How Can Imaging Scans Help Diagnose Mesothelioma?

Imaging scans help diagnose mesothelioma by identifying fluid accumulation, invasion of cancer cells into tissue, the size and location of tumors and other abnormalities. These noninvasive imaging techniques include X-rays, computed tomography scans, magnetic resonance imaging and positron emission tomography.

Types of Mesothelioma Imaging Scans
  • X-rays: Typically, the first imaging test used when mesothelioma is suspected. They can identify abnormalities in the chest or abdomen, including tumors or fluid buildup (pleural effusion), which are common indicators of mesothelioma. However, X-rays only provide a two-dimensional view of parts of the body.
  • CT scans: Combine X-rays with computer technology to produce high-resolution images that show cross-sections of the entire body or specific parts of the body. These scans provide detailed views of the chest and abdomen, making it easier to spot small tumors and other abnormalities.
  • MRI scans: Similar to CT scans, but they use a strong magnetic field and radio waves instead of X-rays to create detailed images of the body’s soft tissues. MRI scans are better than CT scans for imaging soft tissue in the body but can take 30-90 minutes to complete.
  • PET scans: Use an injected radioactive tracer to find cancer cells throughout the body. PET scans are often combined with CT scans for a comprehensive diagnostic tool known as PET/CT scans but take 30-90 minutes.

Mesothelioma shares many signs and symptoms with other diseases, making it difficult to diagnose. While imaging scans are essential tools in this process, they cannot confirm a diagnosis on their own. A biopsy is required to definitely identify mesothelioma. 

X-rays and other types of mesothelioma imaging scans offer unique benefits and insights into the disease, helping doctors accurately detect, stage and plan treatment.

X-Rays and Mesothelioma

A mesothelioma X-ray can show pleural effusions and tumors in the chest caused by mesothelioma. X-ray scans use a small amount of radiation to produce a two-dimensional image that shows the inside of the body. A chest X-ray is the first imaging test your doctor will order if you have lung symptoms, such as shortness of breath, difficulty breathing or a chronic cough. This is done to look for signs of lung diseases, including mesothelioma, lung cancer and various others.

X-Ray scan of someone's chest.
X-ray scans can show abnormalities in the body such as tumors.

X-rays have limited usefulness in diagnosing mesothelioma. However, they can identify abnormalities that may suggest mesothelioma and point doctors toward a diagnosis. In an X-ray, pleural mesothelioma tumors can appear as wispy white areas. Tumors can also distort the normal shape of the lungs and, in some cases, elevate the diaphragm. These changes are easily visible in an X-ray.

The use of X-rays is safe. They expose you to the same level of radiation that you are naturally exposed to over a period of 10 days. The safety and wide availability of chest X-rays make them a useful tool for diagnosing lung diseases. They are an important first step in mesothelioma diagnosis.

Dr. Jacques Fontaine and Dr. Andrea Wolf
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CT Scans for Mesothelioma

CT scans help diagnose mesothelioma by providing detailed cross-sectional images that allow doctors to visualize abnormalities such as tumors, pleural thickening and fluid accumulation. Mesothelioma CT scans provide much more detail than a standard X-ray, allowing doctors to see small tumors throughout the body. CT scans for mesothelioma can be limited to the chest or abdomen but can also scan the entire body.

Image of someone using a CT scan machine.
CT scans can give doctors a more detailed look at tumors.

Images from a CT scan will look different depending on the type of mesothelioma you have. For instance, if you have pleural mesothelioma, a CT scan may show pleural thickening, where the pleura appears abnormally thickened. It may also show pleural effusion, which is fluid accumulation between the layers of the pleura. If you have peritoneal mesothelioma, the scan may show tumors on the peritoneal surfaces. This is frequently associated with ascites, the accumulation of fluid in the abdominal cavity.

CT scans are perhaps the most important scan used to detect mesothelioma. A 2023 study published in the Japanese Journal of Radiology explains CT scans are “paramount for primary staging and treatment planning.” They can help with mesothelioma diagnosis and staging as well as surgical planning. Recent research has shown that CT scans may be able to identify different mesothelioma cell types, further aiding in diagnosis.

The CT scanner takes hundreds of small X-rays while rotating around your body and moving your body through the machine. This exposes you to significantly more radiation, about 70 times more, than a chest X-ray. While it is safe to have repeated chest X-rays, multiple CT scans are generally avoided because of the higher level of radiation exposure.

But even just getting the imaging, whether it be CT scan and/or PET scan, those two things are the most important things for a surgeon to assess resectability.

Doctor Jeffrey Velotta

What to Expect

When you arrive for your CT scan, the technologists will guide you through the process and answer any questions. You will need to lie flat on your back and remain still throughout the scan. If you have limited mobility or pain, inform the CT personnel, so they can ensure your comfort. You will also need to wear a hospital gown to prevent clothing from interfering with the scan.

CT Scan Process
  1. You may be given a contrast dye orally or intravenously to enhance image visibility.
  2. You will lie flat on your back on a platform that moves into the CT scanner.
  3. The CT tech will communicate with you through a speaker, instructing you to hold your breath briefly if needed.
  4. Staying as motionless as possible is crucial for clear imaging.
  5. The scan typically takes 10 minutes but can be longer depending on the area being scanned.

After the scan, a computer processes the images to create a 3D model of your body, allowing doctors to identify small tumors and other abnormalities. Results are usually available within a day or two, as a radiologist needs to review the scans and write a report. Your health care provider will then discuss the findings with you to help diagnose your condition.

Survivor Story
Survivor Story
Karen R. Pleural Mesothelioma

Mesothelioma Survivor First Diagnosed Thanks to Optional Scan

Karen R. was diagnosed with pleural mesothelioma after deciding to receive an optional scan that wasn’t covered by her insurance during an annual check-up. “The doctors detected fluid around my lungs during this scan. If I had not chosen to get this optional scan the cancer would have gone undetected for much longer,” Karen said.

Read Karen’s Story

MRI Scans for Mesothelioma

MRI scans help diagnose mesothelioma by providing detailed images of soft tissues, which are crucial for detecting this type of cancer. Unlike X-rays and CT scans, MRIs use powerful magnetic fields and radio waves to create detailed images of the body without using radiation. This makes MRIs a safer option for repeated imaging, especially for patients requiring long-term monitoring.

MRI Scan Graphic
MRI scans can help locate tumors earlier than X-ray or CT scans.

MRI is good at identifying changes in soft tissue that can’t be seen clearly using X-rays or CT, meaning MRI can potentially detect mesothelioma earlier than other scans. For instance, MRIs can show the extent of tumor invasion into nearby structures such as the chest wall, diaphragm or other organs, which is critical for staging the disease and planning treatment​.

Newer MRI techniques have enhanced the ability to detect mesothelioma by highlighting small changes at the atomic level caused by the magnetic field. These advanced imaging techniques provide additional detail that can reveal tumor spread and tissue changes not visible with other imaging methods. This makes MRIs invaluable for a comprehensive assessment of mesothelioma​.

Before undergoing an MRI, be sure to inform your doctor and MRI technicians if you have any metal in your body before your scan. This includes surgical implants and prosthetics as well as shrapnel or other metal embedded in the body.

What to Expect

An MRI scan is similar to a CT scan but has some key differences. Unlike a CT scanner, an MRI is loud. The scanner makes banging noises that are completely normal throughout the scan. The MRI scanner is also more enclosed, which can cause anxiety. You can communicate with the staff if you develop anxiety. As with other imaging scans, you will need to wear a hospital gown and remove all jewelry and piercings.

MRI Scan Process
  1. Contrast Dye: You may receive a contrast dye orally or intravenously to enhance image clarity.
  2. Positioning: You will lie flat on a platform that slides into the MRI scanner.
  3. Noise Protection: You will wear a headset for hearing protection and communication with the MRI tech.
  4. Distress Button: You will have a button to press if you need to stop the scan.
  5. Remain Still: It’s essential to stay as motionless as possible.
  6. Duration: The scan can take 30 to 90 minutes.

During the scan, you might experience temporary dizziness, nausea, a metallic taste, or brief flashes of light from the magnetic field. After the scan, a computer will process the results and a radiologist will read them and produce a report within several days. This report will help your doctor diagnose and stage mesothelioma.

PET Scans for Mesothelioma

PET scans help diagnose mesothelioma by detecting cancerous cells based on their metabolic activity. These scans use radioactive isotopes combined with glucose (sugar) to identify cells using the most glucose, including cancer cells, which are highly metabolically active.

PET Scan Graphic
PET scans are widely used since they can find even the smallest of tumors.

This makes PET scans particularly useful for early detection and accurate staging of mesothelioma, as they can identify small tumors and metastases throughout the body.​ Additionally, PET scans can reveal other areas cancer has affected, providing a comprehensive view of disease spread​.

PET scans are often combined with CT scans to form PET/CT scans. The combination of scans provide a comprehensive view that pairs the metabolic detection capabilities of PET with the detailed anatomical imaging of CT. This integrated approach helps locate tumors precisely and assess their size and location, offering critical information for treatment planning.

Research suggests that PET/CT scans can be superior to both CT and MRI for staging mesothelioma, providing valuable insights into the disease’s progression and prognosis.

Additionally, PET scans are instrumental in monitoring the response to treatment. By comparing PET scan results over time, doctors can determine whether the cancer is responding to therapy, remaining stable or progressing, which is crucial for adjusting treatment strategies. Despite their high cost and limited availability, PET scans remain a vital tool in managing mesothelioma from initial diagnosis to ongoing treatment assessment​.

The PET Scan Process

A PET scan is similar to a CT scan. You will need to put on a hospital gown for the scan and receive an IV infusion of the radioactive tracer. You will have to wait about an hour to allow time for tumor cells to absorb the tracer.

PET Scan Process
  1. You will have an IV infusion of the radioactive tracer an hour before your scan.
  2. You will lie flat on your back on a platform that slides your body into the PET scanner.
  3. The PET tech will communicate instructions, such as when to briefly hold your breath while your chest is being imaged, to you through a speaker.
  4. You will need to remain as motionless as possible during the scan.
  5. The scan will take 30 to 90 minutes.

After your scan, the data collected is processed by a computer. Like other scans, it can take several days for a radiologist to carefully analyze the results. PET scans may be read in as little as 24 hours, but it may take several days to get the results. Your doctor can then use the information to help diagnose and stage mesothelioma.

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Managing Anxiety About Scans

Many people have anxiety about CT scans, MRIs and PET scans. It is understandable and completely normal. Whether you are concerned about the results of a scan or the process itself, it is completely natural to fear the worst. Some people are also claustrophobic or simply do not like being in small, confined spaces like an MRI scanner.

Understanding what to expect during a scan can help ease anxiety. Ask questions when you see your doctor and when you arrive for your scan. The process may be new to you, but doctors and radiology technicians have a great deal of experience performing scans and helping patients like you feel as safe and comfortable as possible during your scan. If you might have difficulty during a scan, talk to your doctor about prescribing a sedative to keep you calm during the procedure.

Tips to Reduce Anxiety
  • Relax. Practice breathing exercises or mindfulness exercises to calm your mind and body.
  • Stay positive. Don’t focus on the negative aspects of having a scan or the possible results.
  • Talk about your anxiety. If you are nervous, let those around you know what you are going through.
  • Don’t be afraid to ask for help. Your friends, family and doctors can help you find ways to handle your anxiety.

Mesothelioma and other complicated diseases can require multiple imaging scans over the course of weeks to years. Mesothelioma diagnosis, staging and treatment is a long process that can be physically and emotionally exhausting. Maintaining a positive outlook can be difficult, but it can help you deal with stress and anxiety.

Role of Imaging Scans in Consults and Second Opinions

Imaging scans play a crucial role during initial mesothelioma consultations and when receiving second opinions. It takes experience to identify mesothelioma and not confuse it with another disease such as lung cancer. Because few doctors have extensive experience diagnosing and treating mesothelioma, getting a second opinion is important if you have been diagnosed with mesothelioma or think you may have mesothelioma. 

Mesothelioma is rare, so doctors do not routinely see the disease, except at mesothelioma treatment centers. It is important to have a doctor with mesothelioma experience look at all of your previous diagnostic tests.

Thoracic surgeon Dr. Jeffrey Velotta at Kaiser Permanente Oakland Medical Center empasizes the importance of imaging scans for mesothelioma: “For consultations or second opinions, really it’s about the imaging.”

Doctors need all available information to inform their decisions about diagnosis and treatment, especially when it comes to surgery and radiation treatment for mesothelioma. 

“What patients want to know when they get a second opinion is, ‘Can you do something about it?’ They want to know whether or not as a surgeon if you feel you can operate on them,” Velotta told The Mesothelioma Center. “What we really need to see first is the CT and PET scans.”

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