Imaging is one of the essential technology frameworks used in cancer diagnosis in general and for the diagnosis of mesothelioma in particular. Scientists have developed a number of different technologies that provide doctors with the tools to diagnose cancer, treat it and to track one’s progress in fighting it. While these tools are not perfect and have not cured cancer in toto, their successes cannot be discounted and it is not hyperbole to say that these imaging systems have truly revolutionized the practice of medicine in the United States and around the world. However, not all imaging technologies are created equal, nor can they be applied interchangeably. Each individual system has its own set of strengths and weaknesses and part of the job of doctors and researchers is to discover the strengths of the technology and maximize its use towards those ends, while also identifying its weaknesses and minimizing or stopping its use in scenarios that can exploit those weaknesses.

The imaging of pleural masses, such as those found in pleural mesothelioma, represents an especially important area of research as it requires as much precision as possible in the use of the available modalities. Because of the structure of the tissues involved, however, it can be difficult to return scans with high enough resolution to definitely determine a diagnosis. Because of this, doctors and researchers are actively studying which imaging modalities are the most effective for making certain kinds of diagnoses. It is within this light that doctors from the Ohio State University Medical Center in Columbus, Ohio have recently released a summation of their use of the standard imaging technologies in their diagnoses of pleural masses.

Introduction to the Study

The doctors compared the efficacy of the following imaging technologies for the diagnosis of pleural masses: chest radiography (chest x-ray), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). The doctors noted both the strengths and weaknesses of each system and made specific recommendations regarding the applicability of the technology for particular uses. While pleural mesothelioma remains the most feared of pleural malignancies, there are other malignancies which require imaging precision for the development of a definitive diagnosis as well.

Chest Radiography (X-Ray)

X-rays are the oldest and most commonly used imaging technology in medicine. An x-ray is frequently the first diagnostic test used by a doctor when pulmonary issues are suspected, but it’s rarely the final one in the diagnosis of pleural masses as its results are limited by poor resolution and it is not generally effective in the differentiation between benign and malignant tissue.

Computed Tomography (CT)

For the diagnosis of pleural issues, CT is a markedly superior technology to x-ray. Not only can CT better distinguish pleural disease from lung parenchymal (the functional tissues in the lungs, such as alevoli and alveolar duct) disease, but it is more adept at determining the location and extent of disease, detecting chest wall invasion and identifying pleural plaques.

Magnetic Resonance Imaging (MRI)

While CT has become the standard imaging technology for the diagnosis of pleural masses, MRI represents an improvement upon CT in a number of ways. It provides an image with superior soft tissue contrast, as well as superior spatial resolution, and this allows it to be even more sensitive to chest wall invasion or the invasion of adjacent tissues by cancerous cells than is CT. This latter facility is important in the staging of disease and in developing a resection strategy before surgery. However, MRIs cost has made it prohibitive for some of these purposes and its limited availability in certain areas has also restricted the number of people who can undergo it.

Positron Emission Tomography (PET)

PET is the newest of the modalities under discussion. While it has shown an ability to recognize individual tumors in the body and to show the results of distant metastases, its use for the diagnosis of pleural masses is limited because it’s not as effective as CT or MRI in showing chest wall or diaphragmatic infiltration.

Conclusion

The techniques discussed in this article all serve important medical functions and their applicability or inapplicability to the diagonosis of pleural masses should not be seen as invalidating their general use. As we said above, each of the technologies have their own strengths and weaknesses and the key is to maximize the use of these strengths and to minimize their use when their weaknesses impact their diagnostic value. CT remains the standard of care for most imaging involving pleural masses, but MRI does show improvements upon CT in a number of ways. With diseases such as pleural mesothelioma continuing to attack the lives of people, these technologies all serve important functions in the quest to keep patients healthy.

Labels: mesothelioma