Imaging of pleural and chest wall tumors.

MPM is a difficult disease to characterize radiographically because of its diffuse nature and propensity to infiltrate between tissue planes. Although significant information is obtained by CT, MRI, and PET, correlation with intraoperative findings is inconsistent. Overall, CT and MRI are similar in predicting surgical resectability of pleural and chest wall malignancies. MRI has a slight advantage in select situations such as Pancoast tumors; however, CT is less expensive and is sufficient in the majority of cases. Because radiologic imaging cannot differentiate benign from malignant lesions with 100% accuracy, surgical biopsy remains the gold standard for diagnosis. Newer imaging modalities such as PET scan and combined PET/CT might provide greater information and warrant further study in the preoperative evaluation of pleural and chest wall tumors.