Solitary pulmonary nodule: Comparison of quantitative capability for differentiation and management among dynamic CE-perfusion MRI at 3 T system, dynamic CE-perfusion ADCT and FDG-PET/CT

• Published in: European journal of radiology Vol. 115; pp. 22 - 30
• Main Authors: Ohno, Yoshiharu, Fujisawa, Yasuko, Yui, Masao, Takenaka, Daisuke, Koyama, Hisanobu, Sugihara, Naoki, Yoshikawa, Takeshi
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.06.2019
• Subjects: Lung; MRI; Nodule; Perfusion; PET/CT; CT; MRI; Perfusion; Lung; Nodule; PET/CT
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2019.03.018

•Dynamic first-pass CE-perfusion ADCT and MR imaging with ultra-short TE have similar potential capabilities, and are superior to FDG-PET/CT for differentiation of malignant from benign nodules.•The same results were also obtained in routine clinical practice for distinguishing nodules requiring aggressive intervention and treatment from those needing only follow-up examinations.•When applied same mathematical model, dynamic first-pass CE-perfusion ADCT and MR imaging with ultra-short TE had same potential for pulmonary nodule evaluation. To prospectively compare the capability of dynamic first-pass contrast-enhanced (CE) perfusion MR imaging with ultra-short TE and area-detector CT (ADCT), analyzed with the same mathematical methods, and that of FDG-PET/CT for diagnosis and management of solitary pulmonary nodules (SPNs). Our institutional review board approved this study and written informed consent was obtained from all subjects. A total 57 consecutive patients with 71 nodules prospectively underwent dynamic CE-perfusion ADCT and MR imaging with ultra-short TE, FDG-PET/CT, as well as microbacterial and/or pathological examinations. The nodules were classified into malignant nodules (n = 45) and benign nodules (n = 26). Pulmonary arterial, systemic arterial and total perfusions were determined by means of dual-input maximum slope models on ADCT and MR imaging and maximum values of standard uptake values (SUVmax) on PET/CT. Receiver operating characteristic (ROC) analysis was performed for each index, and sensitivity, specificity and accuracy were compared by McNemar's test. Areas under the curve (Azs) of total perfusion on ADCT (Az = 0.89) and MR imaging (Az = 0.88) were significantly larger than those of systemic arterial perfusion and MR imaging (p<0.05). Accuracy of total perfusion on ADCT (87.3% [62/71]) and MR imaging (87.3% [62/71]) was significantly higher than that of systemic arterial perfusion for both methods (77.5% [55/71] p = 0.02) and SUVmax (78.9% [56/71], p = 0.03). Dynamic CE-perfusion MR imaging with ultra-short TE and ADCT and have similar potential capabilities, and are superior to FDG-PET/CT in this setting.