Can Malignant and Benign Pulmonary Nodules Be Differentiated with Diffusion-Weighted MRI?
Shiro Satoh1,
Yoshio Kitazume1,
Shinichi Ohdama2,3,
Yuji Kimula4,5,
Shinichi Taura1 and
Yasuyuki Endo2,6
1 Department of Radiology, Ohme Municipal General Hospital, 4-16-5,
Higashi-Ohme, Ohme City, Tokyo 198-0042, Japan.
2 Department of Pulmonary Medicine, Ohme Municipal General Hospital, Ohme City,
Tokyo, Japan.
3 Present address: Department of Pulmonary Medicine, National Printing Bureau
Tokyo Hospital, Tokyo, Japan.
4 Department of Pathology, Ohme Municipal General Hospital, Ohme City, Tokyo,
Japan.
5 Present address: Department of Pathology, Kurashiki Medical Center, Kurashiki,
Japan.
6 Present address: Department of Pulmonary Medicine, Graduate School of Tokyo
Medical and Dental University, Tokyo, Japan.
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Fig. 1A —Images of small cell lung carcinoma in right upper lobe in
88-year-old man in whom diagnosis was true-positive. Transverse T1-weighted
image (TR/TE, 150/4.6) shows mass (arrow) in right upper lobe.
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Fig. 1B —Images of small cell lung carcinoma in right upper lobe in
88-year-old man in whom diagnosis was true-positive. Transverse
diffusion-weighted (DW) echo-planar image (3,084/70) obtained with b factor of
1,000 s/mm2 shows mass (arrow) with very high signal
intensity compared with spinal cord; it scored 5 on 5-point rank scale. Spinal
cord scored 3 on 5-point rank scale on DW images obtained with b factor of
1,000 s/mm2.
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Fig. 1C —Images of small cell lung carcinoma in right upper lobe in
88-year-old man in whom diagnosis was true-positive. Transverse T2-weighted
echo-planar image (3,084/70) obtained with b factor of 0 s/mm2
shows mass (arrow) with slightly low signal intensity compared with
CSF or saline bag and high signal intensity compared with dorsal muscle; it
scored 4 on 5-point rank scale. CSF or saline bag scored 5 on 5-point rank
scale on T2-weighted image obtained with b factor of 0 s/mm2.
Dorsal muscle scored 2 on 5-point rank scale on T2-weighted images obtained
with b factor of 0 s/mm2.
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Fig. 1D —Images of small cell lung carcinoma in right upper lobe in
88-year-old man in whom diagnosis was true-positive. Photomicrograph of
surgically resected specimen shows small cell lung carcinoma. Tumor cells are
densely packed, with scant cytoplasm. (H and E, x 40)
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Fig. 2A —Images of round atelectasis in right lower lobe in
68-year-old man in whom diagnosis was true-negative. Coronal T1-weighted image
(TR/TE, 119/4.6) shows mass (arrow) in right lower lobe.
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Fig. 2B —Images of round atelectasis in right lower lobe in
68-year-old man in whom diagnosis was true-negative. Transverse
diffusion-weighted (DW) image (4,654/70) obtained with b factor of 1,000
s/mm2 shows mass (arrow) with slightly lower signal
intensity compared with spinal cord; it scored 2 on 5-point rank scale. Spinal
cord scored 3 on 5-point rank scale on DW images obtained with b factor of
1,000 s/mm2.
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Fig. 2C —Images of round atelectasis in right lower lobe in
68-year-old man in whom diagnosis was true-negative. Transverse T2-weighted
image (4,654/70) obtained with b factor of 0 s/mm2 shows mass
(arrow) with slightly high signal intensity compared with dorsal
muscle; it scored 3 on 5-point rank scale. Small pleural effusion is evident
in posteromedial vicinity of mass. Dorsal muscle scored 2 on 5-point rank
scale on T2-weighted images obtained with b factor of 0 s/mm2.
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Fig. 2D —Images of round atelectasis in right lower lobe in
68-year-old man in whom diagnosis was true-negative. Photomicrograph of
CT-guided core lung biopsy specimen shows slight inflammatory cell
accumulation in alveolar septa and no neoplastic tissue. (H and E, x
4)
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Fig. 3A —Images of adenocarcinoma in left upper lobe in 53-year-old
man in whom diagnosis was false-negative. Transverse T1-weighted image (TR/TE,
148/4.6) shows nodule (arrow) in left upper lobe.
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Fig. 3B —Images of adenocarcinoma in left upper lobe in 53-year-old
man in whom diagnosis was false-negative. Transverse diffusion-weighted (DW)
image (3,602/50) obtained with b factor of 1,000 s/mm2 shows nodule
(arrow) with very low signal intensity similar to that of surrounding
more-normal lung; it scored 1 on 5-point rank scale. More-normal lung scored 1
on 5-point rank scale on DW images obtained with b factor of 1,000
s/mm2.
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Fig. 3C —Images of adenocarcinoma in left upper lobe in 53-year-old
man in whom diagnosis was false-negative. Photomicrograph of surgically
resected specimen shows well-differentiated adenocarcinoma of lung. Cuboidal
to columnar cells grow along alveolar walls in lepidic fashion. (H and E,
x10)
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Fig. 4B —Image of granuloma in left upper lobe in 62-year-old woman in
whom diagnosis was false-positive. Transverse diffusion-weighted (DW) image
(9,050/50) obtained with b factor of 1,000 s/mm2 shows nodule
(arrow) with very high signal intensity compared with spinal cord; it
scored 5 on 5-point rank scale. Spinal cord scored 3 on 5-point rank scale on
DW images obtained with b factor of 1,000 s/mm2.
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Fig. 5 —Receiver operating characteristic (ROC) curve of 5-point rank
scale for use in differentiation between malignant and benign pulmonary
nodules. Area under ROC curve is 0.796 (95% CI, 0.665–0.927).
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