Related Experiment Videos
[Pleural diseases in magnetic resonance tomography (MRT)]
R C Bittner1, W Schörner, C Loddenkemper
1Strahlen- und Poliklinik, Universitätsklinikum Rudolf Virchow, Berlin.
Abstract:
MR images of 48 patients with histologically confirmed benign and malignant diseases of the pleura were retrospectively compared with CT and bioptically/surgically obtained findings. In 47/48 patients pathological changes of the pleura were visualized by increased signal intensities on T2-weighted and contrast enhanced T1-weighted MR images. This lead to a slightly improved sensitivity compared to CT, where pathological pleura findings were confirmed in 45/48 patients. MRI was able to identify 24/28 confirmed pleural effusions, whereas CT was successful in 26/28 patients. In two cases effusions not identified on CT were visible on T2-weighted MRI. 4 pleural effusions were missed with MRI.. On CT images differentiation of pleural changes vs effusions or adjacent lesions of lung parenchyma was successful in 20/28 and in 17/23 cases, respectively. Contrast enhanced T1-weighted images achieved the highest diagnostic accuracy with 22/28 and 20/23 cases, respectively. Signal intensities on MRI were unsuitable as sole criterion for the differentiation of benign and malignant diseases of the pleura. Contour and pattern of spreading of pleural changes were helpful in differential diagnosis. Nodular changes, thickening of more than 10 mm and mediastinal, circumferential and entire hemithoracic affection of the pleura were suggestive for malignant pleural disease. Infiltration of the diaphragm and the chest wall were most indicative for malignancy; here MRI (2/2 resp. 18/19 cases) was superior to CT (0/2 resp. 14/19 cases). CT was superior in the detection of pleural calcifications and osseous destruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Magnetic resonance imaging (MRI) shows improved sensitivity for detecting pleural diseases compared to computed tomography (CT). While MRI signal intensity is insufficient alone, contour and spread patterns aid in differentiating benign from malignant pleural conditions.
Area of Science:
- Radiology
- Medical Imaging
- Thoracic Imaging
Background:
- Pleural diseases encompass a range of benign and malignant conditions.
- Accurate diagnosis of pleural abnormalities is crucial for patient management.
- Both CT and MRI are utilized for evaluating pleural pathology.
Purpose of the Study:
- To compare the diagnostic accuracy of MRI and CT in evaluating pleural diseases.
- To assess the effectiveness of different MRI sequences in detecting and characterizing pleural abnormalities.
- To determine imaging features suggestive of malignancy in pleural disease.
Main Methods:
- Retrospective analysis of MR images from 48 patients with histologically confirmed pleural diseases.
- Comparison of MRI findings with CT scans and biopsy/surgical results.
- Evaluation of T2-weighted and contrast-enhanced T1-weighted MRI sequences.
Main Results:
- MRI visualized pathological pleural changes in 47/48 patients, showing slightly improved sensitivity over CT (45/48).
- MRI identified 24/28 pleural effusions; CT identified 26/28, though MRI detected two effusions missed by CT.
- Contrast-enhanced T1-weighted MRI demonstrated higher accuracy in differentiating pleural changes from adjacent lesions.
Conclusions:
- MRI, particularly contrast-enhanced T1-weighted imaging, is highly sensitive for detecting pleural abnormalities.
- While signal intensity alone is insufficient, MRI's ability to assess contour and spread patterns aids in differentiating benign from malignant pleural disease.
- MRI showed superiority over CT in detecting infiltration of the diaphragm and chest wall, indicative of malignancy.