Diseases of the Pleura and the Chest Wall

Key Points

Primary tumours of the chest wall and pleura are rare in comparison to tumours of the lung such as bronchial carcinomas. Chest wall tumours are a heterogeneous group that pose an interesting diagnostic challenge for radiologists. They make up less than 5% of thoracic malignancies and vary widely in pathology as they arise from all anatomic structures of the chest wall. Since chemotherapy is rarely effective and local control is the most important prognostic factor, wide local excision might be the solely curative treatment. Therefore, the margins need to be identified by imaging prior to surgery and adjuvant radiation, which might be applied in cases with positive margins. Malignant pleural mesothelioma is an aggressively growing tumour and a rising incidence is expected in the next decades. CT is still the general diagnostic tool for staging and therapy planning of malignant pleural mesothelioma. However, within the last years novel MRI techniques have been developed and introduced into clinical routine to improve tumour delineation and characterization in order to optimize individual therapy planning. Typical findings of those tumours using modern MRI techniques are discussed. Techniques are compared with CT and modern PET techniques, especially concerning characterization, precision of tumour delineation, therapy planning, and monitoring.