The role of new imaging techniques in diagnosis and staging of malignant pleural mesothelioma.

This review highlights the different imaging modalities for the detection of malignant pleural mesothelioma. The chest film is the initial diagnostic tool of choice because it is easy to perform, inexpensive, and widely available. Unfortunately, it demonstrates malignant pleural mesothelioma in later stages of disease and is not suitable for an early sensitive and specific diagnosis. Computed tomography is capable of distinguishing the different forms of pleural abnormalities. The knowledge of computed tomography findings is important for differentiation of malignant pleural diseases from benign diseases. Contrast-enhanced magnetic resonance imaging in three planes can be clinically useful to differentiate pleural mesothelioma from other malignancies or from benign pleural diseases. Furthermore, magnetic resonance imaging offers the possibility to differentiate invasion of the diaphragm from transdiaphragmatic tumor growth, and, in patients who are surgical candidates and who have questionable areas of local tumor extension on computed tomography, magnetic resonance imaging may provide additional information to plan or avoid surgery. Improvements in the detection of regional and distant metastases are needed to identify patients most likely to benefit from aggressive combined modality treatment regimes. In this context, positron emission tomography is a metabolic imaging technique that offers the possibility to evaluate active malignant cells. Drawbacks to this technique include false-positive findings, which may occur at sides of inflammation, and lesser anatomic detail information. A complete and accurate staging of malignant pleural mesothelioma is essential to evaluate the efficacy of new therapeutic strategies. This implies the need to be familiar with the most recently developed staging system from the International Mesothelioma Interest Group.