Implementation of a high-resolution, high-contrast magnetic resonance imaging protocol with extended delayed phases for peritoneal mesothelioma

Milica Medved; Hunter D D Witmer; Ankit Dhiman; Yaniv Berger; Scott K Sherman; Enal S Hindi; Samuel G Armato III; Ingrid S Reiser; Aytekin Oto; Roger M Engelmann; Hedy L Kindler; Nisa C Oren; Carla B Harmath; Kiran K Turaga

doi:10.21037/qims-23-13

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Implementation of a high-resolution, high-contrast magnetic resonance imaging protocol with extended delayed phases for peritoneal mesothelioma

Journal article

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Implementation of a high-resolution, high-contrast magnetic resonance imaging protocol with extended delayed phases for peritoneal mesothelioma

Milica Medved, Hunter D D Witmer, Ankit Dhiman, Yaniv Berger, Scott K Sherman, Enal S Hindi, Samuel G Armato III, Ingrid S Reiser, Aytekin Oto, Roger M Engelmann, …

Quantitative imaging in medicine and surgery, Vol.14(3), pp.2580-2589

03/15/2024

DOI: 10.21037/qims-23-13

PMCID: PMC10963817

PMID: 38545076

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Abstract

Imaging of peritoneal malignancies using conventional cross-sectional imaging is challenging, but accurate assessment of peritoneal disease burden could guide better selection for definitive surgery. Here we demonstrate feasibility of high-resolution, high-contrast magnetic resonance imaging (MRI) of peritoneal mesothelioma and explore optimal timing for delayed post-contrast imaging. Prospective data from inpatients with malignant peritoneal mesothelioma (MPM), imaged with a novel MRI protocol, were analyzed. The new sequences augmenting the clinical protocol were (I) pre-contrast coronal high-resolution T2-weighted single-shot fast spin echo (COR hr T2w SSH FSE) of abdomen and pelvis; and (II) post-contrast coronal high-resolution three-dimensional (3D) T1-weighted modified Dixon (COR hr T1w mDIXON) of abdomen, acquired at five delay times, up to 20 min after administration of a double dose of contrast agent. Quantitative analysis of contrast enhancement was performed using linear regression applied to normalized signal in lesion regions of interest (ROIs). Qualitative analysis was performed by three blinded radiologists. MRI exams from 14 participants (age: mean ± standard deviation, 60±12 years; 71% male) were analyzed. The rate of lesion contrast enhancement was strongly correlated with tumor grade (cumulative nuclear score) (r=-0.65, P<0.02), with 'early' delayed phase (12 min post-contrast) and 'late' delayed phase (19 min post-contrast) performing better for higher grade and lower grade tumors, respectively, in agreement with qualitative scoring of image contrast. High-resolution, high-contrast MRI with extended post-contrast imaging is a viable modality for imaging peritoneal mesothelioma. Multiple, extended (up to 20 min post-contrast) delayed phases are necessary for optimal imaging of peritoneal mesothelioma, depending on the grade of disease.

magnetic resonance imaging (MRI)

gadolinium (Gd)

malignant mesothelioma

Peritoneal surface malignancy

Details

Title: Subtitle: Implementation of a high-resolution, high-contrast magnetic resonance imaging protocol with extended delayed phases for peritoneal mesothelioma
Creators: Milica Medved - University of Chicago
Hunter D D Witmer - Yale School of Medicine
Ankit Dhiman - Yale School of Medicine
Yaniv Berger - Tel Aviv University
Scott K Sherman - University of Iowa
Enal S Hindi - Yale School of Medicine
Samuel G Armato III - University of Chicago
Ingrid S Reiser - University of Chicago
Aytekin Oto - University of Chicago
Roger M Engelmann - University of Chicago
Hedy L Kindler - University of Chicago
Nisa C Oren - University of Chicago
Carla B Harmath - University of Chicago
Kiran K Turaga - Yale School of Medicine
Resource Type: Journal article
Publication Details: Quantitative imaging in medicine and surgery, Vol.14(3), pp.2580-2589
DOI: 10.21037/qims-23-13
PMID: 38545076
PMCID: PMC10963817
NLM abbreviation: Quant Imaging Med Surg
ISSN: 2223-4292
eISSN: 2223-4306
Language: English
Date published: 03/15/2024
Academic Unit: Surgery
Record Identifier: 9984577036502771

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