Imaging in pleural mesothelioma: A review of the 13th International Conference of the International Mesothelioma Interest Group

Abstract

Imaging plays an important role in the detection, diagnosis, staging, response assessment, and surveillance of malignant pleural mesothelioma. The etiology, biology, and growth pattern of mesothelioma present unique challenges for each modality used to capture various aspects of this disease. Clinical implementation of imaging techniques and information derived from images continue to evolve based on active research in this field worldwide. This paper summarizes the imaging-based research presented orally at the 2016 International Conference of the International Mesothelioma Interest Group (iMig) in Birmingham, United Kingdom, held May 1–4, 2016. Presented topics included intraoperative near-infrared imaging of mesothelioma to aid the assessment of resection completeness, an evaluation of tumor enhancement improvement with increased time delay between contrast injection and image acquisition in standard clinical magnetic resonance imaging (MRI) scans, the potential of early contrast enhancement analysis to provide MRI with a role in mesothelioma detection, the differentiation of short- and long-term survivors based on MRI tumor volume and histogram analysis, the response-assessment potential of hemodynamic parameters derived from dynamic contrast-enhanced computed tomography (DCE-CT) scans, the correlation of CT-based tumor volume with the post-surgical tumor specimen weight, and consideration of the need to update the mesothelioma tumor response assessment paradigm.

Mesothelioma: Scientific clues for prevention, diagnosis, and therapy

“…The IASLC/IMIG Mesothelioma Registry found that histology, age, sex, and white blood cell and platelet counts stratified survival for 906 patients; further validation can be found in the eighth edition of the Mesothelioma Staging Registry . Greater emphasis on preoperative quantitation imaging studies, including CT volume of the pleural mesothelioma or linear measurements at 3 levels or of diaphragm thickness, also may add to clinical/laboratory stratification. In the immediate future, greater use of novel IHC, genomic, and immune‐based tissue biomarkers may influence whether surgical therapy is indicated.…”

Progress and challenges in Mesothelioma: From bench to bedside

“…Moreover, direct, histological assessment of the mediastinum should be considered, particularly in light of emerging data regarding the prognostic importance of mediastinal nodal involvement in MPM (see 'Staging'). Importantly, MRI also allows more precise estimation of pleural tumour volume [16] and acquisition of functional data [17] that may be useful in future T-staging and early detection strategies. Local Anaesthetic Thoracoscopy (LAT) images recorded in the same patient demonstrating widespread parietal pleural tumour (some highlighted by white arrows) after complete evacuation of the large pleural effusion.…”

“…Therapeutic options appear likely to increase in the near future. MRI may also prove to be a better screening tool than CT, since it does not involve exposure to ionising radiation and offers superior precision [16] and complementary (but as yet unproven) diagnostic functional end-points [17]. In addition, recent data suggests that reconstruction of cumulative life-time asbestos exposure and accurate modelling of lifetime MPM risk is possible [109], and may better select individuals most likely to benefit.…”

Prediagnostic detection of mesothelioma by circulating calretinin and mesothelin – a case-control comparison nested into a prospective cohort of asbestos-exposed workers

“…For screening of an at-risk population, only less invasive methods like imaging can be employed. Unfortunately, imaging methods for MM screening are currently not available 9 , 10 . The non-circular tumor growth pattern of MM and the differentiation of pleural changes, especially between early MM and plaques, is challenging when interpreting computed tomography (CT) scans 11 .…”