Dynamic MRI of Solitary Pulmonary Nodules: Comparison of Enhancement Patterns of Malignant and Benign Small Peripheral Lung Lesions
Rei Kono1,
Kiminori Fujimoto1,
Hiroshi Terasaki1,
Nestor L. Müller2,
Seiya Kato3,
Junko Sadohara1,
Naofumi Hayabuchi1 and
Shinzo Takamori4
1 Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi,
Kurume, Fukuoka 830-0011, Japan.
2 Department of Radiology, Vancouver General Hospital and University of British
Columbia, Vancouver, BC, V5Z 1M9, Canada.
3 Department of Pathology, Kurume University School of Medicine, Kurume,
Japan.
4 Department of Surgery, Kurume University School of Medicine, Kurume,
Japan.
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Fig. 1 —66-year-old man with adenocarcinoma of the lung. Solitary
nodule measuring 15 mm in diameter is present in right middle lobe. Dynamic MR
images obtained before and after IV injection of gadopentetate dimeglumine
show rapid and relatively heterogeneous enhancement that continues to late
phase. Maximum enhancement ratio, 68%; time at maximum enhancement ratio, 2
minutes; slope, 34%/min; washout ratio, 4% (prior). Subsequent panels (left to
right) show dynamic MR images obtained at times noted. Last panel shows
placement of region of interest (ROI).
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Fig. 2A —66-year-old man with inactive tuberculoma in left upper lobe
of lung. Dynamic MR image obtained before bolus injection of gadopentetate
dimeglumine shows solitary nodule measuring 25 mm in diameter with low signal
intensity.
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Fig. 2B —66-year-old man with inactive tuberculoma in left upper lobe
of lung. Dynamic MR image obtained 6 minutes after contrast injection shows
lesion in A as being peripheral rim enhancement. Outer rim of lesion
shows gradual enhancement; most of central area shows no enhancement (thin-rim
enhancement).
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Fig. 2C —66-year-old man with inactive tuberculoma in left upper lobe
of lung. Photograph of cut surface shows thin-rim fibrous capsule, epithelioid
granulomas (arrows) on periphery, and areas of caseous necrosis with
scattered anthracosis in central portion.
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Fig. 2D —66-year-old man with inactive tuberculoma in left upper lobe
of lung. Photomicrograph shows small congestive capillaries (arrows)
scattered in border between fibrous rim and epithelioid granuloma with
scarring. (H and E, x100)
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Fig. 3A —30-year-old woman with hamartoma of middle lobe of lung.
Images show marked rim enhancement of solitary nodule measuring 29 mm in
diameter and mixture of gradually heterogeneous and irregular linear
enhancement and lack of enhancement (network enhancement) in central area.
Dynamic MR image obtained before contrast injection.
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Fig. 3B —30-year-old woman with hamartoma of middle lobe of lung.
Images show marked rim enhancement of solitary nodule measuring 29 mm in
diameter and mixture of gradually heterogeneous and irregular linear
enhancement and lack of enhancement (network enhancement) in central area.
Dynamic MR image obtained 3 minutes after contrast injection.
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Fig. 3C —30-year-old woman with hamartoma of middle lobe of lung.
Images show marked rim enhancement of solitary nodule measuring 29 mm in
diameter and mixture of gradually heterogeneous and irregular linear
enhancement and lack of enhancement (network enhancement) in central area.
Dynamic MR image obtained 8 minutes after contrast injection.
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Fig. 3D —30-year-old woman with hamartoma of middle lobe of lung.
Images show marked rim enhancement of solitary nodule measuring 29 mm in
diameter and mixture of gradually heterogeneous and irregular linear
enhancement and lack of enhancement (network enhancement) in central area.
Loupe magnification shows hamartoma well circumscribed with islands of
cartilage and fat. Outer fibrous rim of tumor exhibits invagination
(arrows) toward central cartilaginous tissue.
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Fig. 3E —30-year-old woman with hamartoma of middle lobe of lung.
Images show marked rim enhancement of solitary nodule measuring 29 mm in
diameter and mixture of gradually heterogeneous and irregular linear
enhancement and lack of enhancement (network enhancement) in central area.
Low-power photomicrograph shows tumor components. Cleftlike space in
invaginated stromal tissue is lined by respiratory epithelium
(arrows). M = primitive mesenchymal tissue, F = fat, C= cartilage. (H
and E, x20).
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Fig. 4A —Graphs show curves of time-enhancement ratios. Dotted lines
connect medians of enhancement ratios at each time point for each solitary
pulmonary nodule. Horizontal bars indicate medians; vertical bars, ranges.
Horizontal boundaries of boxes represent 25th and 75th percentiles of
interquartile range. Lung cancer.
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Fig. 4B —Graphs show curves of time-enhancement ratios. Dotted lines
connect medians of enhancement ratios at each time point for each solitary
pulmonary nodule. Horizontal bars indicate medians; vertical bars, ranges.
Horizontal boundaries of boxes represent 25th and 75th percentiles of
interquartile range. Focal organizing pneumonia.
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Fig. 4C —Graphs show curves of time-enhancement ratios. Dotted lines
connect medians of enhancement ratios at each time point for each solitary
pulmonary nodule. Horizontal bars indicate medians; vertical bars, ranges.
Horizontal boundaries of boxes represent 25th and 75th percentiles of
interquartile range. Tuberculoma.
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Fig. 4D —Graphs show curves of time-enhancement ratios. Dotted lines
connect medians of enhancement ratios at each time point for each solitary
pulmonary nodule. Horizontal bars indicate medians; vertical bars, ranges.
Horizontal boundaries of boxes represent 25th and 75th percentiles of
interquartile range. Hamartoma.
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Fig. 5A —68-year-old woman with focal organizing pneumonia in right
middle lobe of lung. Thin-section CT scan shows solitary nodule measuring
20-mm in diameter with irregular margin. Pleural tag is visible in subpleural
region.
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Fig. 5C —68-year-old woman with focal organizing pneumonia in right
middle lobe of lung. Dynamic MR image obtained 3 minutes after IV injection of
gadopentetate dimeglumine shows slightly heterogeneous enhancement that is
strongest in early phase (3 minutes = time at maximum enhancement ratio).
Signal intensity before and 3 and 6 minutes (time at maximum enhancement ratio
+ 3) after contrast injection was calculated by each region of interest.
Maximum enhancement ratio, 126%; slope, 42%/min; washout ratio, 15%.
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Fig. 5D —68-year-old woman with focal organizing pneumonia in right
middle lobe of lung. Photomicrograph shows focal organizing pneumonia lesion
characterized by patchy interstitial inflammation and air-space organizing
granulation tissue. Dilated small vessels (arrows) are highlighted
with congestion and intraalveolar hemorrhage. (H and E, x100)
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Fig. 6A —Graphs show receiver operating characteristic curve of
enhancement characteristics. Fraction of true-positive results (sensitivity)
and false-positive results (1 minus specificity) for maximum enhancement ratio
(thick solid line), slope (thin solid line), and washout
ratio (dashed line) as markers of malignancy. Value of 0.5 is no
better than expected by chance, and value of 1.0 reflects perfect indicator.
Graph shows receiver operating characteristic curve for differentiating lung
cancer from focal organizing pneumonia. Calculated area under curve is 0.72
for maximum enhancement ratio, 0.65 for slope, and 0.54 for washout ratio.
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Fig. 6B —Graphs show receiver operating characteristic curve of
enhancement characteristics. Fraction of true-positive results (sensitivity)
and false-positive results (1 minus specificity) for maximum enhancement ratio
(thick solid line), slope (thin solid line), and washout
ratio (dashed line) as markers of malignancy. Value of 0.5 is no
better than expected by chance, and value of 1.0 reflects perfect indicator.
Graph shows receiver operating characteristics curve for differentiating lung
cancer from benign solitary pulmonary nodules (tuberculoma and hamartoma).
Calculated area under curve is 0.87 for maximum enhancement ratio (thick
solid line), 0.97 for slope (thin solid line), and 0.75 for
washout ratio (dashed line).
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Copyright © 2007 by the American Roentgen Ray Society.
