Sumiaki Matsumoto

Non–Small Cell Lung Cancer: Whole-Body MR Examination for M-Stage Assessment—Utility for Whole-Body Diffusion-weighted Imaging Compared with Integrated FDG PET/CT

PURPOSE To prospectively and directly compare the capability of whole-body diffusion-weighted (DW) imaging, whole-body magnetic resonance (MR) imaging with and that without DW imaging, and integrated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for M-stage assessment in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS The institutional review board approved this study; informed consent was obtained from patients. A total of 203 NSCLC patients (109 men, 94 women; mean age, 72 years) prospectively underwent whole-body DW imaging, whole-body MR imaging, and FDG PET/CT. Final diagnosis of the M-stage in each patient was determined on the basis of results of all radiologic and follow-up examinations. Two chest radiologists and two nuclear medicine physicians independently assessed all examination results and used a five-point visual scoring system to evaluate the probability of metastases. Final diagnosis based on each of the methods was made by consensus of two readers. Receiver operating characteristic (ROC) analysis was used to compare the capability for M-stage assessment among whole-body DW imaging, whole-body MR imaging with and that without DW imaging, and PET/CT on a per-patient basis. Sensitivity, specificity, and accuracy were compared with the McNemar test. RESULTS Area under ROC curve (A(z)) values of whole-body MR imaging with DW imaging (A(z) = 0.87, P = .04) and integrated FDG PET/CT (A(z) = 0.89, P = .02) were significantly larger than that of whole-body DW imaging (A(z) = 0.79). Specificity and accuracy of whole-body MR imaging with (specificity, P = .02; accuracy, P < .01) and that without DW imaging (specificity, P = .02; accuracy, P = .01) and integrated FDG PET/CT (specificity, P < .01; accuracy, P < .01) were significantly higher than those of whole-body DW imaging. CONCLUSION Whole-body MR imaging with DW imaging can be used for M-stage assessment in NSCLC patients with accuracy as good as that of PET/CT.

Detection of bone metastases in non-small cell lung cancer patients: comparison of whole-body diffusion-weighted imaging (DWI), whole-body MR imaging without and with DWI, whole-body FDG-PET/CT, and bone scintigraphy.

To prospectively compare the capability for bone metastasis assessment of whole‐body diffusion‐weighted imaging (DWI), magnetic resonance imaging (MRI) without and with DWI, [18F] fluoro‐2‐D‐glucose positron emission tomography with computed tomography (FDG‐PET/CT) and bone scintigraphy in non‐small cell carcinoma (NSCLC) patients.

N stage disease in patients with non-small cell lung cancer: efficacy of quantitative and qualitative assessment with STIR turbo spin-echo imaging, diffusion-weighted MR imaging, and fluorodeoxyglucose PET/CT.

PURPOSE To prospectively compare the diagnostic capability of short inversion time inversion-recovery (STIR) turbo spin-echo (SE) imaging, diffusion-weighted (DW) magnetic resonance (MR) imaging, and fluorodeoxyglucose (FDG) combined positron emission tomography (PET) and computed tomography (CT) in N stage assessment in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This prospective study was approved by the institutional review board, and written informed consent was obtained from all patients. A total of 250 consecutive patients with NSCLC (136 men; mean age, 73 years; 114 women; mean age, 72 years) prospectively underwent pretherapeutic STIR turbo SE imaging, DW MR imaging, and FDG PET/CT, as well as surgical and pathologic examinations (N0 disease, n = 157; N1 disease, n = 72; N2 disease, n = 16; N3 disease, n = 5). Lymph node-to-saline ratio (LSR), lymph node-to-muscle ratio (LMR), apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV(max)), and visual scoring were assessed for 135 metastatic lymph nodes and 135 randomly selected nonmetastatic lymph nodes. Receiver operating characteristic curve analysis was used to determine feasible threshold values. Diagnostic capabilities for N stage assessment were compared with the McNemar test on a per-patient basis. RESULTS When feasible, threshold values were used for quantitative assessment; sensitivity and accuracy of LSR and LMR (sensitivity, 82.8%; accuracy, 86.8%) proved to be significantly higher than those of ADC (sensitivity: 74.2%, P = .01; accuracy: 84.4%, P = .04) and SUV(max) (sensitivity: 74.2%, P = .01). For qualitative assessment, sensitivity of STIR turbo SE imaging (77.4%) was significantly higher than that of DW MR imaging (71.0%, P = .03) and FDG PET/CT (69.9%, P = .02). CONCLUSION Quantitative and qualitative assessments of N stage disease in patients with NSCLC obtained with STIR turbo SE MR imaging are more sensitive and/or more accurate than those obtained with DW MR imaging and FDG PET/CT. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11110281/-/DC1.

Postoperative Lung Function in Lung Cancer Patients: Comparative Analysis of Predictive Capability of MRI, CT, and SPECT

OBJECTIVE The purpose of this study was to prospectively compare the utility of dynamic contrast-enhanced perfusion MRI in the prediction of postoperative lung function in patients with lung cancer with the utility of quantitative and qualitative assessment of CT and perfusion SPECT. SUBJECTS AND METHODS One hundred fifty lung cancer patients (87 men, 63 women) underwent dynamic perfusion MRI, MDCT, perfusion SPECT, and measurement of preoperative and postoperative forced expiratory volume in the first second of expiration (FEV1) expressed as percentage of predicted value. Postoperative FEV1 was predicted with dynamic perfusion MRI by semiquantitative assessment of the perfusion of whole lungs and resected segments of lungs, with quantitative assessment of functional lung volume on CT with commercially available software, with qualitative assessment of CT on the basis of the number of segments of total and resected lung, and with perfusion SPECT by assessment of uptake of microaggregated albumin particles in whole lungs and resected segments of lungs. Correlation and limits of agreement between actual and predicted postoperative FEV1 values were statistically evaluated. RESULTS Actual postoperative FEV1 had stronger correlation with postoperative FEV1 predicted from perfusion MRI (r = 0.87, p < 0.0001) and quantitative CT (r = 0.88, p < 0.0001) than with postoperative FEV1 predicted from qualitative CT (r = 0.83, p < 0.0001) and perfusion SPECT (r = 0.83, p < 0.0001). The limits of agreement between the actual postoperative FEV1 and postoperative FEV1 predicted from perfusion MRI (5.3% +/- 11.8% [mean +/- 2 SD]) were smaller than the values for postoperative FEV1 predicted from qualitative CT (6.8% +/- 14.4%) and perfusion SPECT (5.1% +/- 14.0%) and was almost equal to the value for postoperative FEV1 predicted from quantitative CT (5.0% +/- 11.6%). CONCLUSION Dynamic perfusion MRI is more accurate in prediction of the postoperative lung function of patients with lung cancer than are qualitative CT and perfusion SPECT and may be at least as accurate as quantitative CT.

Prognostic value of dynamic MR imaging for non-small-cell lung cancer patients after chemoradiotherapy.

To determine the prognostic value of dynamic MRI for non‐small‐cell lung cancer (NSCLC) patients after chemoradiotherapy.

Dynamic Oxygen-Enhanced MRI Versus Quantitative CT: Pulmonary Functional Loss Assessment and Clinical Stage Classification of Smoking-Related COPD

OBJECTIVE The purpose of the present study is to prospectively compare the capability of dynamic oxygen-enhanced MRI and quantitative CT for pulmonary functional loss assessment and clinical stage classification of smoking-related chronic obstructive pulmonary disease (COPD). SUBJECTS AND METHODS Ten nonsmoking and 61 consecutive smoking-related COPD subjects underwent dynamic oxygen-enhanced MRI, CT, and pulmonary function tests. COPD subjects were classified into four clinical stages on the basis of the ATS-ERS guidelines. Wash-in time and relative enhancement ratio maps were generated by pixel-by-pixel analyses. Mean wash-in time and relative enhancement ratio were determined as averages of region of interest (ROI) measurements. CT-based functional lung volumes were measured on quantitative CT using the density-masked CT technique. For comparison of assessment capability for smoking-related functional loss, the three parameters were correlated with the percentage predicted forced expiratory volume in 1 second (%FEV1) and the percentage predicted diffusing capacity of the lung for carbon monoxide corrected for alveolar volume (%DL(CO)/VA). To determine the clinical stage classification capability, these parameters were statistically compared for nonsmoking subjects and all clinical stages of smoking-related COPD subjects. RESULTS Correlation between mean wash-in time and %FEV1 (r = -0.74, p < 0.0001) and between mean relative enhancement ratio and %DL(CO)/VA (r = 0.66, p < 0.0001) was better than that between CT-based functional lung volume and either %FEV1 (r = 0.61, p < 0.0001) or %DL(CO)/VA (r = 0.56, p < 0.0001). Mean wash-in time showed a significant difference between nonsmoking and smoking-related COPD subjects at all clinical stages (p < 0.05). CONCLUSION Dynamic oxygen-enhanced MRI has potential for pulmonary functional loss assessment and clinical stage classification of smoking-related COPD as does quantitative CT.

Adaptive Iterative Dose Reduction Using 3D Processing for Reduced- and Low-Dose Pulmonary CT: Comparison With Standard-Dose CT for Image Noise Reduction and Radiological Findings

OBJECTIVE The purpose of this study was to determine the utility of adaptive iterative dose reduction using 3D processing (AIDR 3D) for image noise reduction and assessment of radiologic findings obtained with reduced- and low-dose chest CT in patients with various pulmonary diseases. SUBJECTS AND METHODS Chest CT examinations at three different tube current settings and using 16- and 64-MDCT scanners were performed for 37 patients. Standard-dose (150 mAs) data were reconstructed as thin-section CT without AIDR 3D, and low-dose (25 mAs) and reduced-dose (50 mAs) data were reconstructed as thin-section CT without and with AIDR 3D. To compare image quality, image noises at all CT doses were quantitatively assessed by region of interest measurements. For comparison of radiologic finding assessments, likelihoods of occurrence of emphysema, ground-glass opacity, reticular opacity, bronchiectasis, honeycomb pattern, and nodules were evaluated on a 5-point scale. Then, image noise and agreements of radiologic findings between standard-dose CT and others were statistically evaluated. RESULTS The image quality scores of reduced- and low-dose CT without AIDR 3D were significantly lower than those of both protocols with AIDR 3D and standard-dose CT (p<0.05). All intermethod agreements for emphysema, ground-glass opacity, bronchiectasis, honeycomb pattern, and nodules, except for those observed on low-dose CT without AIDR 3D, were almost perfect (κ>0.81). CONCLUSION AIDR 3D is useful for image noise reduction and assessment of radiologic findings obtained with reduced- and low-dose CT for patients with various pulmonary diseases.

Utility of phase contrast MR imaging for assessment of pulmonary flow and pressure estimation in patients with pulmonary hypertension: Comparison with right heart catheterization and echocardiography

To compare the utility of phase contrast MR imaging (PC‐MRI) for assessment of pulmonary flow and pressure estimation with that of right heart catheterization and echocardiography (cardiac US) in patients with pulmonary arterial hypertension (PAH).

Magnetic resonance imaging for lung cancer.

Since the publication of the Radiologic Diagnostic Oncology Group Report in 1991, the clinical application of pulmonary magnetic resonance imaging (MRI) in patients with lung cancer has been limited. In contrast, MRI for lung cancer has undergone continuous development, and several promising techniques have been introduced to overcome the previously suggested limitations. In addition, comparative studies involving multidetector-row computed tomography and positron emission tomography or positron emission tomography/computed tomography with 2-deoxy-2-[18F]fluoro-D-glucose have shown useful new clinical applications for MRI in lung cancer. Moreover, MRI can provide not only morphologic information based on various parameters such as T1 and T2 relaxation times, tissue diffusion, perfusion, etc. but also functional information; it also has a significant role in nuclear medicine studies. In this review article, we describe recent advances made in MRI with respect to lung cancer, focusing on (1) detection of solid pulmonary nodules; (2) characterization of solid pulmonary nodules; (3) TNM staging assessment using chest and whole-body MRI examinations; (4) prediction of postsurgical lung function; and (5) prediction of tumor treatment response. We believe that further basic studies, as well as studies on clinical applications of new MRI techniques, are important for improving the management of lung cancer patients.

Dynamic perfusion MRI: Capability for evaluation of disease severity and progression of pulmonary arterial hypertension in patients with connective tissue disease

To prospectively evaluate the capability of dynamic perfusion MRI for assessment of disease severity and progression to pulmonary arterial hypertension (PAH) in connective tissue disease (CTD) patients.