Related Experiment Videos
The value of delayed phase enhanced imaging in malignant pleural mesothelioma
Akash M Patel1, Ian Berger1, E Paul Wileyto1
1Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Background:
Cross-sectional imaging of malignant pleural mesothelioma (MPM) can underestimate the presence of local tumor invasion. Since accurate staging is vital optimal choice of therapy, techniques that optimize pleural imaging are needed. Here we estimate the optimal timing of MPM enhancement on magnetic resonance imaging (MRI).
Methods:
All MPM patients with intravenous (IV) contrast enhanced staging MRI between 2000-2016 at our institution were retrospectively selected for image analysis. Patients with incomplete imaging protocol and maximum pleural tumor thickness <1 cm were excluded. Quantitative measurements of tumor signal intensity were obtained on pre-contrast and post-contrast phases where MRI acquisition parameters were fixed. Using best-fit model curves, predicted maximum time points of enhancement were determined using a simulation of predicted values. Additionally, a qualitative assessment of tumor conspicuity was performed at all IV contrast time delays imaged. A statistical analysis assessed for correlation between qualitative lesion conspicuity and quantitative tumor enhancement.
Results:
Of the 42 MPM patients who had undergone staging MRI during the study period, 12 patients met the study criteria. Peak tumor enhancement was between 150 and 300 sec following IV contrast administration. Within this time window, 80% of patients are projected to have reached >80%, >85%, and >90% peak tumor enhancement. There was a statistically significant correlation between increasing tumor enhancement and subjective lesion conspicuity.
Conclusions:
Optimal MPM enhancement on MRI likely occurs at a time delay between 2.5-5 min following IV contrast administration. Further study of delayed phase enhancement of MPM with dynamic contrast enhanced MRI is warranted.
Insights
Optimal magnetic resonance imaging (MRI) timing for malignant pleural mesothelioma (MPM) involves a 2.5-5 minute delay after contrast administration. This enhances tumor visualization for accurate staging and treatment planning.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Malignant pleural mesothelioma (MPM) staging via cross-sectional imaging may underestimate local invasion.
- Accurate staging is crucial for selecting optimal therapy for MPM.
- Improved pleural imaging techniques are needed for MPM.
Purpose of the Study:
- To determine the optimal timing for contrast enhancement in MRI of MPM.
- To enhance the accuracy of MPM staging through improved imaging.
Main Methods:
- Retrospective analysis of 12 MPM patients who underwent contrast-enhanced MRI between 2000-2016.
- Quantitative signal intensity measurements and qualitative conspicuity assessments were performed.
- Best-fit model curves and statistical analysis were used to determine optimal enhancement timing.
Main Results:
- Peak tumor enhancement occurred 150-300 seconds post-contrast administration.
- Within this window, 80% of patients achieved >80-90% peak enhancement.
- A significant correlation was found between increased tumor enhancement and lesion conspicuity.
Conclusions:
- Optimal MPM enhancement on MRI is likely achieved 2.5-5 minutes after IV contrast.
- Further research into delayed-phase dynamic contrast-enhanced MRI for MPM is recommended.