MR Imaging of Benign and Malignant Pleural Disease

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MR imaging serves as a problem-solving tool in the diagnosis of inflammatory and infectious pleural diseases and primary and secondary pleural malignancies. Knowledge of MR imaging appearance of pleural diseases, including pleural effusions and empyema, benign and malignant pleural tumors, and especially mesothelioma, helps guide treatment decisions and surgical planning.

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

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    This work was partially supported by NIH Grant # R21CA116271-02.

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