Chest
Volume 129, Issue 6, June 2006, Pages 1570-1576
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Original Research
Dynamic Contrast-Enhanced MRI of Malignant Pleural Mesothelioma: A Feasibility Study of Noninvasive Assessment, Therapeutic Follow-up, and Possible Predictor of Improved Outcome

https://doi.org/10.1378/chest.129.6.1570Get rights and content

Study objective

Dynamic contrast-enhanced MRI (DCE-MRI) followed by pharmacokinetic analysis has been successfully used in a variety of solid tumors. The aims of this study were to evaluate the feasibility of DCE-MRI in malignant pleural mesothelioma (MPM), to differentiate benign from pathologic tissue and compare pharmacokinetic with clinical parameters and survival in order to map out its microcirculation; and to compare pharmacokinetic with clinical parameter and survival in order to improve our understanding of the in vivo biology of this malignancy.

Methods

Nineteen patients with a diagnosis of MPM who were scheduled to receive chemotherapy with gemcitabine were enrolled in the study. DCE-MRI was performed before treatment (n = 19) and after the third cycle (n = 12) and sixth cycle (n = 7) of chemotherapy. An established pharmacokinetic two-compartment model was used to analyze DCE-MRI. Tumor regions were characterized by the pharmacokinetic parameters amplitude (Amp), redistribution rate constant (kep), and elimination rate constant (kel). Kinetic parameters of tumor tissue and normal tissue were compared using the Student t test. Patients were classified as clinical responders or nonresponders according to clinical outcome, and these groups were compared with the pharmacokinetic parameters derived from DCE-MRI.

Results

Normal and tumor tissue could be distinguished by the pharmacokinetic parameters Amp and kel (p ≤ 0.001). Clinical responders had a median kep value within the tumor of 2.6 min, while nonresponders showed a higher value (3.6 min), which coincided with longer survival (780 days vs 460 days).

Conclusions

DCE-MRI can be used in patients with MPM to assess tumor microvascular properties and to demonstrate tumor heterogeneity for therapy monitoring. High pretherapeutic values of kep within the tumor correlated with a poor overall response to therapy.

Section snippets

Patients and Diagnostic Evaluation

A total of 19 patients (17 men and 2 women; age range, 53 to 77 years; mean, 62.5 years) received a diagnosis of stage II (n = 9) or stage IV (n = 10) MPM, and subsequently were included in a prospective clinical trial with single-agent chemotherapy. All reported patients were enrolled under an investigational protocol that was approved by the investigational review board of the university clinics. Written informed consent was obtained from all patients. DCE-MRI was performed as an exploratory

Results

Pretherapeutic pharmacokinetic quantification of the tumor area presented heterogeneous color maps with different contrast-enhancement patterns showing by characteristic signal-intensity time curves (Fig 1). The color-coded maps were very helpful to successfully guide semiautomated ROI analysis, separating normal from malignant tissue.

Subjects were classified as clinical nonresponders or responders. Nonresponders (n = 15) were characterized by short median survival (460 days). In contrast,

Discussion

This pilot feasibility study successfully demonstrates that parametric mapping based on DCE-MRI in MPM depicts not only the lesion and its extent but can map out the heterogeneity of microcirculation within the full thoracic extent of MPM. The pharmacokinetic parameters (Amp, kep, kel) enabled differentiation of normal and tumor tissue. In addition, the kinetic parameter kep may provide prognostic information with regard to therapeutic response.

MPM has been causally related to asbestos exposure

ACKNOWLEDGMENT

We acknowledge the extensive review and comments by Peter L. Choyke, MD, from the National Cancer Institute Molecular Imaging Program.

References (46)

  • KnoppMV et al.

    PET imaging of lung tumours and mediastinal lymphoma

    Nucl Med Biol

    (1994)
  • DetterbeckFC et al.

    Seeking a home for a PET, part 3: emerging applications of positron emission tomography imaging in the management of patients with lung cancer

    Chest

    (2004)
  • AntmanKH et al.

    Benign and malignant mesothelioma

    (1993)
  • ChahinianAP

    Malignant mesothelioma

    (1993)
  • RuffieP et al.

    Current approach to malignant mesothelioma of the pleura

    Chest

    (1995)
  • StewartDJ et al.

    Malignant pleural mesothelioma: an update

    Int J Occup Environ Health

    (2004)
  • SteinertDJ et al.

    Therapy response evaluation in malignant pleural mesothelioma with integrated PET-CT imaging

    Lung Cancer

    (2005)
  • NiethammerAG et al.

    A DNA vaccine against VEGF receptor 2 prevents effective angiogenesis and inhibits tumor growth

    Nat Med

    (2002)
  • JeswaniT et al.

    Imaging tumor angiogenesis

    Cancer Imaging

    (2005)
  • LardinoisD et al.

    Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography

    N Engl J Med

    (2003)
  • ChoykePL et al.

    Functional tumor imaging with dynamic contrast-enhanced magnetic resonance imaging

    J Magn Reson Imaging

    (2003)
  • HawighorstH et al.

    Pharmacokinetic MRI for assessment of malignant glioma response to stereotactic radiotherapy: initial results

    J Magn Reson Imaging

    (1998)
  • KnoppMV et al.

    Pathophysiologic basis of contrast enhancement in breast tumors

    J Magn Reson Imaging

    (1999)
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