Plain radiographs may show pleural effusions which are the most common manifestation of mesothelioma. these radiographs may also show pleural thickening of the involved lung. Changes due to asbestosis or an actual mass may also be observed with plain radiographs. CT and MRI may further delineate the extent and involvement of mesothelioma. For instance, CT and MRI may determine the amount of lymph node involvement and/or chest wall invasion. However, these methods are often not able to differentiate between mesothelioma and other malignant or benign lung tumors such as adenocarcinoma. CT scans may be used for guidance in tumor biopsy performed by fine needle aspiration. PET scans are sometimes used to determine staging of mesothelioma. All sources seem to agree however, that final diagnosis of mesothelioma is most accurately achieved through thoracotomy and open biopsy.