Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Diagnosing Lung Nodules on Oncologic MR/PET Imaging: Comparison of Fast T1-Weighted Sequences and Influence of Image Acquisition in Inspiration and Expiration Breath-Hold

  • Schwenzer, Nina F. (Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen) ;
  • Seith, Ferdinand (Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen) ;
  • Gatidis, Sergios (Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen) ;
  • Brendle, Cornelia (Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen) ;
  • Schmidt, Holger (Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen) ;
  • Pfannenberg, Christina A. (Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen) ;
  • laFougere, Christian (Department of Nuclear Medicine, University Hospital of Tuebingen) ;
  • Nikolaou, Konstantin (Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen) ;
  • Schraml, Christina (Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen)
  • Received : 2015.12.05
  • Accepted : 2016.04.26
  • Published : 2016.09.01
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Abstract

Objective: First, to investigate the diagnostic performance of fast T1-weighted sequences for lung nodule evaluation in oncologic magnetic resonance (MR)/positron emission tomography (PET). Second, to evaluate the influence of image acquisition in inspiration and expiration breath-hold on diagnostic performance. Materials and Methods: The study was approved by the local Institutional Review Board. PET/CT and MR/PET of 44 cancer patients were evaluated by 2 readers. PET/CT included lung computed tomography (CT) scans in inspiration and expiration (CTin, CTex). MR/PET included Dixon sequence for attenuation correction and fast T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences (volume interpolated breath-hold examination acquired in inspiration [VIBEin], volume interpolated breath-hold examination acquired in expiration [VIBEex]). Diagnostic performance was analyzed for lesion-, lobe-, and size-dependence. Diagnostic confidence was evaluated (4-point Likert-scale; 1 = high). Jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed. Results: Seventy-six pulmonary lesions were evaluated. Lesion-based detection rates were: CTex, 77.6%; VIBEin, 53.3%; VIBEex, 51.3%; and Dixon, 22.4%. Lobe-based detection rates were: CTex, 89.6%; VIBEin, 58.3%; VIBEex, 60.4%; and Dixon, 31.3%. In contrast to CT, inspiration versus expiration did not alter diagnostic performance in VIBE sequences. Diagnostic confidence was best for VIBEin and CTex and decreased in VIBEex and Dixon ($1.2{\pm}0.6$; $1.2{\pm}0.7$; $1.5{\pm}0.9$; $1.7{\pm}1.1$, respectively). The JAFROC figure-of-merit of Dixon was significantly lower. All patients with malignant lesions were identified by CTex, VIBEin, and VIBEex, while 3 patients were false-negative in Dixon. Conclusion: Fast T1-weighted VIBE sequences allow for identification of patients with malignant pulmonary lesions. The Dixon sequence is not recommended for lung nodule evaluation in oncologic MR/PET patients. In contrast to CT, inspiration versus expiratory breath-hold in VIBE sequences was less crucial for lung nodule evaluation but was important for diagnostic confidence.

Keywords

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