patients (M;F = 14:6; mean age, 53.5 yrs) who diagnosed as MPM by histology and underwent CT and MR at initial evaluation from Jan 1997 to Dec 2012. Two radiologists performed clinical staging by using CT alone or MR alone in consensus. In patients underwent surgery (n = 13), we evaluated the diagnostic accuracy of CT and MR in terms of staging compared to surgical staging. In all patients, we compared clinical staging of CT only and CT with MR.

Results

The diagnostic accuracy for T staging of CT only was 23.1% (3/13) and that of combined CT and MR was 38.5% (5/13), respectively. Among 13 patients underwent surgery, surgical stage was higher than combined CT and MR stage in 5 patients, but lower in 3 patients. CT only and combined CT and MR agreed in 85.0% (17/20). In cases of disagree (15.0%, 3/20), combined CT and MR showed higher stage than CT only.

Conclusion

Combined CT and MR increases the diagnostic accuracy in staging of MPM compared to CT only and is important in determining the appropriate treatment in patients being considered for surgery.

Keywords: Malignant pleural mesothelioma, Magnetic resonance imaging (MR), TNM staging

Figures and Tables

Fig. 1
Differences between clinical T stage and corrected surgical T stage in patients with available surgical stage.
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Fig. 2
A representative case of upstaging by MR compared to surgical stage.
a. A CT image shows circumferential pleural thickening involving visceral and parietal pleura. Areas of obliteration of extrapleural fat probably over the expected line of endothoracic fascia suggest chest wall invasion (T4) (arrows).
b. Gadolinium-enhanced T1-weighted MR image shows some indentation of chest wall by the pleural mass suggesting chest wall invasion (T4) (arrows). However, patient underwent pleuropneumonectomy and surgical and histologic findings revealed no evidence of chest wall invasion (T2).
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Fig. 3
Differences between clinical stage by CT only and CT and MR.
jksmrm-17-232-g003
Fig. 4
A representative case of upstaging by MR compared to CT.
a. A CT image shows pleural effusion with diffuse pleural thickening. Soft tissue density lesions are suspicious in intercostal spaces in the lower portion of hemithorax, however chest wall invasion is not clear.
b. Gadolinium-enhanced, 3-dimensional, gradient recalled echo sequence MR image clearly shows enhancing soft tissue lesions in the intercostal spaces suggesting diffuse chest wall invasion (T4) (arrow).
jksmrm-17-232-g004
Table 1
Clinical Characteristics Including Clinical and Surgical Staging of Subjects
jksmrm-17-232-i001

Note.- E, epithelial; B, biphasic, D, desmoplastic, U, unknown; Bx, image-guided biopsy; ET, exploratory thoracotomy; EPP, extrapleural pneumonectomy; VATS, video-assisted thoracoscopic surgery; C, chemotherapy; S, surgery; P, palliative therapy; 3D, contrast-enhanced, 3-dimensional, gradient recalled echo sequence; DB, dynamic breathing imaging; B, Basic, basic MR sequence (3 direction T1 weighted image, T2 weighted image, contrast-enhanced T1 weighted image)

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