Elsevier

Lung Cancer

Volume 59, Issue 3, March 2008, Pages 411-420
Lung Cancer

Meeting report
Current state and future directions of pleural mesothelioma imaging

https://doi.org/10.1016/j.lungcan.2007.09.027Get rights and content

Summary

The diagnosis, staging, and response assessment of mesothelioma pose unique challenges to radiologic imaging. No single, conventional imaging approach captures the information necessary to direct all aspects of patient management. Instead, the complexities of this unique disease demand the integration of elements cleverly adapted from different modalities. Imaging-based studies presented at the 8th International Conference of the International Mesothelioma Interest Group (IMIG) in October 2006 sought to further define the current practice and future potential of radiology for the mesothelioma patient. The imaging studies selected through a peer-review process for presentation at the 2006 IMIG Conference were intended to frame this research in the context of the unique imaging challenges presented by mesothelioma while stimulating dialogue on the future resolution of these challenges. This communication conveys the pitfalls and potential of pleural mesothelioma imaging based on work presented at the Conference. From diagnosis to response, PET/CT to molecular bioprobes, volumetric analysis to computerized tumor assessment, imaging promises to provide valuable insight for patients with mesothelioma and the physicians who treat them.

Introduction

Radiologic imaging is essential to the diagnosis, staging, and clinical management of patients with malignant pleural mesothelioma. X-ray imaging techniques (chest radiography and computed tomography (CT)), magnetic resonance (MR) imaging, positron emission tomography (PET), and, most recently, multimodality PET/CT all have been used to evaluate this disease, although the relative importance of these imaging modalities has changed over time. Imaging-based studies presented at the 8th International Conference of the International Mesothelioma Interest Group (IMIG) in October 2006 sought to further define the current practice and future potential of radiology for the mesothelioma patient. The intent of this communication is to highlight the imaging research reported at the 2006 IMIG Conference, to frame this research in the context of the unique imaging challenges presented by mesothelioma, and to stimulate dialogue on future resolution of these challenges.

Section snippets

Clinical applications and challenges

Malignant pleural mesothelioma is a tumor of the pleural lining of the lung. A large majority of patients will die within a year of diagnosis, and only a very small minority will survive 5 years. Mesothelioma has a very strong association with exposure to asbestos and is exceedingly rare in its absence. The geographic incidence is linked with the pattern of use of asbestos and any subsequent ban. Mesothelioma in Western Europe is predicted to rise to 9000 deaths per annum in around 2018, with a

Tumor measurement and response assessment

The acquisition and comparison of temporally sequential imaging studies is standard practice for the evaluation of tumor response. While CT is the dominant study for this application, complementary roles are being developed for other imaging modalities. CT provides essential information on tumor morphology at any one time point so that CT-based response may be assessed on the basis of change in morphology between multiple time points. “Morphology” broadly encompasses lesion “shape,” which is a

PET/CT in staging

The primary imaging modality used in the staging of mesothelioma is CT [19], [20], which is usually performed to assess the extent of chest wall, mediastinal, and diaphragmatic invasion and the presence or absence of nodal and distant metastases [21], [22]. In the preoperative staging evaluation of patients with mesothelioma, contrast-enhanced magnetic resonance imaging (MRI) may be used to address equivocal findings on CT concerning the local extent of tumor. The marked enhancement of this

Computer model for volumetric response assessment

Clinically reliable quantification of mesothelioma extent is challenging. As previously discussed, recent studies have reported the inadequacy of the unidimensional RECIST criteria for assessing therapy response in mesothelioma. Although tumor volume in mesothelioma has been shown to correlate with patient survival better than tumor thickness [42], the lack of automated or semi-automated tools to quantify tumor volume prevents further validation of this correlation and hinders clinical use of

Molecular imaging of mesothelioma

Improved imaging techniques are needed for more accurate assessment of disease extent, evaluation of treatment response, and better matching of patient and treatment in the setting of clinical trials for mesothelioma [45]. Improved imaging also would permit more accurate, targeted drug delivery and better adjuvant radiotherapy planning. Anatomic imaging modalities such as CT and MRI have been used to assess total tumor burden in the course of treatment. The identification of residual viable

Conclusion

The diagnosis, staging, and response assessment of mesothelioma pose unique challenges to radiologic imaging. No single, conventional imaging approach captures the information necessary to direct all aspects of patient management. Instead, the complexities of this unique disease demand the integration of elements cleverly adapted from different modalities.

CT is currently the primary modality for the diagnosis, staging, and response assessment of mesothelioma, although CT has definite

Acknowledgments

The authors gratefully acknowledge the International Mesothelioma Interest Group (IMIG) and all those who contributed to the 8th International Conference. SA would like to thank Dr. Heber MacMahon and Dr. Geoffrey Oxnard. AN acknowledges other investigators on the study at Sir Charles Gairdner Hospital, including Dr. Roslyn Francis, Dr. Michael Byrne, Dr. Agatha van der Schaaf, Dr. Jan Boucek, and Dr. Michael Phillips. BZ would like to acknowledge other investigators on the study at Memorial

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