MR Imaging of Benign and Malignant Pleural Disease
Section snippets
Anatomy
The term pleura encompasses the parietal pleura (lining the inner surface of the chest wall), the visceral pleura (lining the outer surface of the lung and invaginating into the lung in the form of fissures), and the intervening pleural space. Visceral and parietal pleural surfaces consist of a mesothelial layer and three connective tissue layers, with the visceral pleura being thicker than the parietal pleura. Together the visceral and parietal pleural layers and the lubricating liquid in the
Pleural effusions
The normal pleural space contains 1 to 5 mL of lubricating pleural fluid. Pleural effusions occur when there is an imbalance of the normal physiologic processes that are necessary for the maintenance of the equilibrium that balances pleural fluid production and absorption. Exudative pleural effusions occur secondary to an increase in capillary permeability because of malignancy, infection, or thromboembolic disease. Transudative pleural effusions result from an increase in hydrostatic pressure
Pleural diseases
Pleural thickening is readily detectable on CT and MR imaging. It is important to distinguish benign from malignant pleural disease and to determine the possible cause for pleural thickening. On cross-sectional imaging studies, pleural thickening may present as a focal or a diffuse abnormality (see Table 1).
Summary
CT plays a primary role in the diagnosis, staging, and posttreatment management of pleural diseases and malignancies.
MR imaging and PET offer complementary information that balances some of the limitations observed with CT. An understanding of the potential MR imaging options enables formulation of and more efficient application of MR imaging strategies to the study of benign and malignant pleural disease.
When properly performed, MR imaging greatly enhances surgical planning for patients who
References (48)
CT and MR in pleural disease
Clin Chest Med
(1998)- et al.
Imaging of pleural disease
Clin Chest Med
(2006) - et al.
Pleural tumors and pulmonary tumors: differential diagnosis
Semin Roentgenol
(1977) - et al.
Evaluation of pleural disease with 18-flourodeoxyglucose positron emission tomography imaging
Chest
(2004) - et al.
Morphologic and functional imaging of malignant pleural mesothelioma
Eur J Radiol
(2007) Pathology of mesothelioma
Thorac Surg Clin
(2004)- et al.
Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases
Eur J Radiol
(2002) - et al.
Dynamic contrast-enhanced MRI of malignant pleural mesothelioma: a feasibility study of noninvasive assessment, therapeutic follow-up, and possible predictor of improved outcome
Chest
(2006) - et al.
Biology and management of malignant pleural mesothelioma
Eur J Cancer
(2006) - et al.
Metabolic imaging of malignant pleural mesothelioma with fluorodeoxyglucose positron emission tomography
Chest
(1998)
Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: staging implications
J Thorac Cardiovasc Surg
CT in differential diagnosis of diffuse pleural disease
AJR Am J Roentgenol
Pleura and pleural disorders
BTS guidelines for the investigation a unilateral pleural effusion in adults
Thorax
MR imaging of pleural effusions
J Comput Assist Tomogr
Diffusion weighted MR imaging of pleural fluid; differentiation of transudative vs exudative pleural effusions
Eur Radiol
Duodenal hematoma: the ring sign in MR imaging
Radiology
Imaging the pleura: sonography, CT and MR imaging
AJR Am J Roentgenol
Visceral pleural thickening in asbestos exposure: the occurrence and implications of thickened interlobar fissures
J Thorac Imaging
Conventional chest radiographs: anatomic understanding of newer observations
Radiology
Asbestos-related pleural disease: value of dedicated magnetic resonance imaging techniques
Invest Radiol
Localized fibrous tumor of the pleura. Archives of the AFIP
Radiographics
Solitary fibrous tumor of the pleura: MR appearance and enhancement pattern
J Comput Assist Tomogr
Computed tomography of pleural disease
AJR Am J Roentgenol
Cited by (29)
Pleural Effusions: Clues for Diagnosis and Characterization
2023, Seminars in RoentgenologyEURACAN/IASLC Proposals for Updating the Histologic Classification of Pleural Mesothelioma: Towards a More Multidisciplinary Approach
2020, Journal of Thoracic OncologyCheck the chest: review of chest findings on abdominal MRI
2020, Clinical ImagingCitation Excerpt :Higher signal intensity on T1W and T2W images with lower diffusion on diffusion-weighted sequences may also suggest exudative rather than transudative pleural effusions. Definitive distinction between the two entities often requires a combination of clinical, biochemical, and pathologic findings [15–17]. Hemothorax can show high signal intensity on T1W and T2W images.
Functional MR Imaging in Chest Malignancies
2016, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :DWI also potentially detects malignant transformation of solitary fibrous tumor of the pleura (seen in 20% of cases) by showing a decrease in ADC value.78 A nonrestrictive pleural plaque in DWI or a nonenhancing lesion or showing a slow RSE on DCE–MR imaging is consistent with a pleural plaque of benign origin (Fig. 11).69,80 DWI has great utility in characterizing benign and malignant mediastinal masses without cystic components and in distinguishing between well and poorly differentiated masses (Fig. 12; see Table 4).81
Response evaluation in mesothelioma: Beyond RECIST
2015, Lung Cancer
This work was partially supported by NIH Grant # R21CA116271-02.