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Quantitative Investigation of Solitary Pulmonary Nodules: Dynamic Contrast-Enhanced MRI and Histopathologic Analysis

¹ Department of Radiology, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qinchun Rd., Hangzhou, Zhejiang Province 310003, China.
² Department of Pathology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
³ Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Graph shows time–signal intensity curve types derived from various solitary pulmonary nodules after bolus injection of gadopentetate dimeglumine.

View larger version (7K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Graph shows calculation of steepest slope value.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Bar graph shows distribution of time–signal intensity curve types for malignant, benign, and active inflammatory lesions. Light gray indicates type A curve; dark gray, type B curve; white, type C curve.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —48-year-old woman with adenocarcinoma. Axial dynamic MR image obtained 0 seconds after contrast injection shows hypointense nodule with indistinct margin.

View larger version (128K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —48-year-old woman with adenocarcinoma. Axial dynamic MR image obtained 30 seconds after contrast injection shows lesion has marked increase in signal intensity.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —48-year-old woman with adenocarcinoma. Photomicrograph shows microvessel density with antibodies against CD31 immunostaining is 47. Abundance of mostly immature tumor microvessels is evident. Vessels are stained brown. (x200)

View larger version (65K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —60-year-old woman with active tuberculosis. Axial dynamic MR image obtained 0 seconds after contrast injection shows hypointense nodule with indistinct margin.

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —60-year-old woman with active tuberculosis. Axial dynamic MR image obtained 30 seconds after contrast injection shows lesion has markedly increased signal intensity.

View larger version (115K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —60-year-old woman with active tuberculosis. Photomicrograph shows microvessel density with antibodies against CD31 immunostaining is 38. Abundance of dilated capillary vessels is evident. Vessels are stained brown. (x200)

View larger version (7K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Results of receiver operating characteristic analysis of steepest slope. Scattergram shows criteria for selecting cutoff point of steepest slope for greatest overall accuracy in differentiating benign from malignant or active inflammatory solitary pulmonary nodules with receiver operating curve analysis. When threshold value of 1.5%/s ( 1.5%/s indicating benign nodules) was selected, sensitivity and specificity were 81% (13 of 16 cases) and 98% (51 of 52 cases).

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Results of receiver operating characteristic analysis of steepest slope. Graph shows relation between sensitivity and specificity and steepest slope. Diamonds indicate sensitivity; squares, specificity.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Results of receiver operating characteristic analysis of steepest slope. Graph shows area under receiver operating characteristic curve for steepest slope.

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —Results of receiver operating characteristic analysis of enhancement ratio of signal intensity at fourth minute. Scattergram shows criterion for selecting cutoff point of enhancement ratios at the fourth minute for greatest overall accuracy in differentiating malignant from active inflammatory solitary pulmonary nodules by means of receiver operating curve analysis. When threshold value of 65% ( 65% indicated malignant nodules) was selected, sensitivity and specificity were 93% (37 of 40 cases) and 100% (12 of 12 cases).

View larger version (9K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —Results of receiver operating characteristic analysis of enhancement ratio of signal intensity at fourth minute. Graph shows relation between sensitivity and specificity and enhancement ratio of signal intensity at fourth minute. Triangles indicate sensitivity; diamonds, specificity.

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —Results of receiver operating characteristic analysis of enhancement ratio of signal intensity at fourth minute. Graph shows area under receiver operating characteristic curve for enhancement ratio of signal intensity at fourth minute.

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