Multimodality Imaging Assessment of Malignant Pleural Mesothelioma

Malignant pleural mesothelioma (MPM) is officially recognized as an occupational neoplasm frequently diagnosed in an advanced stage. The disease is usually diffuse rather than focal, typically invasive. Imaging is pivotal for the early detection of the disease, the identification of patients suitable for surgical resection, and the assessment of response to treatment. Computed tomography (CT), given the high spatial resolution, is often sufficient for disease staging and treatment planning on the condition that optimal technical parameters are employed. Magnetic resonance is not generally adopted to evaluate MPM because of long imaging time, cost reasons, and limited availability; otherwise in selected cases this modality can be employed to characterize a suspected local tumor infiltration, given its high tissue contrast. In evaluating the response to treatment and monitoring recurrence both CT and 18-FDG-PET/TC may be employed whereas CT seems to be the best imaging modality in attempting to differentiate MPM from metastatic cancer and benign pleural effusion.