Imaging roles when diagnosing mesothelioma

Confirmation of a mesothelioma diagnosis can be difficult—and this alone is only a small portion of the treatment timeline. Physicians use x-rays, MRIs, CT scans and PET scans during the early stages of diagnosis when a patient notices symptoms. 

Radiology Business spoke with Alison Grimes, a health advocate at the Mesothelioma + Asbestos Awareness Center, to get a detailed list of what doctors should look for when using each of the four imaging tests to diagnose mesothelioma. X-rays

• New unilateral pleural thickening or effusion
• Unilateral, concentric, plaque-like or nodular pleural thickening
• Loss of hemithoracic volume
• Encased lung causing compression of lung parenchyma, diaphragm elevation, intercostal space narrowing and mediastinal shift toward the tumor
• Tumor extension into fissures that are thickened and irregular in contour
• Pleural plaques are present in approximately 20 percent of mesothelioma patients

 CT scans

• Tumor extent along pleural surfaces and into the diaphragm, mediastinum or chest wall
• Chest wall and diaphragmatic invasion 
• Pleural thickening and effusion
• Nodular pleural thickening, pleural thickening greater than 1 cm, mediastinal pleural surface and concentric pleural thickening
• Calcified pleural plaques

 MRI

• Solitary foci of chest wall invasion, endothoracic fascial involvement, and diaphragmatic invasion.
• Iso-intense T1 signals of chest wall musculature
• Moderate increased signals on T2-weighted images or enhanced T1-weighted images when gadolinium is injected

 PET scans

• Extent or stage of lymph node involvement, tumors, or metastases
• Differentiation of pleural mesothelioma from benign pleural lesions
• Pleural inflammation