AJR Am J Roentgenol. 1999 Apr;172(4):1039-47.Related
Staging of malignant
pleural mesothelioma: comparison of CT and MR imaging.
Heelan RT, Rusch VW, Begg CB, Panicek
DM, Caravelli JF, Eisen C.
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York,
NY 10021, USA.
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.