Computed tomography in the assessment of malignant mesothelioma of the pleura.

Computed tomography (CT) and plain radiography have been performed on 32 patients with malignant mesothelioma of the pleura, in order to assess the extent of disease and suitability for radical treatment. A comparison of the assessments by the two techniques is reported, with confirmation from either thoracotomy or post-mortem findings available in 16 cases. CT was found to be more sensitive than plain radiology in the detection of pleural effusions, although routine lateral decubitus radiographs has not been performed. The two techniques were equally effective in detecting involvement by tumour of the lateral chest wall, mediastinum and lung, with no false positive assessments by either technique, and few false negative assessments. Disease was shown to be extensive and gross at presentation in mesothelioma, so that the greater sensitivity of CT was of no advantage. Diaphragmatic involvement by tumour was accurately assessed by plain radiology but there were frequent false negative assessments by CT, possibly due to difficulty of interpretation of the curved diaphragm on the cross-sectional CT image. In this study CT offered little advantage over conventional radiology.