Bildgebende Diagnostik bei Pleuraerkrankungen

R. C. Bittner

doi:10.1055/s-2004-818351

Pneumologie, Inhaltsverzeichnis

Pneumologie 2004; 58(4): 238-254
DOI: 10.1055/s-2004-818351

Pleuraerkrankungen (1)

Bildgebende Diagnostik bei Pleuraerkrankungen

Diagnostic Imaging in Pleural DiseasesR. C. Bittner¹

¹Klinik für Strahlenheilkunde (Direktor: Prof. Dr. med. Dr. h.c. R. Felix), Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Medizinische Fakultät der Humboldt-Universität Berlin

Abstract

Zusammenfassung

Bildgebende Verfahren spielen eine wesentliche Rolle in der Diagnostik und der Therapie pleuraler Erkrankungen. In der Regel ist die Thoraxröntgenaufnahme, heute meist digital angefertigt, unverändert die erste bildgebende Untersuchung. Abhängig von diesem ersten Bildbefund und dem klinischen Aspekt sind weiterführende Untersuchungen die Sonographie, computertomographische Verfahren sowie die Magnetresonanztomographie. Nuklearmedizinische Verfahren spielten praktisch keine Rolle in der Pleuradiagnostik, bis die Positronenemissionstomographie (PET) in die klinische Routine Eingang gefunden hat. Deren Stellenwert in der Diagnostik von Pleuraerkrankungen ist jedoch derzeit noch weitgehend Gegenstand der Forschung.

Abstract

Imaging plays a major role in the diagnosis and management of pleural diseases. Generally chest radiography remains the initial examination, however, today with digital technique. Depending on first imaging findings and the clinical aspect the diagnostic course may be followed by ultrasound, computed tomography examinations, or magnetic resonance imaging. Radionuclide imaging has not been played a significant role up to now, until positron emission tomography (PET) has gained clinical relevance. However, the role of PET in pleural diseases is not yet defined and scientific works are still in progress.

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Referenzen

Literatur

1 Henschke C I, Davis S D, Romano R M. et al . Pleural effusions: pathogenesis, radiologic evaluation, and therapy. J Thorac Imaging. 1989; 4 49
2 Collins J D, Burwell D, Furmanski S. et al . Minimal detectable pleural effusions. Radiology. 1972; 105 51
3 Kocijancic I, Tercelj M, Vidmar K. et al . The value of inspiratory-expiratory lateral decubitus views in the diagnosis of small pleural effusions. Clin Radiol. 1999; 54 595
4 Ruskin J A, Gurney J W, Thorsen M K. et al . Detection of pleural effusions on supine chest radiographs. Am J Roentgenol. 1987; 148 681
5 Gehmacher O, Kopf A, Scheier M. et al . Can pleurisy be detected with ultrasound?. Ultraschall Med. 1997; 18 214
6 O'Moore P V, Mueller P R, Simeone J F. et al . Sonographic guidance in diagnostic and therapeutic interventions in the pleural space. Am J Roentgenol. 1987; 149 1
7 Mathis G. Thoraxsonography - Part I: chest wall and pleura. Ultrasound Med Biol. 1997; 23 1131
8 Eibenberger K L, Dock W I, Amman M E. et al . Quantification of pleural effusion: Sonography versus Radiography. Radiology. 1994; 191 681
9 Gorg C, Restrepo I, Schwerk W B. Sonography of malignant pleural effusion. Eur Radiol. 1997; 7 1195
10 Herth F J, Becker H D. Transthoracic ultrasound. Respiration. 2003; 70 87-94
11 Civardi G, Fornari F, Cavanna L. et al . Vascular signals from pleura-based lung lesions studied with pulsed Doppler ultrasonography. J Clin Ultrasound. 1993; 21 617
12 Wolek R, Mason B J, Reeser P. et al . Pleural fluid: accuracy of computed tomography in differentiating exsudates from transsudates. Conn Med. 1998; 62 259
13 Aquino S L, Webb W R, Gushiken B J. Pleural exsudates and transsudates: diagnosis with contrast-enhanced CT. Radiology. 1994; 192 803
14 Kuhlman J E, Singha N K. Complex disease of the pleural space: radiographic and CT evaluation. RadioGraphics. 1997; 17 63
15 Müller N L. Imaging of the pleura. Radiology. 1993; 186 297
16 Naidich D P, Megibow A J, Hilton S. et al . Computed tomography of the diaphragm: peridiaphragmatic fluid localization. J Comput Assist Tomogr. 1983; 7 641
17 Halvorsen R A, Fredyshin P J, Korobkin M. et al . Ascites or pleural effusion?. RadioGraphics. 1986; 6 135
18 Silverman P M, Baker M E, Mahoney B S. Atelectasis and subpulmonic fluid: a CT pitfall in distinguishing pleural from peritoneal fluid. J Comput Assist Tomogr. 1985; 5 763
19 Lawton F, Blackledge G, Johnson R. Coexistent chylous and serous pleural effusions associated with ovarian cancer: a case report of Contarini’s syndrome. Eur J Surg Oncol. 1985; 11 177
20 O'Donovan P B, Eng P. Pleural changes in malignant pleural effusions: appearance on computed tomography. Cleve Clin J Med. 1994; 61 127
21 Hierholzer J, Luo L, Bittner R C. et al .MRI and CT in the differential diagnosis of pleural disease. Chest 2000
22 Frola C, Cantoni S, Turtulici I. et al . Transsudative vs exsudative pleural effusions: differentiation using Gd-DTPA-enhanced MRI. Eur Radiol. 1997; 7 860
23 Schmutz G R, Fisch-Ponsot C, Regent D. et al . Computed tomography (CT) and magnetic resonance imaging (MRI) of pleural masses. Crit Rev Diagn Imaging. 1993; 34 309
24 Bittner R C, Schnoy N, Schoenfeld N. et al . High-resolution magnetic resonance imaging (HR-MRI) of the pleura and chest wall: normal findings and pathologic changes. Fortschr Roentgenstr. 1995; 162 296
25 Alavi A, Gupta N C, Alberini J L. et al . Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med. 2002; 32 293-321
26 Gupta N C, Rogers J S, Graeber G M. et al . Clinical role of F-18 fluorodeoxyglucose positron emission tomography imaging in patients with lung cancer and suspected malignant pleural effusion. Chest. 2002; 122 1918-1924
27 Seow A, Kazerooni E A, Cascade P N. et al . Comparison of upright inspiratory and expiratory chest radiographs for detecting pneumothoraces. Am J Roentgenol. 1996; 166 313
28 Goodman T R, Traill Z C, Phillips A J. et al . Ultrasound detection of pneumothorax. Clin Radiol. 1999; 54 736
29 Hanna J W, Reed J C, Choplin R H. Pleural infections: a clinical-radiologic review. J Thorac Imaging. 1991; 6 68
30 Levin D L, Klein J S. Imaging techniques for pleural space infections. Semin Respir Infect. 1999; 14 31
31 Spies V, Butz B, Altjohann C. et al . Guidance of percutaneous biopsies, drainages, and gastrostomies with CT-fluoroscopy: comparison of puncture with conventional CT guidance and CT-fluoroscopy. Fortschr Roentgenstr. 2000; 172 374
32 Sonnenberg E van, Nakamoto S K, Mueller P R. et al . CT- and ultrasound-guided catheter drainage of empyemas after chest-tube failure. Radiology. 1984; 151 349
33 Neff C C, Sonnenberg E van, Lawson D W. et al . CT follow-up of empyemas: pleural peels resolve after percutaneous catheter drainage. Radiology. 1990; 176 195
34 Bressler E L, Francis I R, Glazer G M. et al . Bolus contrast medium enhancement for distinguishing pleural from parenchymal lung disease: CT features. J Comput Assist Tomogr. 1987; 11 436
35 Aberle D R, Gamsu G, Ray C S. High-resolution computed tomography of asbestos-related diseases. Semin Roentgenol. 1991; 26 118
36 Al Jarad N, Poulakis N, Pearson M C. et al . Assessment of asbestos-induced pleural disease by computed tomography - correlation with chest radiograph and lung function. Respir Med. 1991; 85 203
37 Ikezoe J, Takeuchi N, Kido S. et al . Dynamic range control processing of digital chest images. A clinical evaluation. Acta Radiol. 1996; 37 107
38 Staples C A. Computed tomography in the evaluation of benign asbestos-related disorders. Radiol Clin North Am. 1992; 30 1191
39 Topcu F, Bayram H, Simsek M. et al . High-resolution computed tomography in cases with environmental exposure to asbestos in turkey. Respiration. 2000; 67 139
40 Genevois P A, Vuyst P De, Dedeire S. et al . Conventional and high-resolution CT in asymptomatic asbestos-exposed workers. Acta Radiol. 1994; 35 226
41 Im J G, Webb W R, Rosen A. et al . Costal pleura: appearance at high-resolution CT. Radiology. 1989; 171 125
42 Boraschi P, Neri S, Braccini G. et al . Magnetic resonance appearance of asbestos-related benign and malignant pleural diseases. Scand J Work Environ Health. 1999; 25 18
43 Lonneux M, Jamar F, Leners N. et al . Uptake of In-111 pentetreotide by pleural plaques. Clin Nucl Med. 1998; 23 298
44 Gevenois P A, Maertelaer V de, Madani A. et al . Asbestosis, pleural plaques, and diffuse pleural thickening: three distinct benign responses to asbestos exposure. Eur Respir J. 1998; 11 1021
45 Batra P, Brown K, Hayashi K. et al . Rounded atelectasis. J Thorac Imaging. 1996; 11 187
46 Marchbank N D, Wilson A G, Joseph A E. Ultrasound features of folded lung. Clin Radiol. 1996; 51 433
47 Yamaguchi T, Hayashi K, Ashizawa K. et al . Magnetic resonance imaging of rounded atelectasis. J Thorac Imaging. 1997; 12 188
48 Kiryu T, Ohashi N, Matsui E. et al . Rounded atelectasis: delineation of enfolded visceral pleura by MRI. J Comput Assist Tomogr. 2002; 26 37-8
49 England D M, Hochholzer L, McCarthy M J. Localized benign and malignant fibrous tumors of the pleura: a clinicopathologic review of 223 cases. Am J Surg Pathol. 1989; 13 640
50 Yang P C. Ultrasound-guided transthoracic biopsy of the chest. Radiol Clin North AM. 2000; 38 323
51 Spizarny D L, Gross B H, Shepard J O. CT findings in localized fibrous mesothelioma of the pleural fissure. J Comput Assist Tomogr. 1986; 10 942
52 Dynes M C, White E M, Fry W A. et al . Imaging manifestations of pleural tumors. RadioGraphics. 1992; 12 1191
53 Kuhlman J E, Fishman E K, Berg W A. et al . Evaluation of the chest wall: problem solving with CT and MR imaging. Radiology. 1993; 189 357-189
54 Saifuddin A, Costa P Da, Chalmers A G. et al . Primary malignant localized fibrous tumors of the pleura: clinical, radiological, and pathological features. Clin Radiol. 1992; 45 13
55 Shirakawa T, Fukuda K, Miyamoto Y. et al . Parietal pleural invasion of lung masses: evaluation with CT performed during deep inspiration and expiration. Radiology. 1994; 192 809
56 Perrot M de, Fischer S, Brundler M A. et al . Solitary fibrous tumors of the pleura. Ann Thorac Surg. 2002; 74 285-293
57 Falashi F, Battolla L, Mascalchi M. et al . Usefulness of MR signal intensity in distinguishing benign from malignant pleural disease. Am J Roentgenol. 1996; 166 963
58 Carlsen S E, Bergin C J, Hoppe R T. MR imaging to detect chest wall and pleural involvement in patients with lymphoma: effect on radiation therapy planning. Am J Roentgenol. 1993; 160 1191
59 Bittner R C, Kaiser D, Loddenkemper R. et al . Wertigkeit der Magnetresonanztomographie (MR) bei Pancoast- und anderen Tumoren mit Infiltration der Thoraxwand. Pneumologie. 1990; 44 62
60 Tateishi U, Nishihara H, Morikawa T. et al . Solitary fibrous tumor of the pleura: MR appearance and enhancement pattern. J Comput Assist Tomogr. 2002; 26 174-179
61 Feretti G R, Chiles C, Choplin R H. et al . Localized benign fibrous tumors of the pleura. Am J Roentgenol. 1997; 169 683
62 Padovani B, Mouroux J, Raffaelli C. et al . Benign fibrous mesothelioma of the pleura: MR study and pathologic correlation. Eur Radiol. 1996; 6 425
63 Escott N, Masood K, Millward S. The diagnosis of a pleural lipoma by CT and fine-needle biopsy to avoid thoracotomy. J Can Assoc Radiol. 1988; 39 57
64 Epler G R, McLoud T C, Munn C S. et al . Pleural lipoma: diagnosis by computed tomography. Chest. 1986; 90 65
65 Munk P L, Müller N L. Pleural liposarcoma: CT diagnosis. J Comput Assist Tomogr. 1988; 12 709
66 Buchmann I, Guhlmann C A, Elsner K. et al . F-18-FDG-PET for primary diagnosis and differential diagnosis of pleural processes. Nuklearmedizin. 1999; 38 319
67 Lassen U, Daugaard G, Eigtved A. et al . 18F-FDG whole body positron emission tomography (PET) in patients in patients unknown primary tumours (UPT). Eur J Cancer. 1999; 37 1076
68 Facciolo F, Cardillo G, Lopergolo M. et al . Chest wall invasion in non-small cell lung carcinoma: a rationale for en bloc resection. J Thorac Cardiovasc Surg. 2001; 121 649-656
69 Scott I R, Müller N L, Miller R R. et al . Resectable stage III lung cancer: CT, surgical, and pathologic correlation. Radiology. 1988; 166 5
70 Beute G H, Lewis J W Jr, Madrazo B L. et al . Limitations of CT in evaluation of neoplasms involving the chest wall. J Comput Assist Tomogr. 1987; 11 290
71 Yokoi K, Mori K, Miyazawa N. et al . Tumor invasion of the chest wall and mediastinum in lung cancer: evaluation with pneumothorax CT. Radiology. 1991; 181 147
72 Kodalli N, Erzen C, Yuksel M. Evaluation of parietal pleural invasion of lung cancers with breathhold inspiration and expiration MRI. Clin Imaging. 1999; 23 227
73 Padovani B, Mouroux J, Seksik L. et al . Chest wall invasion by bronchogenic carcinoma: evaluation with MR imaging. Radiology. 1993; 187 33
74 Knisely B L, Broderick L S, Kuhlmann J E. MR imaging of the pleura and chest wall. Magn Reson Imaging Clin N Am. 2000; 8 125
75 Knuuttila A, Kivisaari L, Kivisaari A. et al . Evaluation of pleural disease using MR and CT. With special reference to malignant pleural mesothelioma. Acta Radiol. 2001; 42 502-507
76 North L B, Libshitz H I, Corigan J G. Thoracic lymphoma. Radiol Clin N Am. 1990; 28 754
77 Bernardeschi P, Bonechi I, Urbano U. Recurrent pleural effusion as manifesting feature of primitive chest wall Hodgkin's disease. Chest. 1988; 94 424
78 Aquino S L, Chen M Y, Kuo W T. et al . The CT appearance of pleural and extrapleural disease in lymphoma. Clin Radiol. 1999; 54 647
79 Negendank W G, Alkatib A, Karanes C. et al . Lymphomas: MR imaging contrast characteristics with clinical-pathologic correlations. Radiology. 1990; 177 209
80 Chajari M, Lacroix J, Peny A M. et al . Gallium-67 scintigraphy in lymphoma: is there a benefit of image fusion with computed tomography?. Eur J Nucl Med Mol Imaging. 2002; 29 380-387
81 Goldsmith S J, Kostakoglu L. Nuclear medicine imaging of lung cancer. Radiol Clin North Am. 2000; 38 511
82 McLoud T C, Woods B O, Carrington C B. et al . Diffuse pleural thickening in an asbestos-exposed population: prevalence and causes. Am J Roentgenol. 1985; 144 9
83 Lynch D A, Gamsu G, Aberle D R. Conventional and high-resolution computed tomography in the diagnosis of asbestos-related disease. RadioGraphics. 1989; 9 523
84 International Labour Office .Guidelines for the use of the ILO international classification of radiographs of pneumoconioses, revised edition. International Labour Office Occupational Safety and Health Series, no. 22 (revised 1980). Geneva, Switzerland: International Labour Office 1980
85 Friedman A C, Fiel S B, Radecki P D. et al . Computed tomography of benign pleural and pulmonary parenchymal abnormalities related to asbestos exposure. Semin Ultrasound CT MR. 1990; 11 393
86 Aberle D R, Gamsu G, Ray C S. et al . Asbestos-related pleural and parenchymal fibrosis: detection with high-resolution CT. Radiology. 1988; 166 729
87 Herbert A. Pathogenesis of pleurisy, pleural fibrosis, and mesothelial proliferation. Thorax. 1986; 41 176
88 McLoud T C. The use of CT in the examination of asbestos-exposed persons. Radiology. 1988; 169 862
89 Mossman B T, Gee J BL. Asbestos-related diseases. N Engl J Med. 1989; 320 1721
90 Kawashima A, Libshitz H I, Lukeman J M. Radiation-induced malignant pleural mesothelioma. Can Assoc Radiol J. 1990; 41 384-385
91 Ball N J, Green F H, Kieser T. et al . Pleural multicystic mesothelial proliferation. The so-called multicystic mesothelioma. Am J Surg Pathol. 1990; 14 375
92 Wechsler R J, Steinert R M, Conant E F. Occupationally induced neoplasms of the lung and pleura. Radiol Clin North Am. 1992; 30 1245
93 Gotfried M H, Quan S F, Sobonya R E. Diffuse epithelial pleural mesothelioma presenting as a solitary lung mass. Chest. 1983; 84 99
94 Ng C S, Munden R F, Libshitz H I. Malignant pleural mesothelioma: the spectrum of manifestations on CT in 70 cases. Clin Radiol. 1999; 54 415
95 Layer G, Schmitteckert H, Steudel A. et al . MRT, CT and sonography in the preoperative assessment of the primary tumor spread in malignant pleural mesothelioma. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr. 1999; 170 365
96 Maasilta P, Vehmas T, Kivisaari L. et al . Correlations between findings at computed tomography (CT) and at thoracoscopy/thoracotomy/autopsy in pleural mesothelioma. Eur Respir J. 1991; 4 952
97 Heelan R T, Rusch V W, Begg C B. et al . Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. Am J Roentgenol. 1999; 172 1039
98 Adams H, Butchart E G. Computed tomographic assessment of patients following radical surgery for malignant mesothelioma. Clin Radiol. 1992; 45 120
99 Lorigan J G, Lipshitz H I. MR imaging of malignant pleural mesothelioma. J Comput Assist Tomogr. 1989; 13 617
100 Bittner R C, Teichgraeber U K. Imaging techniques in the diagnosis of pleural diseases. In: Loddenkemper R, Antony VB, eds. Pleural diseases. The European Respiratory Monograph. 2002 22: 76-109
101 Gerbaudo V H, Sugarbaker D J, Britz-Cunningham S. et al . Assessment of malignant pleural mesothelioma with (18)F-FDG dual-head gamma-camera coincidence imaging: comparison with histopathology. J Nucl Med. 2002; 43 1144-1149
102 Matthay R A, Coppage L, Shaw C. et al . Malignancies metastatic to the pleura. Invest Radiol. 1990; 25 601
103 Henschke C I, Yankelevitz D F, Davis S D. Pleural disease: multimodality imaging and clinical management. Curr Probl Diagn Radiol. 1991; 20 159
104 Tateishi U, Kusumoto M, Hasegawa T. et al . Primary malignant fibrous histiocytoma of the chest wall: CT and MR appearance. J Comput Assist Tomogr. 2002; 26 558-563
105 Light R W. Diseases of the pleura, mediastinum, chest wall, and diaphragm. In: George RB, Light RW, Matthay MA, Matthey RA, eds. Chest medicine. Baltimore: Williams & Wilkins 1990: 381

Dr. med. Roland C. Bittner

Klinik für Strahlenheilkunde · Campus Virchow-Klinikum

Augustenburger Platz 1

13353 Berlin

eMail: roland.bittner@charite.de