Diffusion-weighted MR imaging assessment of mesothelioma
Research type
Research Study
Full title
Total tumour volume and global apparent diffusion coefficient for the evaluation of treatment response in patients with malignant mesothelioma (TOTEM)
IRAS ID
130843
Contact name
Koh Dow-Mu
Contact email
Sponsor organisation
The Royal Marsden Hospital
Research summary
Malignant mesothelioma (MPM) is an asbestos-related neoplasm that spreads along the pleura (lining of the thorax) until it encases the lungs and mediastinum, ultimately causing death. Imaging plays a crucial role in diagnosis and optimal management with CT being the primary imaging modality. However, due to the nature of disease – its shape and often presence of both solid disease and loculated pleural fluid, accurate assessment of tumour volume and response assessment are suboptimal on CT. Using tumour volume derived from CT imaging at baseline has been shown to be associated with preoperative clinical stage and survival1. However, due the lack of contrast between tumour and normal tissues on CT, it is time consuming to segment the disease on CT making it difficult to implement the approach in clinical practice.
Diffusion Weighted MRI (DW-MRI) does not use ionizing radiation and is superior to CT in delineating the tumour and differentiating tumour from non-tumour tissue. The DW-MRI images lend themselves to semi-automatic disease segmentation, from which the total tumour volume (TTV) can be readily derived. Furthermore, DW-MRI allows us to quantify the Apparent Diffusion Coefficient (ADC) of the segmented tumour volume, which reflects the tissue cellularity2 . ADC has been shown to increase in response to effective anti-tumour treatment3. In this way, using DW-MRI allows to derive two potential response biomarkers – the TTV and the global ADC (gADC) of the segmented tumour volume.
The aim of the study is to determine whether quantitative imaging derived using DW-MRI have any relationship (agreement/correlation) with response assessed by conventional CT imaging and patient overall survival. It is not the primary end point of the study to compare the difference in response rate determined by DW-MRI and CT. If the technique is feasible and shows significant correlation with patient outcome, we will perform a larger more definite study to evaluate whether DW-MRI is superior to CT.
REC name
West Midlands - Black Country Research Ethics Committee
REC reference
14/WM/0134
Date of REC Opinion
9 May 2014
REC opinion
Further Information Favourable Opinion