Article Text

Download PDFPDF
Original article
Pleural abnormalities in the Framingham Heart Study: prevalence and CT image features
  1. Tetsuro Araki1,
  2. Masahiro Yanagawa2,
  3. Fangui Jenny Sun3,
  4. Josée Dupuis3,4,
  5. Mizuki Nishino1,
  6. Yoshitake Yamada1,5,
  7. George R Washko6,
  8. David C Christiani7,
  9. Noriyuki Tomiyama2,
  10. George T O'Connor4,8,
  11. Gary M Hunninghake6,
  12. Hiroto Hatabu1
  1. 1 Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Department of Radiology, Osaka University Graduate School of Medicine, Suita, Japan
  3. 3 Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
  4. 4 The National Heart Lung and Blood Institute’s Framingham Heart Study, Boston, Massachusetts, USA
  5. 5 Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
  6. 6 The Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  7. 7 Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
  8. 8 Department of Medicine and Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
  1. Correspondence to Dr Tetsuro Araki, Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St. Boston, MA 02215, USA; taraki{at}


Background The prevalence of pleural abnormalities in the general population is an epidemiologically important index of asbestos exposure, which has not been investigated since a radiography-based study in 1980.

Methods We examined 2633 chest CT scans (mean 59.2 years, 50% female) from the Framingham Heart Study (FHS) for the presence and image characteristics of pleural plaques and diffuse pleural thickening. Demographics and pulmonary function were stratified by the presence of pleural abnormalities in association with interstitial lung abnormalities.

Results Pleural abnormalities were present in 1.5% (95% CI 1.1% to 2.1%). Pleural lesions were most commonly bilateral (90.0%), multiple (77.5%), calcified (97.5%) and commonly involved posterior (lower: 92.5%, middle: 87.5%), anterior (upper: 77.5%, middle: 77.5%) and diaphragmatic areas (72.5%). Participants with pleural abnormalities were significantly older (75.7 years, p <0.0001), male (92.5%, p <0.0001), former or current smokers (80.0%, p <0.001) with higher pack-years (33.3, p <0.0001). No significant reduction was noted in pulmonary function measures (p=0.07–0.94) when adjusted for the associated covariates, likely due to small number of cases with pleural abnormalities. Information about prior history of asbestos exposure and occupation was not available.

Conclusions Pleural plaques and diffuse pleural thickening are present on CT in 1.5% of the FHS cohort. The current prevalence of the pleural abnormalities is smaller than that reported in the previous population-based study using chest radiography, likely representing lower asbestos exposure in recent decades. The posterior portion of the pleura is most frequently involved but the anterior portion is also commonly involved.

  • epidemiology
  • pleural plaque
  • diffuse pleural thickening
  • asbestos
  • CT

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors Each author has participated sufficiently in this submission to take public responsibility for its content. Publication has been approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out.

  • Funding MN is supported by NIH Grant Number: K23 CA157631. GRW is supported by NIH Grant Number: R01 HL122464, R01 HL116473 and R01 HL107246. GMH and this work were supported by NIH Grant Numbers: P01 HL114501, and R01 HL111024. This work was partially supported by the NHLBI’s Framingham Heart Study contract: N01 HC25195.

  • Competing interests MN reports consultancies or research grants with Bristol-Myers Aquibb Company, Canon Inc, and Merck & Co Inc. GW reports consultancies with GlaxoSmithKline and Genentech. HH reports research grants from Toshiba Corporation, AZE Ltd, Canon Inc and Konica Minolta Group.

  • Ethics approval Brigham and Women's Hospital, and Boston University.

  • Provenance and peer review Not commissioned; externally peer reviewed.