Mesothelioma Radiology

How Is Radiology Used to Diagnose Mesothelioma?

Radiology plays a critical role in detecting and diagnosing mesothelioma through imaging tests that show tumors, fluid buildup and cancer spread. Doctors typically start with a chest X-ray to identify abnormalities like fluid around the lungs or unusual shadows. X-rays provide a basic 2D image that helps determine whether additional testing is necessary.

Key Facts About Mesothelioma Radiology

1. X-rays provide a 2D image that can show tumors, fluid buildup and other signs of disease.
2. CT scans use a machine that takes many X-rays to produce 3D images of cross-sections of the body.
3. PET/CT uses a CT scan taken after injecting a radioactive dye into the bloodstream to find cancer cells in the body.
4. MRI (less common for mesothelioma patients) uses a strong magnetic field to produce a 3D image of soft tissues in the body.

CT and PET scans are mainstays for staging mesothelioma. CT scans create detailed 3D images showing tumor location, size and whether mesothelioma has spread to lymph nodes or other organs. PET scans combine CT imaging with a small amount of radioactive tracer to highlight active cancer cells throughout the body, helping doctors stage mesothelioma and track how well treatment is working. Doctors may also order a chest MRI, which uses strong magnets to create high-resolution images of soft tissues, as an extra test to help assess diaphragm involvement for staging purposes, though this is less common.

Imaging also guides biopsies, which remain essential for diagnosis. While radiology can identify suspicious areas and provide crucial staging information, only a biopsy can definitively confirm a diagnosis of mesothelioma. These imaging approaches work together to create a complete picture that guides diagnosis and treatment planning.

Experience From a Mesothelioma Survivor

“I believe we all have scanxiety in the beginning. One thing I came to realize was that it was to be expected. We had never been in that type of situation before and we didn’t know what to think.”

Tamron Little, peritoneal mesothelioma survivor

Can Radiology Detect All Types of Mesothelioma?

Imaging scans can identify all 4 types of mesothelioma: Pleural, peritoneal, pericardial and testicular. However, some types of imaging scans are better suited than others for visualizing mesothelioma in different locations in the body.

Imaging for Different Types of Mesothelioma

• Peritoneal and testicular mesothelioma: Chest X-rays can detect tumors and fluid buildup around the lungs and heart. CT scans provide more detailed cross-sectional images for staging.
• Pleural and pericardial mesothelioma: X-rays are less effective for soft tissue areas. CT scans are the primary tool for detecting abdominal tumors, while ultrasound is commonly used to examine the testicles.

CT scans remain the primary imaging tool across all mesothelioma types because they provide detailed views of tumor location and spread. These scans can show abnormalities throughout the body, from the chest to the abdomen, making them essential for both initial detection and ongoing monitoring.

The most versatile imaging technique for mesothelioma diagnosis is PET/CT imaging. It can detect very small tumors anywhere in the body and can be used to help diagnose every type of mesothelioma. However, PET scans are very expensive and aren’t available everywhere.

What Does Mesothelioma Look Like on an X-Ray?

On a chest X-ray, pleural or pericardial mesothelioma tumors appear as wispy white areas around the lungs, while calcified tumors appear bright white. Bones appear white and healthy lungs are dark. Most abnormalities appear as lighter areas that are hazy or solid. 

Large fluid buildup called pleural effusions, a common mesothelioma symptom, can make an entire lung field look “cloudy” or even completely white on an X-ray. Tumors and scarring may distort chest anatomy. Compressed lungs or a raised diaphragm can be visible on an X-ray.

X-rays are 2D, making it hard to determine if a tumor is in the lung, pleura or the mediastinum around the heart. Additionally, X-rays don’t clearly show peritoneal or testicular mesothelioma. CT, MRI and PET/CT scans offer more detailed images for all mesothelioma types.

Radiology-Guided Procedures for Mesothelioma

Radiologists use imaging to guide procedures that diagnose and treat mesothelioma. With real-time ultrasound or CT, doctors can direct needles and instruments to tumors deep in the body without open surgery.

These image-guided procedures require smaller incisions and often lead to faster recovery with fewer complications. This matters especially for patients who are older or not strong enough for major surgery.

Radiology-Guided Procedures for Mesothelioma

• Ablation: Using CT or ultrasound, a needle-like probe is precisely placed into tumors. Small tumors can be destroyed with heat, cold, lasers, microwaves or radio waves.
• Biopsy: Fine-needle biopsies collect tissue samples from tumors. Doctors use ultrasound or CT to precisely place a needle into a tumor to collect a tissue sample.
• Catheter placement: CT scanning can guide the placement of a catheter or port for drug infusions or chemotherapy injected directly into the blood vessels feeding a tumor (transarterial chemoperfusion).
• Drainage: Fluid around the heart or other hard-to-reach areas can be drained using a precisely placed needle. CT or ultrasound is necessary to guide the needle when tumors and scarring distort the normal anatomy.

These procedures carry lower risks than open surgery, with faster recovery times and the option to repeat them if symptoms return. While there are some risks like bleeding or infection, they remain much safer than invasive surgery. This makes them especially valuable for patients who can’t undergo major operations. Some tumors may still require chemo, immunotherapy or surgery if they’re too large or difficult to reach.

One of the most exciting advances in interventional radiology treatments for mesothelioma is transarterial chemoperfusion. This procedure uses CT-guided placement of needles to deliver chemotherapy drugs directly into the arteries that are providing blood to a tumor. This allows the chemotherapy drugs to attack the cancer while minimizing unwanted side effects.

Insight From a Mesothelioma Specialist

“We were pleasantly surprised to find that [transarterial chemoperfusion] doesn’t come with the same side effects of traditional intravenous chemotherapy. To see these promising results with so few side effects means we are able to make a positive impact on quality of life for these patients.”

Dr. Bela Kis, interventional radiologist at Moffitt Cancer Center

How Interventional Radiology Treats Mesothelioma

Interventional radiologists insert thin needles, catheters or probes through small incisions while watching their placement on a screen in real time. They use imaging like ultrasound and CT scans to guide these tools inside your body.

For tumor ablation, for example, they guide a probe directly into the tumor and apply heat to destroy cancer cells. The precise, image-guided approach of interventional radiology works well for small or deep tumors, including those near vital organs. Traditional surgery can be too risky in these locations, making interventional radiology a valuable alternative for many patients.

While interventional radiology differs from radiation therapy, which uses high-energy beams to kill cancer cells, it can also be used to deliver targeted radiation. Interventional radiologists place radioactive markers for external beam therapy, using image guidance to direct radiation to tumors with precision. This often allows higher doses to reach the tumor with fewer side effects to surrounding tissue.

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