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European Radiology

, Volume 24, Issue 2, pp 531–541 | Cite as

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

  • Johan CoolenEmail author
  • Johan Vansteenkiste
  • Frederik De Keyzer
  • Herbert Decaluwé
  • Walter De Wever
  • Christophe Deroose
  • Christophe Dooms
  • Eric Verbeken
  • Paul De Leyn
  • Vincent Vandecaveye
  • Dirk Van Raemdonck
  • Kristiaan Nackaerts
  • Steven Dymarkowski
  • Johny Verschakelen
Chest

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).

Keywords

Single pulmonary lesion Magnetic resonance imaging Diffusion-weighted imaging Dynamic contrast-enhanced MR imaging Characterisation of lung nodule or mass 

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Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Johan Coolen
    • 1
    Email author
  • Johan Vansteenkiste
    • 2
  • Frederik De Keyzer
    • 1
  • Herbert Decaluwé
    • 3
  • Walter De Wever
    • 1
  • Christophe Deroose
    • 4
  • Christophe Dooms
    • 2
  • Eric Verbeken
    • 5
  • Paul De Leyn
    • 3
  • Vincent Vandecaveye
    • 1
  • Dirk Van Raemdonck
    • 3
  • Kristiaan Nackaerts
    • 2
  • Steven Dymarkowski
    • 1
  • Johny Verschakelen
    • 1
  1. 1.Department of RadiologyUniversity Hospitals LeuvenLeuvenBelgium
  2. 2.Department of PneumologyUniversity Hospitals LeuvenLeuvenBelgium
  3. 3.Department of Thoracic SurgeryUniversity Hospitals LeuvenLeuvenBelgium
  4. 4.Department of Nuclear MedicineUniversity Hospitals LeuvenLeuvenBelgium
  5. 5.Department of PathologyUniversity Hospitals LeuvenLeuvenBelgium

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