Author of

• 25943

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  P2.06 - Mesothelioma (Not CME Accredited Session) (ID 955)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall

  • 27026

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    P2.06-17 - Real-World Accuracy of Malignant Pleural Mesothelioma (MPM) Preoperative Magnetic Resonance Imaging (MRI) for Staging the Diaphragm. (ID 14284)

    16:45 - 18:00  |  Author(s): Stephanie Wu
    • Abstract

    Background
    

    Magnetic resonance imaging (MRI) of the chest is commonly employed for preoperative staging of patients with malignant pleural mesothelioma. Here we evaluate the accuracy of preoperative MRI for detection of diaphragmatic invasion in patients undergoing pleurectomy in a real-world setting.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    All adult patients who had a MRI of the chest performed as part of routine preoperative staging with subsequent pleurectomy for malignant pleural mesothelioma during a 20-month interval were identified. Patients without available MRI imaging reports were excluded. MRI reports for each patient were reviewed by a thoracic radiologist for evidence of diaphragmatic invasion and correlated with intraoperative findings. The MRI images for those patients with discrepant readings between MRI exam and intraoperative findings of diaphragm invasion were directly reviewed by the radiologist to assess for technical aspects that may have contributed to limitations in imaging interpretation.

    4c3880bb027f159e801041b1021e88e8 Result
    

    A total of 16 adult patients with MPM, 14 male and 2 female, had preoperative MRI examinations performed with reports that were available for review, noting that a subset of examinations were obtained at outside community imaging sites resulting in variability of the imaging techniques and scanner types. Five patients had suspected or definitive diaphragmatic invasion on MRI, all of which were confirmed at pleurectomy. However, 9 of the patients that were initially assessed by MRI as not having diaphragmatic invasion, were later found at surgery to have some degree of diaphragmatic invasion necessitating diaphragmatic repair or diaphragmatic graft placement. When MRI exams were analyzed from patients that had missed diaphragmatic invasion on MRI interpretation, technical parameters such as differences in study image acquisition and technical artifacts due to cardiac, aortic pulsation and respiration motion may have contributed to the lack of identification of diaphragmatic invasion.

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    MRI for preoperative planning in patients with MPM may miss diaphragmatic invasion. Further study is needed to determine if technical factors may contribute to limitations in detection of diaphragmatic invasion in MPM with a goal to optimize and harmonize MRI imaging protocols for preoperative staging.

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