Abstract
Simple SummaryComputed tomography plays a pivotal role in malignant pleural mesothelioma imaging management, ranging from diagnosis, differential diagnosis and staging to assessment of therapy response. Indeed, CT still presents some intrinsic limitations such as a poor contrast resolution between tumor and contiguous soft tissues, resulting in a challenging assessment of locoregional staging. Moreover, the current response evaluation criteria are based on unidimensional criteria, while malignant pleural mesothelioma has a complex tridimensional pattern of growth. To overcome these limits, the recent efforts in literature focused on computer-based methods, such as radiomics or automated segmentation, and magnetic resonance imaging. This review aims to describe their potential role in diagnosis, staging and assessment of therapy response in malignant pleural mesothelioma. Malignant pleural mesothelioma is a rare neoplasm with poor prognosis. CT is the first imaging technique used for diagnosis, staging, and assessment of therapy response. Although, CT has intrinsic limitations due to low soft tissue contrast and the current staging system as well as criteria for evaluating response, it does not consider the complex growth pattern of this tumor. Computer-based methods have proven their potentiality in diagnosis, staging, prognosis, and assessment of therapy response; moreover, computer-based methods can make feasible tasks like segmentation that would otherwise be impracticable. MRI, thanks to its high soft tissue contrast evaluation of contrast enhancement and through diffusion-weighted-images, could replace CT in many clinical settings.
Highlights
We focused on diagnostic and prognostic aspects of malignant pleural mesothelioma from a radiological point of view, evaluating the strengths and weaknesses of computed tomography, magnetic resonance, and machine learning approaches for both diagnosis and follow-up
The studies were separated into two categories: computer-based methods (Table 1) and magnetic resonance imaging (Table 2)
Because magnetic resonance imaging (MRI) evaluation is not related to radiation exposure, it could be a suitable tool for repeatedly screening programs and in monitoring patients treated with chemotherapy [38]
Summary
Imaging plays a key role in MPM management because it can provide early detection of pleural disease, differentiation between the benign and malignant process, staging, Cancers 2021, 13, 4377. One of the first studies regarding the role of MRI in assessing pleural disease evaluated the morphological appearance of benign and malignant lesions and their differential diagnosis. The assessment of a lesion with a thickness lower than 1 cm, regular margin, hypo, or isointense signal intensity on T2-weighted sequences (compared to that of muscle) and homogenous contrast enhancement were defined as signs of benignity, whereas malignant lesions were characterized by thicknesses greater than 1 cm, irregular margins, mediastinal pleural involvement, pleural “rind”, pleurisy, and extension to other thoracic structures.
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