Plain film
Chest x-rays are of limited utility and non-specific 6 , demonstrating a pleural opacity which may extend around and encase the lung. Reduction in volume of the affected hemithorax is common resulting in shift of the mediastinum towards the lesion 4.
Rib destruction or extension beyond the lateral and anterior margins of the chest wall may be evident. Mediastinal lymph node enlargement and pleural effusion may also be seen.
CT
CT is the most used modality for assessment of mesothelioma, and is able to stage the disease accurately in most patients.
The appearance is that of soft tissue attenuation nodular mass which spreads along pleural surfaces including into pleural fissures and often creating a pleural rind.
Calcification is seen in 20% of cases which usually represents engulfed calcified pleural plaques rather than true tumour calcification 4. Sarcomatoid variants may demonstrate osteosarcoma or chondrosarcomatous components which may also be calcified.
An uncommon variant is the solitary mediastinal malignant mesothelioma which has appearances reminiscent of a solitary fibrous tumour of the pleura 1.
Mesotheliomas have a predilection of direct invasion of adjacent structures (chest wall, diaphragm and mediastinal content) but also frequently metastasise to contralateral lung and local nodes1-2,4.
To confidently predict chest wall invasion the extrapleural fat plane should be seen to be infiltrated and / or direct extension in bone or muscle identified 4.
Presence of a pericardial effusion suggests transpericardial extension 3-4.
MRI
MRI although not routinely used may have a role in refining the staging and better delineation in surgical candidates especially with regard to chest mesothelioma wall and diaphragmatic invasion 4.
* T1 : iso to slightly hyperintense c.f muscle 4,6
* T2 : iso to hyper intense c.f muscle 4,6
* C+ (GAD) : enhancement usually present
PET
Positron emission tomography is becoming useful in two clinical settings 4:
Chest x-rays are of limited utility and non-specific 6 , demonstrating a pleural opacity which may extend around and encase the lung. Reduction in volume of the affected hemithorax is common resulting in shift of the mediastinum towards the lesion 4.
Rib destruction or extension beyond the lateral and anterior margins of the chest wall may be evident. Mediastinal lymph node enlargement and pleural effusion may also be seen.
CT
CT is the most used modality for assessment of mesothelioma, and is able to stage the disease accurately in most patients.
The appearance is that of soft tissue attenuation nodular mass which spreads along pleural surfaces including into pleural fissures and often creating a pleural rind.
Calcification is seen in 20% of cases which usually represents engulfed calcified pleural plaques rather than true tumour calcification 4. Sarcomatoid variants may demonstrate osteosarcoma or chondrosarcomatous components which may also be calcified.
An uncommon variant is the solitary mediastinal malignant mesothelioma which has appearances reminiscent of a solitary fibrous tumour of the pleura 1.
Mesotheliomas have a predilection of direct invasion of adjacent structures (chest wall, diaphragm and mediastinal content) but also frequently metastasise to contralateral lung and local nodes1-2,4.
To confidently predict chest wall invasion the extrapleural fat plane should be seen to be infiltrated and / or direct extension in bone or muscle identified 4.
Presence of a pericardial effusion suggests transpericardial extension 3-4.
MRI
MRI although not routinely used may have a role in refining the staging and better delineation in surgical candidates especially with regard to chest mesothelioma wall and diaphragmatic invasion 4.
* T1 : iso to slightly hyperintense c.f muscle 4,6
* T2 : iso to hyper intense c.f muscle 4,6
* C+ (GAD) : enhancement usually present
PET
Positron emission tomography is becoming useful in two clinical settings 4:
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