Malignant mesothelioma is as challenging to diagnose as it is to treat. Radiologists are physicians with specialized training who are integral to a prompt and accurate diagnosis. In addition to interpreting the results of imaging studies, radiologists play a key role in the staging and monitoring of mesothelioma, and interventional radiologists are increasingly involved in treating the rare, asbestos-related disease, as the increased use of chemoperfusion requires their skill and expertise.
What is a Radiologist?
Radiologists are medical doctors who specialize in the use of medical imaging procedures to diagnose and treat injuries and diseases.[1] They have specialized training that allows them to analyze and interpret the results of scans and reports including those from the following procedures:
- Computed tomography (CT)
- Fluoroscopy
- Fusion imaging (a technique that fuses two different imaging tests)
- Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA)
- Mammography
- Nuclear medicine imaging
- Positron emission tomography (PET)
- Ultrasound
- X-rays
What is an Interventional Radiologist?
Interventional radiologists are physicians who diagnose and treat patients using imaging technologies including X-ray and Magnetic Resonance Imaging to guide them as they insert instruments into the body through tiny incisions. These minimally invasive procedures and techniques allow interventional radiologists to reach the source of the medical problem and administer targeted tests and treatments that previously required open surgery. Some of the procedures they may perform for mesothelioma patients include:[3]
- Placement of venous access devices (chest ports, tunneled and temporary central venous lines)
- Tumor embolizations (Chemoembolization, Radioembolization, Bland embolization)
- Ablation (Microwave, Radiofrequency ablation (RFA), Cryoablation, thyroid nodule RFA)
- Image-guided biopsies
- Abscess drainages
- Chest tube placements
- Thoracentesis and tunneled chest PleurX catheter placement for recurrent pleural effusions
- Paracentesis and tunneled abdominal PleurX catheter placement for recurrent ascites
How Does a Doctor Become a Radiologist/Interventional Radiologist?
All physicians begin their educational journey with a bachelor’s degree and graduation from an accredited medical school. Following graduation, candidates to become radiologists complete a four-year residency. Interventional radiologists complete a one- or two-year fellowship of specialized training. They are certified by the American Board of Radiology and are required to fulfill extensive continuing education requirements.
Radiologists and Interventional Radiologists Diagnosing Malignant Mesothelioma
When it comes to diagnosing malignant mesothelioma, radiologists most frequently read CT scans, which have become the first-line imaging technique for its diagnosis, staging, and assessment of therapy response. Chest X-rays may also be ordered and read, but their use is limited as the technology isn’t detailed enough to allow the radiologist to distinguish between benign and malignant structures. FDG positron emission tomography (PET) scans are used for staging the disease. MRI may become the solution to overcoming the limitations of all other scans, as radiologists can use its higher spatial resolution and soft tissue contrast to more accurately identify diaphragm and chest-wall invasion.[2]
Interventional radiologists use several minimally invasive procedures to diagnose and stage mesothelioma. Thoracocentesis is usually the first line investigation of malignant pleural mesothelioma, though computed tomography-guided biopsy and video-assisted thoracoscopy are also effective. For peritoneal mesothelioma, interventional radiologists are frequently asked to perform contrast-enhanced ultrasound-guided biopsies, which have proven to be a simple, safe, and accurate diagnostic method.
How Interventional Radiologists Treat Mesothelioma
One of the most exciting new malignant pleural mesothelioma treatment options being investigated is transarterial chemoperfusion, a technique in which interventional radiologists inject a relatively high concentration of chemotherapy into the internal mammary artery that supplies the pleura as well as into the descending aorta, reaching the intercostal vessels that also supply the pleura.[4] Similarly, interventional radiologists play an integral role in the complex surgical procedure in which patients diagnosed with malignant peritoneal mesothelioma undergo cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC).
Radiologists and Interventional Radiologists Are Integral to the Management of Mesothelioma
Radiologists and interventional radiologists are integral members of collaborative teams of clinical experts who care for patients with mesothelioma. The expertise is integrated with the expertise of surgical oncologists, medical oncologists, and radiation oncologists working to evaluate each case and decide the best treatment course.
