Detailed guidelines pertaining to radiological assessment of malignant pleural mesothelioma (MPM) are currently lacking due to the rarity of the disease, complex morphology, propensity to invade multiple planes simultaneously and lack of specific recommendations within the radiology community about assessment, reporting and follow-up. In March 2017, a multidisciplinary meeting of mesothelioma experts was co-sponsored by the National Cancer Institute (NCI) Thoracic Malignancy Steering Committee, International Association for the Study of Lung Cancer (IASLC), and the Mesothelioma Applied Research Foundation (MARF). One of the outcomes of this conference was the foundation of detailed, multidisciplinary consensus imaging and management guidelines. Here, we present the recommendations for radiologic assessment of MPM in the setting of clinical trial enrollment. We discuss optimization of imaging parameters across modalities, standardized reporting and response assessment within clinical trials.