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Malignant pleural mesothelioma: Computed tomography and correlation with histology
European Journal of Radiology, 06/18/09

Seely JM et al. – Study concludes that ipsilateral volume loss is most frequently associated with sarcomatous or mixed mesothelioma. The remaining imaging findings are not helpful in predicting the histological subtype of malignant mesothelioma.

Methods

A review of CT imaging findings of pleural mesothelioma at presentation and to correlate the CT with the histological subtype
Pathology reports from 1997 to 2006 were reviewed
Diagnosis was based on histologic findings in specimens obtained by transthoracic needle biopsy, surgical biopsy or resection
CT scans, available in 92 pts, were reviewed by 2 independent radiologists

Results

72/92 mesotheliomas were epithelial, 15 sarcomatous, and 5 of mixed histology
All pts (77 male, 15 female, mean age 68 yrs) had pleural thickening on CT; the thickening was nodular in 86% and mediastinal 95%
Ipsilateral volume loss was seen in 46%; pleural effusions in 87%, being large (>2/3 hemithorax) in 21%
Atypical features at presentation included bilateral disease in 3%, and spontaneous pneumothoraces in 10%
Internal mammary lymphadenopathy was observed 52% and cardiophrenic lymphadenopathy in 46%
Inter-observer agreement was excellent
Logistic regression analysis: other CT findings did not correlate with histological subtype

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