Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

Abstract

ObjectiveTo compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD).Materials and MethodsThe authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque.ResultsPleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD.ConclusionAwareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.

Prognosis and role of clinical and imaging features in patients with malignant pericardial effusion: a single-center study in China

“…Echocardiography is the sensitive imaging technique for detecting pericardial effusion, and it perfectly shows a large number of pericardial effusion features [ 15 ]. And chest CT also has an irreplaceable advantage in the diagnosis of pericardial cavity occupation [ 16 ]. In our study, although chest CT had a diagnostic rate of only 79.4% for MPE yet it didn't indicate that the diagnostic efficacy of CT was weaker than that of echocardiography.…”

Clinical course of non-small cell lung cancer patients with dry pleural dissemination

“…Kim et al reported that MPE developed in all 19 patients with radiologic DPD, and the mean interval to MPE was 19 ± 16.7 months. [ 19 ] Li et al reported that MPE developed in 18.6% of 43 patients with intraoperatively diagnosed DPD (without radiologic evidence) during the 3-year follow-up period. [ 4 ] In the present study, MPE developed in 49% of patients with DPD of NSCLC and the median interval to MPE was 42 months.…”

Malignant Pleural Mesothelioma with Marked Lymphatic Involvement: A Report of Two Autopsy Cases

“…They reported lymphangitic metastases were observed in 6 patients (5.8%) of the malignant pleural mesothelioma and 2 patients (8.3%) of the metastatic pleural disease [7]. In this way, the frequency of lymphatic involvement in malignant pleural mesothelioma differs between the histopathology and radiology.…”

“…Kim et al analyzed multidetector CT images of 103 patients with malignant pleural mesothelioma and 24 patients with metastatic pleural disease from extrathoracic malignancy. They reported lymphangitic metastases were observed in 6 patients (5.8%) of the malignant pleural mesothelioma and 2 patients (8.3%) of the metastatic pleural disease [ 7 ]. In this way, the frequency of lymphatic involvement in malignant pleural mesothelioma differs between the histopathology and radiology.…”