MRI and CT in the Differential Diagnosis of Pleural Disease

To explore the role of MRI in thedifferential diagnosis of pleural disease. Forty-two patients with pleural disease were included. Retrospective study. All patients were examinedwith 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. Mediastinal pleural involvement, circumferentialpleural thickening, nodularity, irregularity of pleural contour, and infiltration of the chest wall and /or diaphragm were most suggestive ofa malignant cause both on CT and MRI. Pleural calcification on CT wassuggestive of a benign cause. Contrary to what has been previouslyreported in the literature, neither on CT nor on MRI, pleural thickness>1 cm revealed significant difference between malignant and benignpleural disease (p > 0.05, χ2 test). High signalintensity in relation to intercostal muscles on T2-weighted and /orcontrast-enhanced T1-weighted images was significantly suggestive for amalignant disease. Using morphologic features in combination with thesignal intensity features, MRI had a sensitivity of 100% and aspecificity of 93% in the detection of pleural malignancy. When signal intensity and morphologic featuresare assessed, MRI is more useful and therefore superior to CT indifferentiation of malignant from benign pleuraldisease.