AJR Am J Roentgenol 1999 Apr;172(4):1039-47
Staging of malignant pleural mesothelioma: comparison of CT and MR
imaging.
Heelan RT, Rusch VW, Begg CB, Panicek DM, Caravelli JF, Eisen C.
OBJECTIVE: This article compares the accuracy of CT with that of MR imaging in staging of
malignant pleural mesothelioma. SUBJECTS AND METHODS: Ninety-five patients were enrolled
in a prospective staging protocol based on the International Mesothelioma Interest Group
staging system. Sixty-five patients underwent CT and MR imaging and a surgical procedure
(excluding percutaneous needle biopsy) to stage and resect the tumor. Receiver operating
characteristic analyses were performed. CT and MR scans were interpreted independently by
observers who were unaware of the results of the other imaging study; these imaging
findings were compared with the results of surgery and pathologic examination. RESULTS:
The areas under the receiver operating characteristic curves for eight of 10 features
revealed by imaging showed no statistically significant differences between CT and MR
imaging. However, MR imaging was superior to CT in revealing invasion of the diaphragm
(A(z) = .55 for CT versus .82 for MR imaging) and in revealing invasion of endothoracic
fascia or solitary resectable foci of chest wall invasion (A(z) = .46 for CT; A(z) = .69
for MR imaging). Several anatomic regions could not be evaluated because positive findings
at surgery were rare. CONCLUSION: CT and MR imaging are of nearly equivalent diagnostic
accuracy in staging malignant pleural mesothelioma. MR imaging is superior to CT in
revealing solitary foci of chest wall invasion and endothoracic fascia involvement and in
showing diaphragmatic muscle invasion; however, this advantage does not affect surgical
treatment. For cost reasons, CT should be considered the standard diagnostic study before
therapy.
PMID: 10587144
