| Title | Solitary pulmonary nodules: dynamic contrast-enhanced MR imaging--perfusion differences in malignant and benign lesions. | | Author(s) | Schaefer JF, Vollmar J, Schick F, Vonthein R, Seemann MD, Aebert H, Dierkesmann R, Friedel G, Claussen CD | | Institution | Department of Diagnostic Radiology, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany. juergen.schaefer@med.uni-tuebingen.de | | Source | Radiology 2004 Aug; 232(2):544-53. | | MeSH | Adult
Aged
Carcinoid Tumor
Carcinoma, Non-Small-Cell Lung
Carcinoma, Small Cell
Coin Lesion, Pulmonary
Contrast Media
Decision Trees
Diagnosis, Differential
Female
Gadolinium DTPA
Humans
Image Enhancement
Image Processing, Computer-Assisted
Lung
Lung Diseases
Lung Neoplasms
Magnetic Resonance Imaging
Male
Middle Aged
Observer Variation
ROC Curve
Research Support, Non-U.S. Gov't
Retrospective Studies
Tomography, X-Ray Computed
| | Abstract | PURPOSE: To determine whether dynamic contrast material-enhanced magnetic resonance (MR) imaging with use of kinetic and morphologic parameters reveals statistically significant differences between malignant and benign solitary pulmonary nodules.
MATERIALS AND METHODS: Fifty-eight patients met the inclusion criteria of a solitary 5-40-mm pulmonary nodule without calcification or fat at computed tomography. Fifty-one patients were examined successfully; 46 received a histologic diagnosis, and five received a diagnosis by means of observation over 2 years. Dynamic MR images were acquired every 10 seconds for a total of 4 minutes. Diagnostic characteristics for differentiation were examined by using threshold values for maximum peak enhancement, slope of enhancement, and washout. Receiver operating characteristic curves were calculated to test the usefulness of these parameters. The diagnostic performance of a combination of curve profiles and morphologic contrast material distribution were tested by using a decision tree.
RESULTS: Frequency of malignancy was 53% (27 of 51 nodules). Malignant nodules showed stronger enhancement with a higher maximum peak and a faster slope (P <.001). Significant washout (>0.1% increase in signal intensity per second) was found only in malignant lesions (14 of 27 lesions). Sensitivity, specificity, and accuracy were 96%, 88%, and 92%, respectively, for maximum peak; 96%, 75%, and 86% for slope; and 52%, 100%, and 75% for washout. When curve profiles and morphologic enhancement patterns were combined, sensitivity increased to 100%.
CONCLUSION: Dynamic MR imaging delineates significant kinetic and morphologic differences in vascularity and perfusion between malignant and benign solitary pulmonary nodules. Washout seems to be highly specific for malignancy. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 15215548 |
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