"skipMainNavigation"
closeDrawerMenuopenDrawerMenu
Search
Quick Search in Journals
Quick Search anywhere
Advanced Search
Radiology
Menu
  • Information
    • Previous
    Next
    Original Research

    Malignant Pleural Disease: Diagnosis by Using Diffusion-weighted and Dynamic Contrast-enhanced MR Imaging—Initial Experience

    Published Online:Jun 1 2012https://doi.org/10.1148/radiol.12110872

    Abstract

    Diffusion-weighted imaging supplemented with dynamic contrast-enhanced MR imaging seems to be a promising tool for the differential diagnosis of malignant pleural diseases, particularly for malignant pleural mesothelioma.

    Purpose

    To investigate the use of diffusion-weighted (DW) imaging for differentiating benign lesions from malignant pleural disease (MPD) and to retrospectively assess dynamic contrast material–enhanced (DCE) magnetic resonance (MR) imaging acquisitions to find out whether combining these measurements with DW imaging could improve the diagnostic value of DW imaging.

    Materials and Methods

    This study was approved by the local ethics committee, and all patients provided written informed consent. Thirty-one consecutive patients with pleural abnormalities suspicious for MPD underwent whole-body positron emission tomography (PET)/computed tomography (CT) and thorax MR examinations. Diagnostic thoracoscopy with histopathologic analysis of pleural biopsies served as the reference standard. First-line evaluation of each suspicious lesion was performed by using the apparent diffusion coefficient (ADC) calculated from the DW image, and the optimal cutoff value was found by using receiver operating characteristic curve analysis. Afterward, DCE MR imaging data were used to improve the diagnosis in the range of ADCs where DW imaging results were equivocal.

    Results

    Sensitivity, specificity, and accuracy of PET/CT for diagnosis of MPD were 100%, 35.3%, and 64.5%. The optimal ADC threshold to differentiate benign lesions from MPD with DW MR imaging was 1.52 × 10−3 mm2/sec, with sensitivity, specificity, and accuracy of 71.4%, 100%, and 87.1%, respectively. This result could be improved to 92.8%, 94.1%, and 93.5%, respectively, when DCE MR imaging data were included in those cases where ADC was between 1.52 and 2.00 × 10−3 mm2/sec. A total of 20 patients had disease diagnosed correctly, nine had disease diagnosed incorrectly, and two cases were undetermined with PET/CT. DW imaging helped stage disease correctly in 27 patients and incorrectly in four. The undetermined cases at PET/CT were correctly diagnosed at MR imaging.

    Conclusion

    DW imaging is a promising tool for differentiating MPD from benign lesions, with high accuracy, and supplementation with DCE MR imaging seems to further improve sensitivity.

    © RSNA, 2012

    Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12110872/-/DC1

    References

    • 1 Bonomo L, Feragalli B, Sacco R, Merlino B, Storto ML. Malignant pleural disease. Eur J Radiol 2000;34(2):98–118. Crossref, Medline, Google Scholar
    • 2 Aisner J. Current approach to malignant mesothelioma of the pleura. Chest 1995;107(6 suppl):332S–344S. Crossref, Medline, Google Scholar
    • 3 Lee TT, Everett DL, Shu HK, et al.. Radical pleurectomy/decortication and intraoperative radiotherapy followed by conformal radiation with or without chemotherapy for malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2002;124(6):1183–1189. Crossref, Medline, Google Scholar
    • 4 Tsao AS, Wistuba I, Roth JA, Kindler HL. Malignant pleural mesothelioma. J Clin Oncol 2009;27(12):2081–2090. Crossref, Medline, Google Scholar
    • 5 Metintas M, Ak G, Parspour S, et al.. Local recurrence of tumor at sites of intervention in malignant pleural mesothelioma. Lung Cancer 2008;61(2):255–261. Crossref, Medline, Google Scholar
    • 6 Scherpereel A, Astoul P, Baas P, et al.. Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma. Eur Respir J 2010;35(3):479–495. Crossref, Medline, Google Scholar
    • 7 Metintas M, Ucgun I, Elbek O, et al.. Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases. Eur J Radiol 2002;41(1):1–9. Crossref, Medline, Google Scholar
    • 8 Wang ZJ, Reddy GP, Gotway MB, et al.. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. RadioGraphics 2004;24(1):105–119. Link, Google Scholar
    • 9 Kawashima A, Libshitz HI. Malignant pleural mesothelioma: CT manifestations in 50 cases. AJR Am J Roentgenol 1990;155(5):965–969. Crossref, Medline, Google Scholar
    • 10 Sahin AA, Cöplü L, Selçuk ZT, et al.. Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients. AJR Am J Roentgenol 1993;161(3):533–537. Crossref, Medline, Google Scholar
    • 11 Beyer T, Townsend DW, Brun T, et al.. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000;41(8):1369–1379. Medline, Google Scholar
    • 12 Erasmus JJ, Truong MT, Smythe WR, et al.. Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: staging implications. J Thorac Cardiovasc Surg 2005;129(6):1364–1370. Crossref, Medline, Google Scholar
    • 13 Jaruskova M, Belohlavek O. Role of FDG-PET and PET/CT in the diagnosis of prolonged febrile states. Eur J Nucl Med Mol Imaging 2006;33(8):913–918. Crossref, Medline, Google Scholar
    • 14 Fujimoto K. Usefulness of contrast-enhanced magnetic resonance imaging for evaluating solitary pulmonary nodules. Cancer Imaging 2008;8:36–44. Crossref, Medline, Google Scholar
    • 15 Yi CA, Jeon TY, Lee KS, et al.. 3-T MRI: usefulness for evaluating primary lung cancer and small nodules in lobes not containing primary tumors. AJR Am J Roentgenol 2007;189(2):386–392. Crossref, Medline, Google Scholar
    • 16 Thoeny HC, De Keyzer F. Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol 2007;17(6):1385–1393. Crossref, Medline, Google Scholar
    • 17 Kwee TC, Takahara T, Ochiai R, Nievelstein RA, Luijten PR. Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol 2008;18(9):1937–1952. Crossref, Medline, Google Scholar
    • 18 Kono R, Fujimoto K, Terasaki H, et al.. Dynamic MRI of solitary pulmonary nodules: comparison of enhancement patterns of malignant and benign small peripheral lung lesions. AJR Am J Roentgenol 2007;188(1):26–36. Crossref, Medline, Google Scholar
    • 19 Yamamuro M, Gerbaudo VH, Gill RR, Jacobson FL, Sugarbaker DJ, Hatabu H. Morphologic and functional imaging of malignant pleural mesothelioma. Eur J Radiol 2007;64(3):356–366. Crossref, Medline, Google Scholar
    • 20 Giesel FL, Bischoff H, von Tengg-Kobligk H, et al.. Dynamic contrast-enhanced MRI of malignant pleural mesothelioma: a feasibility study of noninvasive assessment, therapeutic follow-up, and possible predictor of improved outcome. Chest 2006;129(6):1570–1576. Crossref, Medline, Google Scholar
    • 21 Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 1988;168(2):497–505. Link, Google Scholar
    • 22 Bammer R. Basic principles of diffusion-weighted imaging. Eur J Radiol 2003;45(3):169–184. Crossref, Medline, Google Scholar
    • 23 Inan N, Arslan A, Akansel G, Arslan Z, Elemen L, Demirci A. Diffusion-weighted MRI in the characterization of pleural effusions. Diagn Interv Radiol 2009;15(1):13–18. Medline, Google Scholar
    • 24 Luna A, Sánchez-Gonzalez J, Caro P. Diffusion-weighted imaging of the chest. Magn Reson Imaging Clin N Am 2011;19(1):69–94. Crossref, Medline, Google Scholar
    • 25 Giesel FL, Choyke PL, Mehndiratta A, et al.. Pharmacokinetic analysis of malignant pleural mesothelioma: initial results of tumor microcirculation and its correlation to microvessel density (CD-34). Acad Radiol 2008;15(5):563–570. Crossref, Medline, Google Scholar
    • 26 Mehndiratta A, Knopp MV, Zechmann CM, et al.. Comparison of diagnostic quality and accuracy in color-coded versus gray-scale DCE-MR imaging display. Int J CARS 2009;4(5):457–462. Crossref, Google Scholar
    • 27 Gill RR, Umeoka S, Mamata H, et al.. Diffusion-weighted MRI of malignant pleural mesothelioma: preliminary assessment of apparent diffusion coefficient in histologic subtypes. AJR Am J Roentgenol 2010;195(2):W125–W130. Crossref, Medline, Google Scholar
    • 28 Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. Pleural mesothelioma. In: Edge SBByrd DRCompton CCFritz AGGreene FLTrotti A, eds. AJCC cancer staging manual. 7th ed. New York, NY: Springer, 2007; 271–277. Google Scholar
    • 29 Husain AN, Colby TV, Ordóñez NG, et al.. Guidelines for pathologic diagnosis of malignant mesothelioma: a consensus statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med 2009;133(8):1317–1331. Crossref, Medline, Google Scholar
    • 30 Rosenbaum SJ, Lind T, Antoch G, Bockisch A. False-positive FDG PET uptake: the role of PET/CT. Eur Radiol 2006;16(5):1054–1065. Crossref, Medline, Google Scholar
    • 31 Flores RM, Akhurst T, Gonen M, Larson SM, Rusch VW. Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2003;126(1):11–16. Crossref, Medline, Google Scholar
    • 32 Heelan RT, Rusch VW, Begg CB, Panicek DM, Caravelli JF, Eisen C. Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol 1999;172(4):1039–1047. Crossref, Medline, Google Scholar
    • 33 Ahmadzadehfar H, Palmedo H, Strunk H, Biersack HJ, Habibi E, Ezziddin S. False positive 18F-FDG-PET/CT in a patient after talc pleurodesis. Lung Cancer 2007;58(3):418–421. Crossref, Medline, Google Scholar
    • 34 Sager S, Ergul N, Ciftci H, Cermik TF. False positive (18)F-FDG-PET/CT findings in a patient with talc pleurodesis. Hell J Nucl Med 2010;13(2):179–180. Medline, Google Scholar
    • 35 Thoeny HC, De Keyzer F, Vandecaveye V, et al.. Effect of vascular targeting agent in rat tumor model: dynamic contrast-enhanced versus diffusion-weighted MR imaging. Radiology 2005;237(2):492–499. Link, Google Scholar
    • 36 Taouli B, Thakur RK, Mannelli L, et al.. Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology 2009;251(2):398–407. Link, Google Scholar
    • 37 Taouli B, Koh DM. Diffusion-weighted MR imaging of the liver. Radiology 2010;254(1):47–66. Link, Google Scholar
    • 38 Lyng H, Haraldseth O, Rofstad EK. Measurement of cell density and necrotic fraction in human melanoma xenografts by diffusion weighted magnetic resonance imaging. Magn Reson Med 2000;43(6):828–836. Crossref, Medline, Google Scholar

    Article History

    Received April 28, 2011; revision requested July 23; revision received December 21; accepted January 13, 2012; final version accepted January 18.
    Published online: June 2012
    Published in print: June 2012