The role of imaging in the management of primary pleural malignancies

Malignant pleural mesothelioma is a rare tumour, but its incidence is increasing. Imaging is invariably involved in its diagnosis, staging, and follow-up. Although there are some characteristic radiological signs, none are pathognomonic. Computed tomography (CT) and magnetic resonance (MR) have similar local staging accuracies, but have distinct limitations; MR has marginal superiority in specific areas and should probably be offered to surgical candidates. The capabilities of multidector CT await evaluation. The role of positron emission tomography (PET), and PET–CT is undefined, but will likely have a major contribution. The challenges in imaging are matched by controversies in staging and treatment, which require future close multidisciplinary and multicentre collaboration.