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Dynamic contrast-enhanced CT for the assessment of tumour response in malignant pleural mesothelioma: a pilot study



The aim of this pilot study was to investigate the utility of haemodynamic parameters derived from dynamic contrast-enhanced computed tomography (DCE-CT) scans in the assessment of tumour response to treatment in malignant pleural mesothelioma (MPM) patients.


The patient cohort included nine patients undergoing chemotherapy and five patients on observation. Each patient underwent two DCE-CT scans separated by approximately 2 months. The DCE-CT parameters of tissue blood flow (BF) and tissue blood volume (BV) were obtained within the dynamically imaged tumour. Mean relative changes in tumour DCE-CT parameters between scans were compared between the on-treatment and on-observation cohorts. DCE-CT parameter changes were correlated with relative change in tumour bulk evaluated according to the modified RECIST protocol.


Differing trends in relative change in BF and BV between scans were found between the two patient groups (p = 0.19 and p = 0.06 for BF and BV, respectively). No significant rank correlations were found when comparing relative changes in DCE-CT parameters with relative change in tumour bulk.


Differing trends in the relative change of BF and BV between patients on treatment and on observation indicate the potential of DCE-CT for the assessment of pharmacodynamic endpoints with respect to treatment in MPM. A future study with a larger patient cohort and unified treatment regimens should be undertaken to confirm the results of this pilot study.

Key Points

• CT-derived haemodynamic parameters show differing trends between malignant pleural mesothelioma patients on treatment and patients off treatment

• Changes in haemodynamic parameters do not correlate with changes in tumour bulk as measured according to the modified RECIST protocol

• Differing trends across the two patient groups indicate the potential sensitivity of DCE-CT to assess pharmacodynamic endpoints in the treatment of MPM

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Fig. 1
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Tissue blood flow


Tissue blood volume


Confidence interval


Dynamic contrast-enhanced computed tomography


Malignant pleural mesothelioma


Response Evaluation Criteria in Solid Tumours


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The authors would like to thank The University of Chicago’s Human Imaging Research Office (HIRO) for their assistance in coordinating the imaging aspects of this study and providing anonymised, compliant images for evaluation. The HIRO is supported in part by pilot research funding provided by the Virginia and D. K. Ludwig Fund for Cancer Research via the Imaging Research Institute in the Biological Sciences Division of the University of Chicago and through Cancer Center Support Grant number P30 CA014599 from the University of Chicago Comprehensive Cancer Center.


This study has received funding by the Hodges Society of the Department of Radiology at The University of Chicago and the Plooy Family and the Kazan McClain Partners’ Foundation, Inc.

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Correspondence to Eyjolfur Gudmundsson.

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The scientific guarantor of this publication is Samuel G. Armato III, Ph.D., at the University of Chicago.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: SGA receives royalties and licensing fees for computer-aided diagnostic technology through the University of Chicago. SGA is a consultant for Aduro Biotech, Inc.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution

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Gudmundsson, E., Labby, Z., Straus, C.M. et al. Dynamic contrast-enhanced CT for the assessment of tumour response in malignant pleural mesothelioma: a pilot study. Eur Radiol 29, 682–688 (2019).

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  • Mesothelioma
  • Multidetector computed tomography
  • Response Evaluation Criteria in Solid Tumours
  • Haemodynamics
  • Perfusion imaging