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Delayed-Phase Enhancement for Evaluation of Malignant Pleural Mesothelioma on Computed Tomography: A Prospective
Akash Patel1, Leonid Roshkovan1, Sally McNulty2
1Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Background:
Radiologic assessment of malignant pleural mesothelioma (MPM) on computed tomography (CT) imaging can be limited by similar attenuations of MPM and adjacent tissues. This can result in inaccuracies in defining the presence and extent of pleural tumor burden. We hypothesized that increasing the time delay for pleural enhancement will optimize discrimination between MPM and noncancerous tissues on CT. Here we conduct a prospective observational study to determine the optimal time delay for imaging MPM on CT.
Patients And Methods:
Adult MPM patients (n = 15) were enrolled in this prospective exploratory imaging trial. Patients with < 1 cm MPM thickness, prior pleurectomy, pleurodesis, pleural radiotherapy, or antiangiogenic therapy were excluded. All patients underwent a dynamically-enhanced CT with multiple time delays (0 - 10 minutes) after intravenous contrast administration. Tumor tissue attenuation was measured at each phase of enhancement. A qualitative assessment of tumor enhancement kinetics was also performed. The optimal phase of enhancement based on qualitative lesion conspicuity and quantitative tumor enhancement was then compared.
Results:
MPM tumor enhancement was quantitatively and qualitatively increased at time delays beyond the conventional time delay for thoracic CT imaging (40-60 seconds). Patient tumor enhancement kinetics, displayed as the fraction of maximal tumor tissue attenuation as a function of time, revealed an optimal time delay of 230 to 300 seconds after intravenous contrast administration. There was an association between degree of tumor enhancement and subjective lesion conspicuity.
Conclusion:
Optimal MPM contrast enhancement occurs at a later phase than typically acquired with conventional thoracic CT imaging.
Insights
Delayed contrast enhancement on CT scans improves the detection of malignant pleural mesothelioma (MPM). Optimal imaging occurs 230-300 seconds after contrast injection, enhancing tumor visibility.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Malignant pleural mesothelioma (MPM) assessment on CT is challenging due to similar tissue attenuation.
- This can lead to inaccuracies in determining tumor burden.
- Optimizing contrast enhancement timing may improve MPM detection.
Purpose of the Study:
- To determine the optimal time delay for contrast enhancement in CT imaging of MPM.
- To enhance the discrimination between MPM and adjacent tissues.
Main Methods:
- Prospective observational study of 15 adult MPM patients.
- Dynamically-enhanced CT with contrast delays from 0-10 minutes.
- Quantitative and qualitative assessment of tumor enhancement kinetics.
Main Results:
- MPM tumor enhancement increased significantly at delays beyond conventional thoracic CT (40-60 seconds).
- Optimal enhancement occurred between 230-300 seconds post-contrast.
- Greater tumor enhancement correlated with improved lesion conspicuity.
Conclusions:
- Optimal contrast enhancement for MPM is achieved at a later phase than standard thoracic CT.
- Delayed imaging protocols can improve the radiologic assessment of MPM.
