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Characterisation of solitary pulmonary lesions combining visual perfusion and quantitative diffusion MR imaging

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Abstract

Objective

To evaluate the diagnostic accuracy of dynamic contrast-enhanced (DCE) magnetic resonance (MR) and diffusion-weighted imaging (DWI) sequences for defining benignity or malignancy of solitary pulmonary lesions (SPL).

Methods

First, 54 consecutive patients with SPL, clinically staged (CT and PET or integrated PET-CT) as N0M0, were included in this prospective study. An additional 3-Tesla MR examination including DCE and DWI was performed 1 day before the surgical procedure. Histopathology of the surgical specimen served as the standard of reference. Subsequently, this functional method of SPL characterisation was validated with a second cohort of 54 patients.

Results

In the feasibility group, 11 benign and 43 malignant SPL were included. Using the combination of conventional MR sequences with visual interpretation of DCE-MR curves resulted in a sensitivity, specificity and accuracy of 100 %, 55 % and 91 %, respectively. These results can be improved by DWI (with a cut-off value of 1.52 × 10−3 mm2/s for ADChigh) leading to a sensitivity, specificity and accuracy of 98 %, 82 % and 94 %, respectively. In the validation group these results were confirmed.

Conclusion

Visual DCE-MR-based curve interpretation can be used for initial differentiation of benign from malignant SPL, while additional quantitative DWI-based interpretation can further improve the specificity.

Key Points

• Magnetic resonance imaging is increasingly being used to help differentiate lung lesions.

• Solitary pulmonary lesions (SPL) are accurately characterised by combining DCE-MRI and DWI.

• Visual DCE-MRI assessment facilitates the diagnostic throughput in patients with SPL.

• DWI provides additional information in inconclusive DCE-MRI (type B pattern).

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Johan Coolen, Frederik De Keyzer, Walter De Wever, Vincent Vandecaveye, Steven Dymarkowski & Johny Verschakelen

  2. Department of Pneumology, University Hospitals Leuven, Leuven, Belgium

    Johan Vansteenkiste, Christophe Dooms & Kristiaan Nackaerts

  3. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium

    Herbert Decaluwé, Paul De Leyn & Dirk Van Raemdonck

  4. Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium

    Christophe Deroose

  5. Department of Pathology, University Hospitals Leuven, Leuven, Belgium

    Eric Verbeken

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  1. Johan Coolen
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  2. Johan Vansteenkiste
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Correspondence to Johan Coolen.

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Coolen, J., Vansteenkiste, J., De Keyzer, F. et al. Characterisation of solitary pulmonary lesions combining visual perfusion and quantitative diffusion MR imaging. Eur Radiol 24, 531–541 (2014). https://doi.org/10.1007/s00330-013-3053-1

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  • DOI: https://doi.org/10.1007/s00330-013-3053-1

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