Advanced imaging techniques and artificial intelligence in pleural diseases: a narrative review

• Published in: European respiratory review Vol. 34; no. 176; p. 240263
• Main Authors: Marchi, Guido, Mercier, Mattia, Cefalo, Jacopo, Salerni, Carmine, Ferioli, Martina, Candoli, Piero, Gori, Leonardo, Cucchiara, Federico, Cenerini, Giovanni, Guglielmi, Giacomo, Mondoni, Michele
• Format: Journal Article
• Language: English
• Published: England European Respiratory Society 01.04.2025
• Subjects: Artificial Intelligence; Humans; Image Interpretation, Computer-Assisted; Pleural Diseases - diagnostic imaging; Pleural Diseases - therapy; Predictive Value of Tests; Prognosis; Reproducibility of Results; Reviews
• ISSN: 0905-9180; 1600-0617; 1600-0617
• DOI: 10.1183/16000617.0263-2024

Pleural diseases represent a significant healthcare burden, affecting over 350 000 patients annually in the US alone and requiring accurate diagnostic approaches for optimal management. Traditional imaging techniques have limitations in differentiating various pleural disorders and invasive procedures are usually required for definitive diagnosis. We conducted a nonsystematic, narrative literature review aimed at describing the latest advances in imaging techniques and artificial intelligence (AI) applications in pleural diseases. Novel ultrasound-based techniques, such as elastography and contrast-enhanced ultrasound, are described for their promising diagnostic accuracy in differentiating malignant from benign pleural lesions. Quantitative imaging techniques utilising pixel-density measurements to noninvasively distinguish exudative from transudative effusions are highlighted. AI algorithms, which have shown remarkable performance in pleural abnormality detection, malignant effusion characterisation and automated pleural fluid volume quantification, are also described. Finally, the role of deep-learning models in early complication detection and automated analysis of follow-up imaging studies is examined. Advanced imaging techniques and AI applications show promise in the management and follow-up of pleural diseases, improving diagnostic accuracy and reducing the need for invasive procedures. However, larger prospective studies are needed for validation. The integration of AI-driven imaging analysis with molecular and genomic data offers potential for personalised therapeutic strategies, although challenges in data privacy, algorithm transparency and clinical validation persist. This comprehensive approach may revolutionise pleural disease management, enhancing patient outcomes through more accurate, noninvasive diagnostic strategies.