Imaging of Mesothelioma

Part of the Recent Results in Cancer Research book series (RECENTCANCER, volume 189)


Malignant pleural mesothelioma (MPM) is an asbestos-related neoplasm that originates in pleural mesothelial cells and progresses locally along the pleura until it encases the lungs and mediastinum, ultimately causing death. Imaging plays a crucial role in diagnosis and optimal management. Computed tomography (CT) continues to be the primary and initial imaging modality. Magnetic resonance imaging (MRI) complements CT scan and is superior in determining chest wall and diaphragmatic invasion. FDG18-PET/CT provides anatamo-metabolic information and is superior to both CT and MRI in overall staging and monitoring response to therapy. This chapter will detail the imaging finding of MPM and role of imaging in guiding management.


  1. 1.
    Armato SG III, Ogarek JL, Starkey A et al (2006) Variability in mesothelioma tumor response classification. AJR Am J Roentgenol 186:1000–1006PubMedCrossRefGoogle Scholar
  2. 2.
    Armato SG III, Oxnard GR, Kocherginsky M et al (2005) Evaluation of semi-automated measurements of mesothelioma tumor thickness on CT scans. Acad Radiol 12:1301–1309PubMedCrossRefGoogle Scholar
  3. 3.
    Armato SG III, Oxnard GR, MacMahon H et al (2004) Measurement of mesothelioma on thoracic CT scans: a comparison of manual and computer-assisted techniques. Med Phys 31:1105–1115PubMedCrossRefGoogle Scholar
  4. 4.
    Drevs J, Schneider V (2006) The use of vascular biomarkers and imaging studies in the early clinical development of anti-tumor agents targeting angiogenesis. J Intern Med 260(6):517–529PubMedCrossRefGoogle Scholar
  5. 5.
    Flores RM (2005) Induction chemotherapy, extrapleural pneumonectomy, and radiotherapy in the treatment of malignant pleural mesothelioma: the Memorial Sloan-Kettering experience. Lung Cancer 49(Suppl 1):S71–74PubMedCrossRefGoogle Scholar
  6. 6.
    Flores RM, Akhurst T, Gonen M et al (2003) Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg 126(1):11–16PubMedCrossRefGoogle Scholar
  7. 7.
    Flores RM, Pass HI, Seshan VE (2008) Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg 135:620–626PubMedCrossRefGoogle Scholar
  8. 8.
    Gerbaudo VH, Mamede M, Trotman-Dickinson B (2007) PET/CT patterns of treatment failure of malignant pleural mesothelioma. J Nucl Med 48(Suppl 2):360Google Scholar
  9. 9.
    Gerbaudo VH, Sugarbaker DJ, Britz-Cunningham S et al (2002) Assessment of malignant pleural mesothelioma with 18F-FDG dual-head gamma-camera coincidence imaging: comparison with histopathology. J Nucl Med 43:1144–1149PubMedGoogle Scholar
  10. 10.
    Gerbaudo VH, Sugarbaker DJ, Britz-Cunningham S et al (2003) Metabolic significance of the pattern, intensity and kinetics of 18F-FDG uptake in malignant pleural mesothelioma. Thorax 58(12):1077–1082PubMedCrossRefGoogle Scholar
  11. 11.
    Giesel FL, Bischoff H, von Tengg-Kobligk H et al (2006) Dynamic contrast-enhanced MRI of malignant pleural mesothelioma: a feasibility study of noninvasive assessment, therapeutic follow-up, and possible predictor of improved outcome. Chest 129(6):1570–1576PubMedCrossRefGoogle Scholar
  12. 12.
    Giesel FL, Choyke PL, Mehndiratta A et al (2008) Pharmacokinetic analysis of malignant pleural mesothelioma – initial results of tumor microcirculation and its correlation to microvessel density (CD-34). Acad Radiol 15(5):563–570PubMedCrossRefGoogle Scholar
  13. 13.
    Gill RR, Gerbaudo VH, Jacobson FL et al (2008) MR imaging of benign and malignant pleural disease. Magn Reson Imaging Clin N Am 16(2):319–339PubMedCrossRefGoogle Scholar
  14. 14.
    Gill RR, Gerbaudo VH, Sugarbaker DJ et al (2009) Current trends in radiologic management of malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg 21(2):111–120PubMedCrossRefGoogle Scholar
  15. 15.
    Gill RR, Poh AC, Camp PC et al (2008) MDCT evaluation of central airway and vascular complications of lung transplantation. AJR Am J Roentgenol 191(4):1046–1056PubMedCrossRefGoogle Scholar
  16. 16.
    Gill RR, Umeoka S, Mamata H, Tilleman TR, Stanwell P, Woodhams R, Padera RF, Sugarbaker DJ, Hatabu H (2010) Diffusion-weighted MRI of malignant pleural mesothelioma: preliminary assessment of apparent diffusion coefficient in histologic subtypes. AJR Am J Roentgenol. 195(2):W125–130Google Scholar
  17. 17.
    Hatabu H, Gaa J, Kim D et al (1996) Pulmonary perfusion: qualitative assessment with dynamic contrast-enhanced MRI using ultra-short TE and inversion recovery turbo FLASH. Magn Reson Med 36:503–508PubMedCrossRefGoogle Scholar
  18. 18.
    Hatabu H, Tadamura E, Levin DL et al (1999) Quantitative assessment of pulmonary perfusion with dynamic contrast enhanced MRI. Magn Reson Med 42:1033–1038PubMedCrossRefGoogle Scholar
  19. 19.
    Heelan RT, Rusch VW, Begg CB et al (1999) Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol 172(4):1039–1047PubMedGoogle Scholar
  20. 20.
    Heilo A, Stenwig AE, Solheim OP (1999) Malignant pleural mesothelioma: US-guided histological core-needle biopsy. Radiology 211:657–659PubMedGoogle Scholar
  21. 21.
    Jänne PA, Baldini EH (2004) Patterns of failure following surgical resection for malignant pleural mesothelioma. Thorac Surg Clin 14(4):567–73PubMedCrossRefGoogle Scholar
  22. 22.
    Kawashima A, Libshitz HI (1990) Malignant pleural mesothelioma: CT manifestations in 50 cases. AJR Am J Roentgenol 155(5):965–969PubMedGoogle Scholar
  23. 23.
    Krug LM, Pass HI, Rusch VW et al (2009) Multicenter phase II trial of neoadjuvant pemetrexed plus cisplatin followed by extrapleural pneumonectomy and radiation for malignant pleural mesothelioma. J Clin Oncol 27(18): 3007–3013PubMedCrossRefGoogle Scholar
  24. 24.
    Matsuoka S, Tilleman RT, Mueller J et al (2008) Semi-automated tumor volume method: a practical and reproducible volume measurement for malignant pleural mesothelioma from standard CT images. International conference of the international mesothelioma interest group (IMIG), Amsterdam, September 2008Google Scholar
  25. 25.
    Metintas M, Ucgun I, Elbek O et al (2002) Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases. Eur J Radiol 41(1):1–9PubMedCrossRefGoogle Scholar
  26. 26.
    Pass HI, Temeck BK, Kranda K et al (1998) Preoperative tumor volume is associated with outcome in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 115(2):310–317PubMedCrossRefGoogle Scholar
  27. 27.
    Patz EF, Shaffer K, Piwnica-Worms DR et al (1992) Malignant pleural mesothelioma: value of CT and MR imaging in predicting resectability. AJR Am J Roentgenol 159(5):961–966PubMedGoogle Scholar
  28. 28.
    Pelucchi C, Malvezzi M, La Vecchia C et al (2004) The mesothelioma epidemic in Western Europe: an update. Br J Cancer 90(5): 1022–1024PubMedCrossRefGoogle Scholar
  29. 29.
    Sugarbaker DJ, Flores RM, Jaklitsch MT (1999) Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. J Thorac Cardiovasc Surg 117:54–63; discussion 63–5PubMedCrossRefGoogle Scholar
  30. 30.
    Tilleman RT, Mujoomdar AA, Richards WG et al (2008) cMED: Mediastinal lymph node dissection and preoperative and postoperative staging of 180 consecutive mesothelioma patients –a single center experience. In: International conference of the international mesothelioma interest group (IMIG), Amsterdam, September 2008Google Scholar
  31. 31.
    Tilleman RT, Richards GW, Zellos L et al (2009) Extrapleural pneumonectomy followed by intracavitary intraoperative hyperthermic cisplatin with pharmacologic cytoprotection for treatment of malignant pleural mesothelioma: a phase II prospective study. J Thorac Cardiovasc Surg 138:405–441PubMedCrossRefGoogle Scholar
  32. 32.
    Van Meerbeeck JP, Gaafar R, Manegold C et al (2005) Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol 23:6881–6889PubMedCrossRefGoogle Scholar
  33. 33.
    Vogelzang NJ, Rusthoven JJ, Symanowski J et al (2003) Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21:2636–2644PubMedCrossRefGoogle Scholar
  34. 34.
    Wang ZJ, Reddy GP, Gotway MB et al (2004) Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics 24(1):105–119PubMedCrossRefGoogle Scholar
  35. 35.
    Wolf AS, Jacobson FL, Tilleman TR (2010) Managing the pneumonectomy space after extrapleural pneumonectomy: postoperative intrathoracic pressure monitoring. Eur J Cardiothorac Surg 37(4):770–775, Epub 2010 Jan 6PubMedCrossRefGoogle Scholar
  36. 36.
    Yamamuro M, Gerbaudo VH, Gill RR (2007) Morphologic and functional imaging of malignant pleural mesothelioma. Eur J Radiol 64(3):356–366, Epub 2007 Oct 22PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of RadiologyBrigham and Women’s HospitalBostonUSA

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