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 Centerto 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