Courtesy of Dr Gordon Cowell, this image shows highlighted regions of interest for patients with Malignant Pleural Mesothelioma (MPM), a cancer of the membrane covering the lungs, in which Early Contrast Enhancement (ECE) MRI was investigated as a non-invasive, perfusion-based biomarker. Some patients with MPM present with overtly nodular pleural disease, as shown in (a), whereas in other patients no visual indicators of pleural tumour are present, as shown in (b). In patients with suspected MPM who received MRI scans prior to pleural biopsy, regions of interest for ECE analysis were placed on the location of pleural mass lesions, if present, or otherwise were defined consistently at anatomically similar locations of the parietal pleura in each patient.
ECE was identified on the basis of peaks in signal intensity from gadobutrol contrast at baseline and at 5 post-injection timepoints within each region of interest. A signal intensity time curve pattern was termed ECE if it peaked at or before the 4th timepoint (4.5 minutes post-injection), as shown in (c) for all regions of interest in a patient with MPM and in (d) for the majority of regions of interest in another patient with MPM; in such cases the patient was classified as malignant. If ECE was not identified in any region of interest, as shown in (e) for a patient with Benign Asbestos Pleural Effusion, then the patient was classified as benign. ECE was found to correlate with tumour micro-vessel density, determined from pleural biopsy results, and poorer survival. These results suggest that ECE shows promise as an MRI biomarker of pleural malignancy, even in patients presenting without overtly nodular pleural disease.
The image is taken from a recent study, funded by the Chief Scientist Office, published in Lung Cancer:
Tsim S, Humphreys CA, Cowell GW, Stobo DB, Noble C, Woodward R, Kelly CA, Alexander L, Foster JE, Dick C, Blyth KG. Early Contrast Enhancement: A novel Magnetic Resonance Imaging biomarker of pleural malignancy. Lung Cancer 2018; 118:48-56.