Evaluation of solitary pulmonary nodules with dynamic contrast-enhanced MR imaging—a promising technique?

doi:10.1016/0730-725X(95)02010-Q

Magnetic Resonance Imaging

Volume 13, Issue 7, 1995, Pages 923-933

https://doi.org/10.1016/0730-725X(95)02010-Q Get rights and content

Abstract

The evaluation of a solitary pulmonary nodule (SPN) is one of the most frequently encountered challenges in thoracic radiology. In addition to a “state-of-the-art” evaluation of SPNs with CT and biopsy techniques, recently the assessment of the enhancement characteristics with iodinized contrast agents has shown its potential to improve the characterization of SPNs. We investigated whether dynamic contrast-enhanced MRI is suitable to assess the degree and kinetics of MR contrast enhancement and whether this technique could help in the noninvasive specification of SPNs. We studied prospectively 21 patients with SPNs. T₁-weighted and proton density-weighted spoiled gradient-echo breath-hold images (2D-FLASH) were obtained before and after the administration of Gd-DTPA in a standard dosage of 0.1 mmol/kg body weight. The maximum enhancement and the initial velocity of contrast uptake were assessed and correlated with pathohistological findings. To quantify contrast enhancement, we used the relative signal intensity increase (S_rel) and the recently introduced enhancement factor (EF) and contrast uptake equivalent (CE). Dynamic contrast-enhanced MRI proved to be well suited for the assessment of the contrast enhancement characteristics of SPNs. Significant differences were found in the degree and kinetics of contrast enhancement for specific types of nodules. Malignant neoplastic SPNs enhanced stronger and faster than benign neoplastic SPNs. The strongest and fastest enhancement, however, was found in a benign type of nodules where histology revealed inflammatory/fibrous lesions. These differences in contrast enhancement between the different pathohistological groups were more significant when EF and CE rather than S_rel was used for the quantification of contrast enhancement. The results of this study indicate a potential role for dynamic contrast-enhanced MRI in the preoperative noninvasive evaluation of SPNs using EF and CE as contrast uptake assessment parameters.

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However, Çakmak and colleagues85 showed that the minimum ADC performed better than the lesion-to-spinal cord SI ratio, with an area under the receiving operating characteristic curve for the minimum ADC (0.931; 95% CI, 0.868–0.993), which was greater than that for lesion-to-spinal cord SI ratio (0.801; 95% CI, 0.675–0.926; P = .029). Dynamic CE-enhanced MR imaging with 2-dimensional, multislice or 3D SE, turbo SE, and/or GRE sequences has been used for differentiating malignant from benign nodules with 1.5T and 3T MR imaging systems (Table 3).17–20,86–91 Dynamic CE MR imaging has been reported to have a sensitivity, specificity, and accuracy ranging from 55% to 100%, 54% to 100%, and 75% to 96%, respectively, in differentiating malignant from benign nodules.17–20,86–91
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This study aims to perform a metaanalysis to assess the diagnostic performance and clinical utility of the dynamic magnetic resonance imaging (MRI) in discrimination of benign and malignant pulmonary nodules.
We searched PubMed, EMBASE, and Cochrane Library from January 1995 to May 2015 for studies evaluating the diagnostic accuracy of dynamic MRI in discriminating benign from malignant pulmonary nodules. Methodological quality was assessed by the Quality Assessment of Diagnostic Accuracy Studies-2. Sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) were calculated. Potential publication bias was investigated.
Twelve studies with 524 malignant and 284 benign nodules were included in this metaanalysis. The publication bias was not significant. Summary receiver operating characteristic curve showed that AUC was 0.94 [95% confidence interval (CI), 0.83–0.98], with pooled sensitivity of 0.95 (95% CI: 0.90, 0.97), specificity of 0.87 (95% CI: 0.72, 0.95), PLR of 7.6 (95% CI: 3.2, 18.0), NLR of 0.06 (95% CI: 0.03, 0.11), and DOR of 133 (95% CI: 45, 393), respectively.
Dynamic contrast-enhanced MRI is valuable for discrimination of benign from malignant pulmonary nodules and is especially useful for exclusion of malignant pulmonary nodules.
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Lung cancer is a leading cause of death worldwide. The National Lung Screening Trial has demonstrated that lung cancer screening can reduce lung cancer specific and all cause mortality. With approval of national coverage for lung cancer screening, it is expected that an increase in exams related to pulmonary nodule detection and surveillance will ensue. Advanced imaging technologies for nodule detection and surveillance will be more important than ever. While computed tomography (CT) remains the modality of choice, other emerging modalities such as magnetic resonance imaging provides viable alternatives to CT.
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Objectives When evaluating anti-tumor treatment response by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) it is necessary to assure its validity and reproducibility. This has not been well addressed in lung tumors. Therefore we have evaluated the inter-reader reproducibility of response classification by DCE-MRI in patients with non-small cell lung cancer (NSCLC) treated with bevacizumab and erlotinib enrolled in a multicenter trial.
Twenty-one patients were scanned before and 3 weeks after start of treatment with DCE-MRI in a multicenter trial. The scans were evaluated by two independent readers. The primary lung tumor was used for response assessment. Responses were assessed in terms of relative changes in tumor mean trans endothelial transfer rate (K^trans) and its heterogeneity in terms of the spatial standard deviation. Reproducibility was expressed by the inter-reader variability, intra-class correlation coefficient (ICC) and dichotomous response classification.
The inter-reader variability and ICC for the relative K^trans were 5.8% and 0.930, respectively. For tumor heterogeneity the inter-reader variability and ICC were 0.017 and 0.656, respectively. For the two readers the response classification for relative K^trans was concordant in 20 of 21 patients (k = 0.90, p < 0.0001) and for tumor heterogeneity in 19 of 21 patients (k = 0.80, p < 0.0001).
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The aims of this study were to optimize the scanning technique of first-pass 64-detector-row perfusion volume computed tomography imaging, to evaluate the effectiveness and stability of this scan protocol, and lastly to evaluate the differential diagnosis ability of perfusion imaging in solitary pulmonary nodules (SPNs).
A total of 144 patients with SPNs underwent perfusion scan with 64-slice spiral CT scanner. The CT perfusion imaging was analyzed for time–density curve, perfusion parametric maps, and the respective perfusion parameters. We then analyzed the main factors concerning the imaging quality and evaluated the effectiveness of scan protocol by determining the receiver operating characteristic (ROC) curve, diagnostic efficacy, and odds ratio as well as the stability of scan protocol by consistency analysis. Immunohistochemical findings of microvessel density measurement and vascular endothelial growth factor expression were evaluated.
The total sensitivity, specificity, accuracy, positive predictive value, negative predictive value, likelihood ratio, and the area under ROC curve during 5–45-s scan period were 78.95%, 82.4%, 80.6%, 83.3%, 77.8%, 4.620, 0.280, and 0.840, respectively, and Kappa value was 0.894. The diagnostic efficacy of CT pulmonary perfusion was significantly higher than during 0–40-s scan period. The parameter values in different nodules were different.
The optimized 5–45-s scan period of CT pulmonary perfusion imaging is effective in pathologic diagnosis and has good stability, worthy of being popularized. Lung perfusion CT could be a promising and feasible method for differentiation of SPNs.
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Citation Excerpt :
Recent technological advances in helical multidetector CT allow precise evaluations of hemodynamic characteristics in tissue. Some authors have reported the usefulness of dynamic CT in the work-up of solitary pulmonary nodules (SPNs) [4–12,19]. Recent studies using manually-defined ROI indicate that enhancement of malignant SPNs is greater than that of benign SPNs depicted on CT scans and MR images [2,3,8,13,20].
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Original contributionEvaluation of solitary pulmonary nodules with dynamic contrast-enhanced MR imaging—a promising technique?

Abstract

An integrated approach to evaluation of the solitary pulmonary nodule

CT of the pulmonary nodule: A cooperative study

Radiology

Solitary pulmonary nodule: CT assessment

Radiology

Pulmonary masses: Contrast enhancement

Radiology

Solitary pulmonary nodule: CT evaluation of enhancement with iodinated contrast material—a preliminary report

Radiology

Invasive pulmonary aspergillosis: Evaluation with MR imaging

Radiology

Pulmonary metastases: MR imaging with surgical correlation-a prospective study

Radiology

Breath-hold FLASH imaging of pulmonary nodules

Radiology

Pulmonary nodules: Detection using magnetic resonance and computed tomography

Radiology

Gadolinium-DTPA enhancement of lung radiation fibrosis

J. Comput. Assist. Tomogr.

A prospective comparison of gadolinum-dimeglumid enhanced MRI and contrast-enhanced CT scanning in the detection of brain metastasis arising from small cell lung cancer

Distinguishing between scar and recurrent herniated disk in postoperative patients: Value of contrast-enhanced CT and MR imaging

AJNR

MR imaging of the breast: Fast imaging sequences with and without gadolinium-dimeglumid

Radiology

Original contribution
Evaluation of solitary pulmonary nodules with dynamic contrast-enhanced MR imaging—a promising technique?