The Use of Chest Magnetic Resonance Imaging in Malignant Pleural Mesothelioma Diagnosis

Our plain-English summary of The Use of Chest Magnetic Resonance Imaging in Malignant Pleural Mesothelioma Diagnosis, by F. Volpi, C.A. D'Amore, L. Colligiani, et al (Diagnostics, 2022).

The study

• Authors: F. Volpi, C.A. D'Amore, L. Colligiani, A. Milazzo, S. Cavaliere, A. De Liperi, E. Neri, C. Romei
• Journal: Diagnostics
• Published: 2022;12(3)
• Type of article: Review
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

In recent years, many articles have demonstrated that magnetic resonance imaging (MRI) may be performed successfully in the study of the chest. The aim of this study was to evaluate the potential role of MRI in the differentiation of benign from malignant pleural disease with a special focus on malignant pleural mesothelioma and on MRI protocols. A systematic literature search was performed to find original articles about chest MRI in patients with either benign or malignant pleural disease. We retrieved 1246 papers and 17 studies were finally identified as being in accordance with our purpose. For a morphologic assessment, T1-weighted and T2-weighted sequences were usually performed, eventually associated with T1 post-contrast sequences for better detection of pleural lesions. Functional sequences such as Diffusion Weighting Imaging (DWI), associated with the evaluation of Apparent Diffusion Coefficient (ADC) maps, were lately and gradually introduced in chest MRI protocols and their potentiality in differentiating benign from malignant disease has been investigated by many authors. Many progresses have been performed to improve quality images and diagnostic performances of MRI. A better and early identification of pleural disease may be obtained, providing MRI as a possible tool that can differentiate malignant from benign pleural disease without using invasive procedures.

In plain English

This article was a systematic review of studies on chest magnetic resonance imaging (MRI) for telling malignant from benign pleural disease, with a focus on malignant pleural mesothelioma. The authors searched Scopus, Web of Science and PubMed, with the last search on 20 November 2021. They looked for English-language original research published after 2000 with more than 10 patients. Of 1246 records retrieved, 17 studies were included. The review did not study asbestos exposure or new patients; it concerned MRI techniques. A 2012 study by Coolen and colleagues, listed with 31 patients (14 with malignant pleural disease), suggested a cut-off of 1.52 x 10^-3 mm2/s for a diffusion measurement, the apparent diffusion coefficient (ADC). At that cut-off, sensitivity was 71.4% and specificity 100%. A 2021 study by Jiang and colleagues found no statistical ADC difference between malignant and benign groups and could not find a cut-off. The authors noted that agreement on an ADC threshold was still missing. Based on the literature, they proposed an MRI protocol on a 1.5 tesla scanner. The authors concluded that further studies are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic literature review of original studies on chest MRI in benign and malignant pleural disease, with a proposed MRI protocol
• Who was studied: 17 published studies selected from 1246 records retrieved from Scopus, Web of Science and PubMed (last search 20 November 2021); English-language original research published after 2000 with more than 10 patients
• Exposure: No asbestos exposure was studied. The review concerned chest MRI methods (morphological T1-weighted and T2-weighted sequences, contrast-enhanced and dynamic contrast-enhanced imaging, and diffusion-weighted imaging with ADC maps) in benign and malignant pleural disease, including malignant pleural mesothelioma
• Main results:
  • Reviewed study (Coolen et al., 2012): a mean ADC value of 1.52 x 10^-3 mm2/s was suggested as the optimal cut-off for malignant pleural disease versus benign lesions. At that cut-off the figures were 71.4% sensitivity, 100% specificity, 87.1% accuracy, 81% NPV and 100% PPV.
  • Table 1 lists Coolen et al., 2012 with 31 eligible and 31 included patients, of whom 14 had malignant pleural disease and 12 had malignant pleural mesothelioma
  • Reviewed study (Sabri et al., 2021): a mean ADC cut-off of 1.68 x 10^-3 mm2/s was suggested to separate malignant from benign pleural lesions (p less than 0.001)
  • Reviewed study (Jiang et al., 2021): mean ADC in the pleural malignancy group was not statistically different from the benign group, and no discriminating cut-off was found
  • Reviewed study (Usuda et al., 2019): mean ADC of malignant pleural mesothelioma was not significantly different from that of pleural dissemination
  • Reviewed study (Gill et al., 2010): the group was 50 patients with histologically proven malignant pleural mesothelioma (35 epithelioid, 10 biphasic, 5 sarcomatoid). ADC of the epithelioid subtype was significantly higher than that of the biphasic and sarcomatoid subtypes.
  • Reviewed study (Coolen et al.): the visual DWI sign called 'pleural pointillism' had sensitivity 92.5%, specificity 78.8%, PPV 89.9%, NPV 83.9% and accuracy 88%. These values were higher than those of the CT signs it was compared with.
  • Based on the literature, the authors proposed an MRI protocol for patients with malignant pleural mesothelioma on a 1.5T system
• The authors' conclusion: The authors concluded that further studies are needed to confirm and improve the use of MRI for pleural and general chest disease assessment
• Limitations the authors state:
  • The authors stated that there was still no agreement in the reviewed literature on a mean ADC threshold able to tell lesions apart

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma.

Related studies

• Diffusion magnetic resonance imaging of chest tumors — A.A. Razek (2012)
• New Updates of the Imaging Role in Diagnosis, Staging, and Response Treatment of Malignant Pleural Mesothelioma — C. Romei, S.C. Fanni, et al. (2021)
• Asbestos-related pleural disease: value of dedicated magnetic resonance imaging techniques — M.A. Weber, M. Bock, et al. (2004)
• Early Contrast Enhancement: A novel magnetic resonance imaging biomarker of pleural malignancy — S. Tsim, C.A. Humphreys, et al. (2018)
• New applications of magnetic resonance imaging for thoracic oncology — Y. Ohno (2014)
• Applications of Magnetic Resonance Imaging of the Thorax in Pleural Diseases: A State-of-the-Art Review — F.M. Pessôa, A.S. de Melo, et al. (2016)

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