Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea

• Published in: Korean journal of radiology Vol. 17; no. 4; pp. 545 - 553
• Main Authors: Kim, Yoon Kyung, Kim, Jeung Sook, Lee, Kyung Won, Yi, Chin A, Koo, Jin Mo, Jung, Soon-Hee
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Radiology 01.07.2016; 대한영상의학회
• Subjects: Adult; Aged; Asbestos; Biopsy; Calcification; Diagnosis, Differential; Disease; Female; Humans; Image-Guided Biopsy; Kidney cancer; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung Neoplasms - secondary; Lymphatic Metastasis; Lymphatic system; Male; Medical imaging; Mesothelioma; Mesothelioma - diagnosis; Mesothelioma - diagnostic imaging; Mesothelioma - pathology; Mesothelioma, Malignant; Metastasis; Middle Aged; Multidetector Computed Tomography; Odds Ratio; Ostomy; Patients; Pleural effusion; Pleural Neoplasms - diagnosis; Pleural Neoplasms - diagnostic imaging; Pleural Neoplasms - pathology; Republic of Korea; Retrospective Studies; Thoracic Imaging; Tomography; 방사선과학; Republic of Korea; United States > US; CT; Mesothelioma; Metastasis; Pleura
• ISSN: 1229-6929; 2005-8330
• DOI: 10.3348/kjr.2016.17.4.545

To compare the multidetector CT (MDCT) features of malignant pleural mesothelioma (MPM) and metastatic pleural disease (MPD). The authors reviewed the MDCT images of 167 patients, 103 patients with MPM and 64 patients with MPD. All 167 cases were pathologically confirmed by sonography-guided needle biopsy of pleura, thoracoscopic pleural biopsy, or open thoracotomy. CT features were evaluated with respect to pleural effusion, pleural thickening, invasion of other organs, lung abnormality, lymphadenopathy, mediastinal shifting, thoracic volume decrease, asbestosis, and the presence of pleural plaque. Pleural thickening was the most common CT finding in MPM (96.1%) and MPD (93.8%). Circumferential pleural thickening (31.1% vs. 10.9%, odds ratio [OR] 3.670), thickening of fissural pleura (83.5% vs. 67.2%, OR 2.471), thickening of diaphragmatic pleura (90.3% vs. 73.4%, OR 3.364), pleural mass (38.8% vs. 23.4%, OR 2.074), pericardial involvement (56.3% vs. 20.3%, OR 5.056), and pleural plaque (66.0% vs. 21.9%, OR 6.939) were more frequently seen in MPM than in MPD. On the other hand, nodular pleural thickening (59.2% vs. 76.6%, OR 0.445), hilar lymph node metastasis (5.8% vs. 20.3%, OR 0.243), mediastinal lymph node metastasis (10.7% vs. 37.5%, OR 0.199), and hematogenous lung metastasis (9.7% vs. 29.2%, OR 0.261) were less frequent in MPM than in MPD. When we analyzed MPD from extrathoracic malignancy (EMPD) separately and compared them to MPM, circumferential pleural thickening, thickening of interlobar fissure, pericardial involvement and presence of pleural plaque were significant findings indicating MPM than EMPD. MPM had significantly lower occurrence of hematogenous lung metastasis, as compared with EMPD. Awareness of frequent and infrequent CT findings could aid in distinguishing MPM from MPD.