Dynamic contrast-enhanced MRI of malignant pleural mesothelioma: a comparative study of pharmacokinetic models and correlation with mRECIST criteria

Martina Vivoda Tomšič,Katarina Šurlan Popovič,Sotirios Bisdas,Viljem Kovač,Igor Serša

doi:10.1186/s40644-019-0189-5

Abstract

BackgroundMalignant pleural mesothelioma (MPM) is a rare and aggressive thoracic malignancy that is difficult to cure. Dynamic contrast-enhanced (DCE) MRI is a functional imaging technique used to analyze tumor microvascular properties and to monitor therapy response. Purpose of this study was to compare two tracer kinetic models, the extended Tofts (ET) and the adiabatic approximation tissue homogeneity model (AATH) for analysis of DCE-MRI and examine the value of the DCE parameters to predict response to chemotherapy in patients with MPM.MethodThis prospective, longitudinal, single tertiary radiology center study was conducted between October 2013 and July 2015. Patient underwent DCE-MRI studies at three time points: prior to therapy, during and after cisplatin-based chemotherapy. The images were analyzed using ET and AATH models. In short-term follow-up, the patients were classified as having disease control or progressive disease according to modified response evaluation criteria in solid tumors (mRECIST) criteria.Receiver operating characteristic curve analysis was used to examine specificity and sensitivity of DCE parameters for predicting response to therapy. Comparison tests were used to analyze whether derived parameters are interchangeable between the two models.ResultsNineteen patients form the study population. The results indicate that the derived parameters are not interchangeable between the models.Significant correlation with response to therapy was found for AATH-calculated median pre-treatment efflux rate (kep) showing sensitivity of 83% and specificity of 100% (AUC 0.9). ET-calculated maximal pre-treatment kep showed 100% sensitivity and specificity for predicting treatment response during the early phase of the therapy and reached a favorable trend to significant prognostic value post-therapy.ConclusionBoth models show potential in predicting response to therapy in MPM. High pre-treatment kep values suggest MPM disease control post-chemotherapy.

Highlights

Malignant pleural mesothelioma (MPM) is a rare and aggressive thoracic malignancy that is difficult to cure
The results indicate that the derived parameters are not interchangeable between the models
Exclusion criteria were as follows: other malignant disease, acute infection, inadequate hematopoietic function, decompensated heart failure, inadequate liver function, chronic kidney disease, peripheral sensory neuropathy grade ≥ 2 according to Common Toxicity Criteria (CTC), vascular disorder grade ≥ 2 according to CTC, positive pregnancy test, absolute or relative contraindication to magnetic resonance imaging and gadolinium administration

Summary

Introduction

Malignant pleural mesothelioma (MPM) is a rare and aggressive thoracic malignancy that is difficult to cure. Dynamic contrast-enhanced (DCE) MRI is a functional imaging technique used to analyze tumor microvascular properties and to monitor therapy response. Purpose of this study was to compare two tracer kinetic models, the extended Tofts (ET) and the adiabatic approximation tissue homogeneity model (AATH) for analysis of DCE-MRI and examine the value of the DCE parameters to predict response to chemotherapy in patients with MPM. Dynamic contrast-enhanced CT (DCE-CT) and MRI (DCE-MRI) are both functional imaging techniques used to analyze tumor microvascular properties and to monitor therapy response. DCE-MRI is the method of choice in research and in pre-clinical studies for the evaluation of early response to treatment [3]. Only one study has explored the potential of DCE-MRI in MPM for the assessment of therapy response with promising results [4]

Methods

Results

Discussion

Conclusion