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Woodworth CF, Frota Lima LM, Bartholmai BJ, Koo CW. Imaging of Solid Pulmonary Nodules. Clin Chest Med 2024; 45:249-261. [PMID: 38816086 DOI: 10.1016/j.ccm.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Early detection with accurate classification of solid pulmonary nodules is critical in reducing lung cancer morbidity and mortality. Computed tomography (CT) remains the most widely used imaging examination for pulmonary nodule evaluation; however, other imaging modalities, such as PET/CT and MRI, are increasingly used for nodule characterization. Current advances in solid nodule imaging are largely due to developments in machine learning, including automated nodule segmentation and computer-aided detection. This review explores current multi-modality solid pulmonary nodule detection and characterization with discussion of radiomics and risk prediction models.
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Affiliation(s)
- Claire F Woodworth
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Livia Maria Frota Lima
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Brian J Bartholmai
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Chi Wan Koo
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Peng L, Liao Y, Zhou R, Zhong Y, Jiang H, Wang J, Fu Y, Xue L, Zhang X, Sun M, Feng G, Meng Z, Peng S, He X, Teng G, Gao X, Zhang H, Tian M. [ 18F]FDG PET/MRI combined with chest HRCT in early cancer detection: a retrospective study of 3020 asymptomatic subjects. Eur J Nucl Med Mol Imaging 2023; 50:3723-3734. [PMID: 37401938 PMCID: PMC10547651 DOI: 10.1007/s00259-023-06273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/18/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE PET/MRI has become an important medical imaging approach in clinical practice. In this study, we retrospectively investigated the detectability of fluorine-18 (18F)-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging ([18F]FDG PET/MRI) combined with chest computerized tomography (CT) for early cancer in a large cohort of asymptomatic subjects. METHODS This study included a total of 3020 asymptomatic subjects who underwent whole-body [18F]FDG PET/MRI and chest HRCT examinations. All subjects received a 2-4-year follow-up for cancer development. Cancer detection rate, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the [18F]FDG PET/MRI with or without chest HRCT were calculated and analyzed. RESULTS Sixty-one subjects were pathologically diagnosed with cancers, among which 59 were correctly detected by [18F]FDG PET/MRI combined with chest HRCT. Of the 59 patients (32 with lung cancer, 9 with breast cancer, 6 with thyroid cancer, 5 with colon cancer, 3 with renal cancer, 1 with prostate cancer, 1 with gastric cancer, 1 with endometrial cancer, and 1 with lymphoma), 54 (91.5%) were at stage 0 or stage I (according to the 8th edition of the tumor-node-metastasis [TNM] staging system), 33 (55.9%) were detected by PET/MRI alone (27 with non-lung cancers and 6 with lung cancer). Cancer detection rate, sensitivity, specificity, PPV, and NPV for PET/MRI combined with chest CT were 2.0%, 96.7%, 99.6%, 83.1%, and 99.9%, respectively. For PET/MRI alone, the metrics were 1.1%, 54.1%, 99.6%, 73.3%, and 99.1%, respectively, and for PET/MRI in non-lung cancers, the metrics were 0.9%, 93.1%, 99.6%, 69.2%, and 99.9%, respectively. CONCLUSIONS [18F]FDG PET/MRI holds great promise for the early detection of non-lung cancers, while it seems insufficient for detecting early-stage lung cancers. Chest HRCT can be complementary to whole-body PET/MRI for early cancer detection. TRIAL REGISTRATION ChiCTR2200060041. Registered 16 May 2022. Public site: https://www.chictr.org.cn/index.html.
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Affiliation(s)
- Liling Peng
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Yi Liao
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Yan Zhong
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Han Jiang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Jing Wang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Yu Fu
- College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, China
| | - Le Xue
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Xiaohui Zhang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
| | - Mingxiang Sun
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Gang Feng
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Zhaoting Meng
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Sisi Peng
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Xuexin He
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Gaojun Teng
- Radiology Department, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
| | - Xin Gao
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China.
| | - Hong Zhang
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Zhejiang, Hangzhou, China.
- The College of Biomedical Engineering and Instrument Science, Zhejiang University, Zhejiang, Hangzhou, China.
| | - Mei Tian
- Department of Nuclear Medicine and PET-CT Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Human Phenome Institute, Fudan University, Shanghai, China.
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Takenaka D, Ozawa Y, Yamamoto K, Shinohara M, Ikedo M, Yui M, Oshima Y, Hamabuchi N, Nagata H, Ueda T, Ikeda H, Iwase A, Yoshikawa T, Toyama H, Ohno Y. Deep Learning Reconstruction to Improve the Quality of MR Imaging: Evaluating the Best Sequence for T-category Assessment in Non-small Cell Lung Cancer Patients. Magn Reson Med Sci 2023:mp.2023-0068. [PMID: 37661425 DOI: 10.2463/mrms.mp.2023-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
PURPOSE Deep learning reconstruction (DLR) has been recommended as useful for improving image quality. Moreover, compressed sensing (CS) or DLR has been proposed as useful for improving temporal resolution and image quality on MR sequences in different body fields. However, there have been no reports regarding the utility of DLR for image quality and T-factor assessment improvements on T2-weighted imaging (T2WI), short inversion time (TI) inversion recovery (STIR) imaging, and unenhanced- and contrast-enhanced (CE) 3D fast spoiled gradient echo (GRE) imaging with and without CS in comparison with thin-section multidetector-row CT (MDCT) for non-small cell lung cancer (NSCLC) patients. The purpose of this study was to determine the utility of DLR for improving image quality and the appropriate sequence for T-category assessment for NSCLC patients. METHODS As subjects for this study, 213 pathologically diagnosed NSCLC patients who underwent thin-section MDCT and MR imaging as well as T-factor diagnosis were retrospectively enrolled. SNR of each tumor was calculated and compared by paired t-test for each sequence with and without DLR. T-factor for each patient was assessed with thin-section MDCT and all MR sequences, and the accuracy for T-factor diagnosis was compared among all sequences and thin-section CT by means of McNemar's test. RESULTS SNRs of T2WI, STIR imaging, unenhanced thin-section Quick 3D imaging, and CE-thin-section Quick 3D imaging with DLR were significantly higher than SNRs of those without DLR (P < 0.05). Diagnostic accuracy of STIR imaging and CE-thick- or thin-section Quick 3D imaging was significantly higher than that of thin-section CT, T2WI, and unenhanced thick- or thin-section Quick 3D imaging (P < 0.05). CONCLUSION DLR is thus considered useful for image quality improvement on MR imaging. STIR imaging and CE-Quick 3D imaging with or without CS were validated as appropriate MR sequences for T-factor evaluation in NSCLC patients.
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Affiliation(s)
- Daisuke Takenaka
- Department of Radiology, Fujita Health University School of Medicine
- Department of Diagnostic Radiology, Hyogo Cancer Center
| | - Yoshiyuki Ozawa
- Department of Radiology, Fujita Health University School of Medicine
| | | | | | | | | | - Yuka Oshima
- Department of Radiology, Fujita Health University School of Medicine
| | - Nayu Hamabuchi
- Department of Radiology, Fujita Health University School of Medicine
| | - Hiroyuki Nagata
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University School of Medicine
| | - Akiyoshi Iwase
- Department of Radiology, Fujita Health University Hospital
| | - Takeshi Yoshikawa
- Department of Radiology, Fujita Health University School of Medicine
- Department of Diagnostic Radiology, Hyogo Cancer Center
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine
| | - Yoshiharu Ohno
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine
- Department of Diagnostic Radiology, Fujita Health University School of Medicine
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Liu S, Wei W, Wang J, Chen T. Theranostic applications of selenium nanomedicines against lung cancer. J Nanobiotechnology 2023; 21:96. [PMID: 36935493 PMCID: PMC10026460 DOI: 10.1186/s12951-023-01825-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/18/2023] [Indexed: 03/21/2023] Open
Abstract
The incidence and mortality rates of lung cancer are among the highest in the world. Traditional treatment methods include surgery, chemotherapy, and radiotherapy. Although rapid progress has been achieved in the past decade, treatment limitations remain. It is therefore imperative to identify safer and more effective therapeutic methods, and research is currently being conducted to identify more efficient and less harmful drugs. In recent years, the discovery of antitumor drugs based on the essential trace element selenium (Se) has provided good prospects for lung cancer treatments. In particular, compared to inorganic Se (Inorg-Se) and organic Se (Org-Se), Se nanomedicine (Se nanoparticles; SeNPs) shows much higher bioavailability and antioxidant activity and lower toxicity. SeNPs can also be used as a drug delivery carrier to better regulate protein and DNA biosynthesis and protein kinase C activity, thus playing a role in inhibiting cancer cell proliferation. SeNPs can also effectively activate antigen-presenting cells to stimulate cell immunity, exert regulatory effects on innate and regulatory immunity, and enhance lung cancer immunotherapy. This review summarizes the application of Se-based species and materials in lung cancer diagnosis, including fluorescence, MR, CT, photoacoustic imaging and other diagnostic methods, as well as treatments, including direct killing, radiosensitization, chemotherapeutic sensitization, photothermodynamics, and enhanced immunotherapy. In addition, the application prospects and challenges of Se-based drugs in lung cancer are examined, as well as their forecasted future clinical applications and sustainable development.
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Affiliation(s)
- Shaowei Liu
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Weifeng Wei
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Jinlin Wang
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
| | - Tianfeng Chen
- College of Chemistry and Materials Science, Guangdong Provincial Key Laboratory of Functional Supramolecular Coordination Materials and Applications, Jinan University, Guangzhou, 510632, China.
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Sanchez F, Tyrrell PN, Cheung P, Heyn C, Graham S, Poon I, Ung Y, Louie A, Tsao M, Oikonomou A. Detection of solid and subsolid pulmonary nodules with lung MRI: performance of UTE, T1 gradient-echo, and single-shot T2 fast spin echo. Cancer Imaging 2023; 23:17. [PMID: 36793094 PMCID: PMC9933280 DOI: 10.1186/s40644-023-00531-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Although MRI is a radiation-free imaging modality, it has historically been limited in lung imaging due to inherent technical restrictions. The aim of this study is to explore the performance of lung MRI in detecting solid and subsolid pulmonary nodules using T1 gradient-echo (GRE) (VIBE, Volumetric interpolated breath-hold examination), ultrashort time echo (UTE) and T2 Fast Spin Echo (HASTE, Half fourier Single-shot Turbo spin-Echo). METHODS Patients underwent a lung MRI in a 3 T scanner as part of a prospective research project. A baseline Chest CT was obtained as part of their standard of care. Nodules were identified and measured on the baseline CT and categorized according to their density (solid and subsolid) and size (> 4 mm/ ≤ 4 mm). Nodules seen on the baseline CT were classified as present or absent on the different MRI sequences by two thoracic radiologists independently. Interobserver agreement was determined using the simple Kappa coefficient. Paired differences were compared using nonparametric Mann-Whitney U tests. The McNemar test was used to evaluate paired differences in nodule detection between MRI sequences. RESULTS Thirty-six patients were prospectively enrolled. One hundred forty-nine nodules (100 solid/49 subsolid) with mean size 10.8 mm (SD = 9.4) were included in the analysis. There was substantial interobserver agreement (k = 0.7, p = 0.05). Detection for all nodules, solid and subsolid nodules was respectively; UTE: 71.8%/71.0%/73.5%; VIBE: 61.6%/65%/55.1%; HASTE 72.4%/72.2%/72.7%. Detection rate was higher for nodules > 4 mm in all groups: UTE 90.2%/93.4%/85.4%, VIBE 78.4%/88.5%/63.4%, HASTE 89.4%/93.8%/83.8%. Detection of lesions ≤4 mm was low for all sequences. UTE and HASTE performed significantly better than VIBE for detection of all nodules and subsolid nodules (diff = 18.4 and 17.6%, p = < 0.01 and p = 0.03, respectively). There was no significant difference between UTE and HASTE. There were no significant differences amongst MRI sequences for solid nodules. CONCLUSIONS Lung MRI shows adequate performance for the detection of solid and subsolid pulmonary nodules larger than 4 mm and can serve as a promising radiation-free alternative to CT.
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Affiliation(s)
- Felipe Sanchez
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Pascal N. Tyrrell
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, Department of Statistical Sciences, Institute of Medical Science, University of Toronto, 263 McCaul Street, Toronto, Ontario M5T 1WT Canada
| | - Patrick Cheung
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Chinthaka Heyn
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Simon Graham
- grid.17063.330000 0001 2157 2938Physical Sciences Platform of Sunnybrook Research Institute, Department of Medical Biophysics, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Ian Poon
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Yee Ung
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Alexander Louie
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - May Tsao
- grid.17063.330000 0001 2157 2938Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5 Canada
| | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
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State of the Art MR Imaging for Lung Cancer TNM Stage Evaluation. Cancers (Basel) 2023; 15:cancers15030950. [PMID: 36765907 PMCID: PMC9913625 DOI: 10.3390/cancers15030950] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Since the Radiology Diagnostic Oncology Group (RDOG) report had been published in 1991, magnetic resonance (MR) imaging had limited clinical availability for thoracic malignancy, as well as pulmonary diseases. However, technical advancements in MR systems, such as sequence and reconstruction methods, and adjustments in the clinical protocol for gadolinium contrast media administration have provided fruitful results and validated the utility of MR imaging (MRI) for lung cancer evaluations. These techniques include: (1) contrast-enhanced MR angiography for T-factor evaluation, (2) short-time inversion recovery turbo spin-echo sequences as well as diffusion-weighted imaging (DWI) for N-factor assessment, and (3) whole-body MRI with and without DWI and with positron emission tomography fused with MRI for M-factor or TNM stage evaluation as well as for postoperative recurrence assessment of lung cancer or other thoracic tumors using 1.5 tesla (T) or 3T systems. According to these fruitful results, the Fleischner Society has changed its position to approve of MRI for lung or thoracic diseases. The purpose of this review is to analyze recent advances in lung MRI with a particular focus on lung cancer evaluation, clinical staging, and recurrence assessment evaluation.
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Mirshahvalad SA, Metser U, Basso Dias A, Ortega C, Yeung J, Veit-Haibach P. 18F-FDG PET/MRI in Detection of Pulmonary Malignancies: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e221598. [PMID: 36692397 DOI: 10.1148/radiol.221598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background There have been conflicting results regarding fluorine 18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI diagnostic performance in lung malignant neoplasms. Purpose To evaluate the diagnostic performance of 18F-FDG PET/MRI for the detection of pulmonary malignant neoplasms. Materials and Methods A systematic search was conducted within the Scopus, Web of Science, and PubMed databases until December 31, 2021. Published original articles that met the following criteria were considered eligible for meta-analysis: (a) detecting malignant lesions in the lung, (b) comparing 18F-FDG PET/MRI with a valid reference standard, and (c) providing data for the meta-analytic calculations. A hierarchical method was used to pool the performances. The bivariate model was used to find the summary points and 95% CIs. The hierarchical summary receiver operating characteristic model was used to draw the summary receiver operating characteristic curve and calculate the area under the curve. The Higgins I2 statistic and Cochran Q test were used for heterogeneity assessment. Results A total of 43 studies involving 1278 patients met the inclusion criteria and were included in the meta-analysis. 18F-FDG PET/MRI had a pooled sensitivity and specificity of 96% (95% CI: 84, 99) and 100% (95% CI: 98, 100), respectively. 18F-FDG PET/CT had a pooled sensitivity and specificity of 99% (95% CI: 61, 100) and 99% (95% CI: 94, 100), respectively, which were comparable with those of 18F-FDG PET/MRI. At meta-regression, studies in which contrast media (P = .03) and diffusion-weighted imaging (P = .04) were used as a part of a pulmonary 18F-FDG PET/MRI protocol showed significantly higher sensitivities. Conclusion Fluorine 18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI was found to be accurate and comparable with 18F-FDG PET/CT in the detection of malignant pulmonary lesions, with significantly improved sensitivity when advanced acquisition protocols were used. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Seyed Ali Mirshahvalad
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Ur Metser
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Adriano Basso Dias
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Claudia Ortega
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Jonathan Yeung
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
| | - Patrick Veit-Haibach
- From the Joint Department of Medical Imaging (S.A.M., U.R., A.B.D., C.O., P.V.H.) and Division of Thoracic Surgery, Department of Surgery (J.Y.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, Canada M5G 2N2
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Bak SH, Kim C, Kim CH, Ohno Y, Lee HY. Magnetic resonance imaging for lung cancer: a state-of-the-art review. PRECISION AND FUTURE MEDICINE 2022. [DOI: 10.23838/pfm.2021.00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Wang X, Li X, Chen H, Peng Y, Li Y. Pulmonary MRI Radiomics and Machine Learning: Effect of Intralesional Heterogeneity on Classification of Lesion. Acad Radiol 2022; 29 Suppl 2:S73-S81. [PMID: 33495072 DOI: 10.1016/j.acra.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/09/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the effect of intralesional heterogeneity on differentiating benign and malignant pulmonary lesions, quantitative magnetic resonance imaging (MRI) radiomics, and machine learning methods were adopted. MATERIALS AND METHODS A total of 176 patients with multiparametric MRI were involved in this exploratory study. To investigate the effect of intralesional heterogeneity on lesion classification, a radiomics model called tumor heterogeneity model was developed and compared to the conventional radiomics model based on the entire tumor. In tumor heterogeneity model, each lesion was divided into five sublesions depending on the spatial location through clustering algorithm. From the five sublesions in multi-parametric MRI sequences, 1100 radiomics features were extracted. The recursive feature elimination method was employed to select features and support vector machine classifier was used to distinguish benign and malignant lesion. The performance of classification was evaluated with the receiver operating characteristic curve and the area under the curve (AUC) was the figure of merit. The 3-fold cross-validation (CV) with and without nesting was used to validate the model, respectively. RESULTS The tumor heterogeneity model (AUC = 0.74 ± 0.04 and 0.90 ± 0.03, CV with and without nesting, respectively) outperforms conventional model (AUC = 0.68 ± 0.04 and 0.87 ± 0.03). The difference between the two models is statistically significant (p = 0.03) for lesions greater than 18.80 cm3. CONCLUSION Intralesional heterogeneity influences the classification of pulmonary lesions. The tumor heterogeneity model tends to perform better than conventional radiomics model.
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Affiliation(s)
- Xinhui Wang
- School of Electronic and Information Engineering, Beijing Jiaotong University, Shangyuan Village No 3 in Haidian, Beijing, China
| | - Xinchun Li
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Houjin Chen
- School of Electronic and Information Engineering, Beijing Jiaotong University, Shangyuan Village No 3 in Haidian, Beijing, China.
| | - Yahui Peng
- School of Electronic and Information Engineering, Beijing Jiaotong University, Shangyuan Village No 3 in Haidian, Beijing, China
| | - Yanfeng Li
- School of Electronic and Information Engineering, Beijing Jiaotong University, Shangyuan Village No 3 in Haidian, Beijing, China
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Ohno Y, Takenaka D, Yoshikawa T, Yui M, Koyama H, Yamamoto K, Hamabuchi N, Shigemura C, Watanabe A, Ueda T, Ikeda H, Hattori H, Murayama K, Toyama H. Efficacy of Ultrashort Echo Time Pulmonary MRI for Lung Nodule Detection and Lung-RADS Classification. Radiology 2021; 302:697-706. [PMID: 34846203 DOI: 10.1148/radiol.211254] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Pulmonary MRI with ultrashort echo time (UTE) has been compared with chest CT for nodule detection and classification. However, direct comparisons of these methods' capabilities for Lung CT Screening Reporting and Data System (Lung-RADS) evaluation remain lacking. Purpose To compare the capabilities of pulmonary MRI with UTE with those of standard- or low-dose thin-section CT for Lung-RADS classification. Materials and Methods In this prospective study, standard- and low-dose chest CT (270 mA and 60 mA, respectively) and MRI with UTE were used to examine consecutive participants enrolled between January 2017 and December 2020 who met American College of Radiology Appropriateness Criteria for lung cancer screening with low-dose CT. Probability of nodule presence was assessed for all methods with a five-point visual scoring system by two board-certified radiologists. All nodules were then evaluated in terms of their Lung-RADS classification using each method. To compare nodule detection capability of the three methods, consensus for performances was rated by using jackknife free-response receiver operating characteristic analysis, and sensitivity was compared by means of the McNemar test. In addition, weighted κ statistics were used to determine the agreement between Lung-RADS classification obtained with each method and the reference standard generated from standard-dose CT evaluated by two radiologists who were not included in the image analysis session. Results A total of 205 participants (mean age: 64 years ± 7 [standard deviation], 106 men) with 1073 nodules were enrolled. Figure of merit (FOM) (P < .001) had significant differences among three modalities (standard-dose CT: FOM = 0.91, low-dose CT: FOM = 0.89, pulmonary MRI with UTE: FOM = 0.94), with no evidence of false-positive findings in participants with all modalities (P > .05). Agreements for Lung-RADS classification between all modalities and the reference standard were almost perfect (standard-dose CT: κ = 0.82, P < .001; low-dose CT: κ = 0.82, P < .001; pulmonary MRI with UTE: κ = 0.82, P < .001). Conclusion In a lung cancer screening population, ultrashort echo time pulmonary MRI was comparable to standard- or low-dose CT for Lung CT Screening Reporting and Data System classification. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Wielpütz in this issue.
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Affiliation(s)
- Yoshiharu Ohno
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Daisuke Takenaka
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Takeshi Yoshikawa
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Masao Yui
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Hisanobu Koyama
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Kaori Yamamoto
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Nayu Hamabuchi
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Chika Shigemura
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Ayumi Watanabe
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Takahiro Ueda
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Hirotaka Ikeda
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Hidekazu Hattori
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Kazuhiro Murayama
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
| | - Hiroshi Toyama
- From the Department of Radiology (Y.O., N.H., C.S., A.W., T.U., H.I., H.H., H.T.) and Joint Research Laboratory of Advanced Biomedical Imaging (Y.O., K.M.), Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan; Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (Y.O., T.Y.); Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan (D.T., T.Y.); Canon Medical Systems, Otawara, Japan (M.Y., K.Y.); and Department of Radiology, Osaka Police Hospital, Osaka, Japan (H.K.)
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11
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Lisini D, Lettieri S, Nava S, Accordino G, Frigerio S, Bortolotto C, Lancia A, Filippi AR, Agustoni F, Pandolfi L, Piloni D, Comoli P, Corsico AG, Stella GM. Local Therapies and Modulation of Tumor Surrounding Stroma in Malignant Pleural Mesothelioma: A Translational Approach. Int J Mol Sci 2021; 22:9014. [PMID: 34445720 PMCID: PMC8396500 DOI: 10.3390/ijms22169014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/06/2021] [Accepted: 08/17/2021] [Indexed: 12/21/2022] Open
Abstract
Malignant Pleural Mesothelioma (MPM) is a rare and aggressive neoplasm of the pleural mesothelium, mainly associated with asbestos exposure and still lacking effective therapies. Modern targeted biological strategies that have revolutionized the therapy of other solid tumors have not had success so far in the MPM. Combination immunotherapy might achieve better results over chemotherapy alone, but there is still a need for more effective therapeutic approaches. Based on the peculiar disease features of MPM, several strategies for local therapeutic delivery have been developed over the past years. The common rationale of these approaches is: (i) to reduce the risk of drug inactivation before reaching the target tumor cells; (ii) to increase the concentration of active drugs in the tumor micro-environment and their bioavailability; (iii) to reduce toxic effects on normal, non-transformed cells, because of much lower drug doses than those used for systemic chemotherapy. The complex interactions between drugs and the local immune-inflammatory micro-environment modulate the subsequent clinical response. In this perspective, the main interest is currently addressed to the development of local drug delivery platforms, both cell therapy and engineered nanotools. We here propose a review aimed at deep investigation of the biologic effects of the current local therapies for MPM, including cell therapies, and the mechanisms of interaction with the tumor micro-environment.
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Affiliation(s)
- Daniela Lisini
- Cell Therapy Production Unit-UPTC and Cerebrovascular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (D.L.); (S.N.); (S.F.)
| | - Sara Lettieri
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (S.L.); (G.A.); (L.P.); (D.P.); (A.G.C.)
| | - Sara Nava
- Cell Therapy Production Unit-UPTC and Cerebrovascular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (D.L.); (S.N.); (S.F.)
| | - Giulia Accordino
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (S.L.); (G.A.); (L.P.); (D.P.); (A.G.C.)
| | - Simona Frigerio
- Cell Therapy Production Unit-UPTC and Cerebrovascular Diseases Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (D.L.); (S.N.); (S.F.)
| | - Chandra Bortolotto
- Unit of Radiology, Department of Intensive Medicine, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy;
| | - Andrea Lancia
- Unit of Radiation Therapy, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (A.L.); (A.R.F.)
| | - Andrea Riccardo Filippi
- Unit of Radiation Therapy, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (A.L.); (A.R.F.)
| | - Francesco Agustoni
- Unit of Oncology, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy;
| | - Laura Pandolfi
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (S.L.); (G.A.); (L.P.); (D.P.); (A.G.C.)
| | - Davide Piloni
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (S.L.); (G.A.); (L.P.); (D.P.); (A.G.C.)
| | - Patrizia Comoli
- Cell Factory and Pediatric Hematology-Oncology Unit, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy;
| | - Angelo Guido Corsico
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (S.L.); (G.A.); (L.P.); (D.P.); (A.G.C.)
| | - Giulia Maria Stella
- Unit of Respiratory Diseases, Department of Medical Sciences and Infective Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, 27100 Pavia, Italy; (S.L.); (G.A.); (L.P.); (D.P.); (A.G.C.)
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12
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Tanaka Y, Ohno Y, Hanamatsu S, Obama Y, Ueda T, Ikeda H, Iwase A, Fukuba T, Hattori H, Murayama K, Yoshikawa T, Takenaka D, Koyama H, Toyama H. State-of-the-art MR Imaging for Thoracic Diseases. Magn Reson Med Sci 2021; 21:212-234. [PMID: 33952785 PMCID: PMC9199970 DOI: 10.2463/mrms.rev.2020-0184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Since thoracic MR imaging was first used in a clinical setting, it has been suggested that MR imaging has limited clinical utility for thoracic diseases, especially lung diseases, in comparison with x-ray CT and positron emission tomography (PET)/CT. However, in many countries and states and for specific indications, MR imaging has recently become practicable. In addition, recently developed pulmonary MR imaging with ultra-short TE (UTE) and zero TE (ZTE) has enhanced the utility of MR imaging for thoracic diseases in routine clinical practice. Furthermore, MR imaging has been introduced as being capable of assessing pulmonary function. It should be borne in mind, however, that these applications have so far been academically and clinically used only for healthy volunteers, but not for patients with various pulmonary diseases in Japan or other countries. In 2020, the Fleischner Society published a new report, which provides consensus expert opinions regarding appropriate clinical indications of pulmonary MR imaging for not only oncologic but also pulmonary diseases. This review article presents a brief history of MR imaging for thoracic diseases regarding its technical aspects and major clinical indications in Japan 1) in terms of what is currently available, 2) promising but requiring further validation or evaluation, and 3) developments warranting research investigations in preclinical or patient studies. State-of-the-art MR imaging can non-invasively visualize lung structural and functional abnormalities without ionizing radiation and thus provide an alternative to CT. MR imaging is considered as a tool for providing unique information. Moreover, prospective, randomized, and multi-center trials should be conducted to directly compare MR imaging with conventional methods to determine whether the former has equal or superior clinical relevance. The results of these trials together with continued improvements are expected to update or modify recommendations for the use of MRI in near future.
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Affiliation(s)
- Yumi Tanaka
- Department of Radiology, Fujita Health University School of Medicine
| | - Yoshiharu Ohno
- Department of Radiology, Fujita Health University School of Medicine.,Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine
| | - Satomu Hanamatsu
- Department of Radiology, Fujita Health University School of Medicine
| | - Yuki Obama
- Department of Radiology, Fujita Health University School of Medicine
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University School of Medicine
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University School of Medicine
| | - Akiyoshi Iwase
- Department of Radiology, Fujita Health University Hospital
| | - Takashi Fukuba
- Department of Radiology, Fujita Health University Hospital
| | - Hidekazu Hattori
- Department of Radiology, Fujita Health University School of Medicine
| | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine
| | | | | | | | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine
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13
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Nguyen ET, Bayanati H, Bilawich AM, Sanchez Tijmes F, Lim R, Harris S, Dennie C, Oikonomou A. Canadian Society of Thoracic Radiology/Canadian Association of Radiologists Clinical Practice Guidance for Non-Vascular Thoracic MRI. Can Assoc Radiol J 2021; 72:831-845. [PMID: 33781127 DOI: 10.1177/0846537121998961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Historically thoracic MRI has been limited by the lower proton density of lung parenchyma, cardiac and respiratory motion artifacts and long acquisition times. Recent technological advancements in MR hardware systems and improvement in MR pulse sequences have helped overcome these limitations and expand clinical opportunities for non-vascular thoracic MRI. Non-vascular thoracic MRI has been established as a problem-solving imaging modality for characterization of thymic, mediastinal, pleural chest wall and superior sulcus tumors and for detection of endometriosis. It is increasingly recognized as a powerful imaging tool for detection and characterization of lung nodules and for assessment of lung cancer staging. The lack of ionizing radiation makes thoracic MRI an invaluable imaging modality for young patients, pregnancy and for frequent serial follow-up imaging. Lack of familiarity and exposure to non-vascular thoracic MRI and lack of consistency in existing MRI protocols have called for clinical practice guidance. The purpose of this guide, which was developed by the Canadian Society of Thoracic Radiology and endorsed by the Canadian Association of Radiologists, is to familiarize radiologists, other interested clinicians and MR technologists with common and less common clinical indications for non-vascular thoracic MRI, discuss the fundamental imaging findings and focus on basic and more advanced MRI sequences tailored to specific clinical questions.
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Affiliation(s)
- Elsie T Nguyen
- Cardiothoracic Division, Joint Department of Medical Imaging, 33540Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hamid Bayanati
- Thoracic Division, Department of Medical Imaging, The Ottawa Hospital, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Ana-Maria Bilawich
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Felipe Sanchez Tijmes
- Joint Department of Medical Imaging, Toronto General Hospital, 7938University of Toronto, Toronto, Ontario, Canada
| | - Robert Lim
- Thoracic Division, Department of Medical Imaging, The Ottawa Hospital, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Scott Harris
- 7512Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, 7938University of Ottawa, Ottawa, Ontario, Canada.,Cardiac Radiology and MRI, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,27337The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, 7938University of Toronto, Toronto, Ontario, Canada
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Hu N, Yin S, Li Q, He H, Zhong L, Gong NJ, Guo J, Cai P, Xie C, Liu H, Qiu B. Evaluating Heterogeneity of Primary Lung Tumor Using Clinical Routine Magnetic Resonance Imaging and a Tumor Heterogeneity Index. Front Oncol 2021; 10:591485. [PMID: 33542900 PMCID: PMC7853693 DOI: 10.3389/fonc.2020.591485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To improve the assessment of primary tumor heterogeneity in magnetic resonance imaging (MRI) of non-small cell lung cancer (NSCLC), we proposed a method using basic measurements from T1- and T2-weighted MRI. Methods One hundred and four NSCLC patients with different T stages were studied. Fifty-two patients were analyzed as training group and another 52 as testing group. The ratios of standard deviation (SD)/mean signal value of primary tumor from T1-weighted (T1WI), T1-enhanced (T1C), T2-weighted (T2WI), and T2 fat suppression (T2fs) images were calculated. In the training group, correlation analyses were performed between the ratios and T stages. Then an ordinal regression model was built to generate the tumor heterogeneous index (THI) for evaluating the heterogeneity of tumor. The model was validated in the testing group. Results There were 11, 32, 40, and 21 patients with T1, T2, T3, and T4 disease, respectively. In the training group, the median SD/mean on T1WI, T1C, T2WI, and T2fs sequences was 0.11, 0.19, 0.16, and 0.15 respectively. The SD/mean on T1C (p=0.003), T2WI (p=0.000), and T2fs sequences (p=0.002) correlated significantly with T stages. Patients with more advanced T stage showed higher SD/mean on T2-weighted, T2fs, and T1C sequences. The median THI in the training group was 2.15. THI correlated with T stage significantly (p=0.000). In the testing group, THI was also significantly related to T stages (p=0.001). Higher THI had relevance to more advanced T stage. Conclusions The proposed ratio measurements and THI based on MRI can serve as functional radiomic markers that correlated with T stages for evaluating heterogeneity of lung tumors.
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Affiliation(s)
- Nan Hu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - ShaoHan Yin
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qiwen Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Haoqiang He
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Linchang Zhong
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Nan-Jie Gong
- Vector Lab for Intelligent Medical Imaging and Neural Engineering, International Innovation Center of Tsinghua University, Shanghai, China
| | - Jinyu Guo
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Peiqiang Cai
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chuanmiao Xie
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hui Liu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Guangdong Association Study of Thoracic Oncology, Guangzhou, China
| | - Bo Qiu
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Guangzhou, China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Radiation Oncology, Guangdong Association Study of Thoracic Oncology, Guangzhou, China
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Measurement Variability in Treatment Response Determination for Non-Small Cell Lung Cancer: Improvements Using Radiomics. J Thorac Imaging 2019; 34:103-115. [PMID: 30664063 DOI: 10.1097/rti.0000000000000390] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Multimodality imaging measurements of treatment response are critical for clinical practice, oncology trials, and the evaluation of new treatment modalities. The current standard for determining treatment response in non-small cell lung cancer (NSCLC) is based on tumor size using the RECIST criteria. Molecular targeted agents and immunotherapies often cause morphological change without reduction of tumor size. Therefore, it is difficult to evaluate therapeutic response by conventional methods. Radiomics is the study of cancer imaging features that are extracted using machine learning and other semantic features. This method can provide comprehensive information on tumor phenotypes and can be used to assess therapeutic response in this new age of immunotherapy. Delta radiomics, which evaluates the longitudinal changes in radiomics features, shows potential in gauging treatment response in NSCLC. It is well known that quantitative measurement methods may be subject to substantial variability due to differences in technical factors and require standardization. In this review, we describe measurement variability in the evaluation of NSCLC and the emerging role of radiomics.
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16
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Kim TJ, Kim CH, Lee HY, Chung MJ, Shin SH, Lee KJ, Lee KS. Management of incidental pulmonary nodules: current strategies and future perspectives. Expert Rev Respir Med 2019; 14:173-194. [PMID: 31762330 DOI: 10.1080/17476348.2020.1697853] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Detection and characterization of pulmonary nodules is an important issue, because the process is the first step in the management of lung cancers.Areas covered: Literature review was performed on May 15 2019 by using the PubMed, US National Library of Medicine National Institutes of Health, and the National Center for Biotechnology information. CT features helping identify the druggable mutations and predict the prognosis of malignant nodules were presented. Technical advancements in MRI and PET/CT were introduced for providing functional information about malignant nodules. Advances in various tissue biopsy techniques enabling molecular analysis and histologic diagnosis of indeterminate nodules were also presented. New techniques such as radiomics, deep learning (DL) technology, and artificial intelligence showing promise in differentiating between malignant and benign nodules were summarized. Recently, updated management guidelines for solid and subsolid nodules incidentally detected on CT were described. Risk stratification and prediction models for indeterminate nodules under active investigation were briefly summarized.Expert opinion: Advancement in CT knowledge has led to a better correlation between CT features and genomic alterations or tumor histology. Recent advances like PET/CT, MRI, radiomics, and DL-based approach have shown promising results in the characterization and prognostication of pulmonary nodules.
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Affiliation(s)
- Tae Jung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Cho Hee Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Ho Yun Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Myung Jin Chung
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Sun Hye Shin
- Respiratory and Critical Care Division of Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Kyung Jong Lee
- Respiratory and Critical Care Division of Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, South Korea
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Broncano J, Alvarado-Benavides AM, Bhalla S, Álvarez-Kindelan A, Raptis CA, Luna A. Role of advanced magnetic resonance imaging in the assessment of malignancies of the mediastinum. World J Radiol 2019; 11:27-45. [PMID: 30949298 PMCID: PMC6441936 DOI: 10.4329/wjr.v11.i3.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
In the new era of functional magnetic resonance imaging (MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high capability for lesion characterization and treatment monitoring. The application of several of these diagnostic weapons in a multiparametric fashion enables to better characterize thymic epithelial tumors and other mediastinal tumoral lesions, accurate assessment of the invasion of adjacent structures and detection of pathologic lymph nodes and metastasis. Also, “do not touch lesions” could be identified with the associated impact in the management of those patients. One of the hot-spots of the multiparametric chest MR is its ability to detect with acuity early response to treatment in patients with mediastinal malignant neoplasms. This has been related with higher rates of overall survival and progression free survival. Therefore, in this review we will analyze the current functional imaging techniques available (18F-Fluorodeoxiglucose positron emission tomography/computed tomography, diffusion-weighted imaging, dynamic contrast-enhanced MRI, diffusion tensor imaging and MR spectroscopy) for the evaluation of mediastinal lesions, with a focus in their correct acquisition and post-processing. Also, to review the clinical applications of these techniques in the diagnostic approach of benign and malignant conditions of the mediastinum.
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Affiliation(s)
- Jordi Broncano
- Cardiothoracic Imaging Unit, Hospital San Juan de Dios, Health Time, Cordoba 14012, Spain
| | - Ana María Alvarado-Benavides
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | - Sanjeev Bhalla
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | | | - Constantine A Raptis
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | - Antonio Luna
- MR imaging Unit, Clínica Las Nieves, Jaen 23007, Spain
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18
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Delacoste J, Dunet V, Dournes G, Lovis A, Rohner C, Elandoy C, Simons J, Long O, Piccini D, Stuber M, Prior JO, Nicod L, Beigelman-Aubry C. MR Volumetry of Lung Nodules: A Pilot Study. Front Med (Lausanne) 2019; 6:18. [PMID: 30809522 PMCID: PMC6379285 DOI: 10.3389/fmed.2019.00018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/21/2019] [Indexed: 01/05/2023] Open
Abstract
Introduction: Computed tomography (CT) is currently the reference modality for the detection and follow-up of pulmonary nodules. While 2D measurements are commonly used in clinical practice to assess growth, increasingly 3D volume measurements are being recommended. The goal of this pilot study was to evaluate preliminarily the capabilities of 3D MRI using ultra-short echo time for lung nodule volumetry, as it would provide a radiation-free modality for this task. Material and Methods: Artificial nodules were manufactured out of Agar and measured using an ultra-short echo time MRI sequence. CT data were also acquired as a reference. Image segmentation was carried out using an algorithm based on signal intensity thresholding (SIT). For comparison purposes, we also performed manual slice by slice segmentation. Volumes obtained with MRI and CT were compared. Finally, the volumetry of a lung nodule was evaluated in one human subject in comparison with CT. Results: Using the SIT technique, minimal bias was observed between CT and MRI across the entire range of volumes (2%) with limits of agreement below 14%. Comparison of manually segmented MRI and CT resulted in a larger bias (8%) and wider limits of agreement (-23% to 40%). In vivo, nodule volume differed of <16% between modalities with the SIT technique. Conclusion: This pilot study showed very good concordance between CT and UTE-MRI to quantify lung nodule volumes, in both a phantom and human setting. Our results enhance the potential of MRI to quantify pulmonary nodule volume with similar performance to CT.
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Affiliation(s)
- Jean Delacoste
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Gael Dournes
- Centre de Recherche Cardio-Thoracique de Bordeaux, Université de Bordeaux, Bordeaux, France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Pessac, France
| | - Alban Lovis
- Service of Pneumology, Department of Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Chantal Rohner
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Christel Elandoy
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Julien Simons
- Department of Physiotherapy, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Olivier Long
- Department of Physiotherapy, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Davide Piccini
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.,Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland
| | - Matthias Stuber
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.,Center for Biomedical Imaging, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurent Nicod
- Service of Pneumology, Department of Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
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Koo CW, Lu A, Takahashi EA, Simmons CL, Geske JR, Wigle D, Peikert T. Can MRI contribute to pulmonary nodule analysis? J Magn Reson Imaging 2018; 49:e256-e264. [PMID: 30575193 DOI: 10.1002/jmri.26587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is no accurate method distinguishing different types of pulmonary nodules. PURPOSE To investigate whether multiparametric 3T MRI biomarkers can distinguish malignant from benign pulmonary nodules, differentiate different types of neoplasms, and compare MRI-derived measurements with values from commonly used noninvasive imaging modalities. STUDY TYPE Prospective. SUBJECTS Sixty-eight adults with pulmonary nodules undergoing resection. SEQUENCES Respiratory triggered diffusion-weighted imaging (DWI), periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) fat saturated T2 -weighted imaging, T1 -weighted 3D volumetric interpolated breath-hold examination (VIBE) using CAIPIRINHA (controlled aliasing in parallel imaging results in a higher acceleration). ASSESSMENT/STATISTICS Apparent diffusion coefficient (ADC), T1 , T2 , T1 and T2 normalized to muscle (T1 /M and T2 /M), and dynamic contrast enhancement (DCE) values were compared with histology to determine whether they could distinguish malignant from benign nodules and discern primary from secondary malignancies using logistic regression. Predictability of primary neoplasm types was assessed using two-sample t-tests. MRI values were compared with positron emission tomography / computed tomography (PET/CT) to examine if they correlated with standardized uptake value (SUV) or CT Hounsfield unit (HU). Intra- and interreader agreements were assessed using intraclass correlations. RESULTS Forty-nine of 74 nodules were malignant. There was a significant association between ADC and malignancy (odds ratio 4.47, P < 0.05). ADC ≥1.3 μm2 /ms predicted malignancy. ADC, T1 , and T2 together predicted malignancy (P = 0.003). No MRI parameter distinguished primary from metastatic neoplasms. T2 predicted PET positivity (P = 0.016). T2 and T1 /M correlated with SUV (P < 0.05). Of 18 PET-negative malignant nodules, 12 (67%) had an ADC ≥1.3 μm2 /ms. With the exception of T2 , all noncontrast MRI parameters distinguished adenocarcinomas from carcinoid tumors (P < 0.05). T1 , T2 , T1 /M, and T2 /M correlated with HU and therefore can predict nodule density. Combined with ADC, washout enhancement, arrival time (AT), peak enhancement intensity (PEI), Ktrans , Kep , Ve collectively were predictive of malignancy (P = 0.012). Combined washin, washout, time to peak (TTP), AT, and PEI values predicted malignancy (P = 0.043). There was good observer agreement for most noncontrast MRI biomarkers. DATA CONCLUSION MRI can contribute to pulmonary nodule analysis. Multiparametric MRI might be better than individual MRI biomarkers in pulmonary nodule risk stratification. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Chi Wan Koo
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aiming Lu
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Jennifer R Geske
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis Wigle
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tobias Peikert
- Department of Medicine, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota, USA
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