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Clinical Investigations: TECHNIQUES |

MRI and CT in the Differential Diagnosis of Pleural Disease*

Johannes Hierholzer, MD; Liangping Luo, MD; Roland C. Bittner, MD; Christian Stroszczynski, MD; Ralf-Jürgen Schröder, MD; Nicolas Schoenfeld, MD; Peter Dorow, MD; Robert Loddenkemper, MD, FCCP; Anne Grassot, MD
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*From the Klinik und Poliklinik für Strahlenheilkunde (Drs. Hierholzer, Bittner, Stroszczynski, and Schröder), Charité Virchow-Klinikum, Humboldt Universitẗ zu Berlin, Germany; the Medical Imaging Center (Dr. Luo), The First Affiliated Hospital, Jinan University Medical College, Guangzhou, People’s Republic of China; Lungenklinik Heckeshorn (Drs. Schoenfeld, Loddenkemper, and Grassot), Berlin, Germany; and DRK-Krankenhaus (Dr. Dorow), Drontheimer Strasse, Berlin, Germany.

Correspondence to: Johannes Hierholzer, MD, Radiologische Klinik, Klinikum Ernst-von-Bergmann, Charlottenstrasse 72, 14467 Potsdam, Germany



Chest. 2000;118(3):604-609. doi:10.1378/chest.118.3.604
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Study objective: To explore the role of MRI in the differential diagnosis of pleural disease.

Patients: Forty-two patients with pleural disease were included.

Method: Retrospective study. All patients were examined with both CT and MRI. The morphologic features of pleural lesions and magnetic resonance signal intensity on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted images were evaluated.

Results: Mediastinal pleural involvement, circumferential pleural thickening, nodularity, irregularity of pleural contour, and infiltration of the chest wall and/or diaphragm were most suggestive of a malignant cause both on CT and MRI. Pleural calcification on CT was suggestive of a benign cause. Contrary to what has been previously reported in the literature, neither on CT nor on MRI, pleural thickness> 1 cm revealed significant difference between malignant and benign pleural disease (p > 0.05, χ2 test). High signal intensity in relation to intercostal muscles on T2-weighted and/or contrast-enhanced T1-weighted images was significantly suggestive for a malignant disease. Using morphologic features in combination with the signal intensity features, MRI had a sensitivity of 100% and a specificity of 93% in the detection of pleural malignancy.

Conclusion: When signal intensity and morphologic features are assessed, MRI is more useful and therefore superior to CT in differentiation of malignant from benign pleural disease.

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