Korean Journal of Radiology

  • 제20권5호
  • /
  • Pages.854-861
  • /
  • 2019
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Quantitative Thoracic Magnetic Resonance Criteria for the Differentiation of Cysts from Solid Masses in the Anterior Mediastinum

  • Eui Jin Hwang (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • MunYoung Paek (Siemens Healthineers) ;
  • Soon Ho Yoon (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jihang Kim (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Ho Yun Lee (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jin Mo Goo (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hyungjin Kim (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Heekyung Kim (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jeanne B. Ackman (Department of Radiology, Massachusetts General Hospital, Harvard Medical School)
  • 투고 : 2018.10.08
  • 심사 : 2019.01.12
  • 발행 : 2019.05.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To evaluate quantitative magnetic resonance imaging (MRI) parameters for differentiation of cysts from and solid masses in the anterior mediastinum. Materials and Methods: The development dataset included 18 patients from two institutions with pathologically-proven cysts (n = 6) and solid masses (n = 12) in the anterior mediastinum. We measured the maximum diameter, normalized T1 and T2 signal intensity (nT1 and nT2), normalized apparent diffusion coefficient (nADC), and relative enhancement ratio (RER) of each lesion. RERs were obtained by non-rigid registration and subtraction of precontrast and postcontrast T1-weighted images. Differentiation criteria between cysts and solid masses were identified based on receiver operating characteristics analysis. For validation, two separate datasets were utilized: 15 patients with 8 cysts and 7 solid masses from another institution (validation dataset 1); and 11 patients with clinically diagnosed cysts stable for more than two years (validation dataset 2). Sensitivity and specificity were calculated from the validation datasets. Results: nT2, nADC, and RER significantly differed between cysts and solid masses (p = 0.032, 0.013, and < 0.001, respectively). The following criteria differentiated cysts from solid masses: RER < 26.1%; nADC > 0.63; nT2 > 0.39. In validation dataset 1, the sensitivity of the RER, nADC, and nT2 criteria was 87.5%, 100%, and 75.0%, and the specificity was 100%, 40.0%, and 57.4%, respectively. In validation dataset 2, the sensitivity of the RER, nADC, and nT2 criteria was 90.9%, 90.9%, and 72.7%, respectively. Conclusion: Quantitative MRI criteria using nT2, nADC, and particularly RER can assist differentiation of cysts from solid masses in the anterior mediastinum.

키워드

참고문헌

  1. Araki T, Nishino M, Gao W, Dupuis J, Washko GR, Hunninghake GM, et al. Anterior mediastinal masses in the framingham heart study: prevalence and CT image characteristics. Eur J Radiol Open 2015;2:26-31 
  2. Henschke CI, Lee IJ, Wu N, Farooqi A, Khan A, Yankelevitz D, et al. CT screening for lung cancer: prevalence and incidence of mediastinal masses. Radiology 2006;239:586-590 
  3. Yoon SH, Choi SH, Kang CH, Goo JM. Incidental anterior mediastinal nodular lesions on chest CT in asymptomatic subjects. J Thorac Oncol 2018;13:359-366 
  4. Shahrzad M, Le TS, Silva M, Bankier AA, Eisenberg RL. Anterior mediastinal masses. AJR Am J Roentgenol 2014;203:W128-W138 
  5. Ackman JB, Verzosa S, Kovach AE, Louissaint A Jr, Lanuti M, Wright CD, et al. High rate of unnecessary thymectomy and its cause. Can computed tomography distinguish thymoma, lymphoma, thymic hyperplasia, and thymic cysts? Eur J Radiol 2015;84:524-533 
  6. Carter BW, Okumura M, Detterbeck FC, Marom EM. Approaching the patient with an anterior mediastinal mass: a guide for radiologists. J Thorac Oncol 2014;9(9 Suppl 2):S110-S118 
  7. Tomiyama N, Honda O, Tsubamoto M, Inoue A, Sumikawa H, Kuriyama K, et al. Anterior mediastinal tumors: diagnostic accuracy of CT and MRI. Eur J Radiol 2009;69:280-288 
  8. Birnbaum BA, Hindman N, Lee J, Babb JS. Renal cyst pseudoenhancement: influence of multidetector CT reconstruction algorithm and scanner type in phantom model. Radiology 2007;244:767-775 
  9. Jurado J, Javidfar J, Newmark A, Lavelle M, Bacchetta M, Gorenstein L, et al. Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients. Ann Thorac Surg 2012;94:974-981; discussion 981-982 
  10. Kent MS, Wang T, Gangadharan SP, Whyte RI. What is the prevalence of a "nontherapeutic" thymectomy? Ann Thorac Surg 2014;97:276-282; discussion 282 
  11. Ackman JB, Gaissert HA, Lanuti M, Digumarthy SR, Shepard JA, Halpern EF, et al. Impact of nonvascular thoracic MR imaging on the clinical decision making of thoracic surgeons: a 2-year prospective study. Radiology 2016;280:464-474 
  12. Ackman JB, Wu CC. MRI of the thymus. AJR Am J Roentgenol 2011;197:W15-W20 
  13. Merine DS, Fishman EK, Zerhouni EA. Computed tomography and magnetic resonance imaging diagnosis of thymic cyst. J Comput Tomogr 1988;12:220-222 
  14. Inaoka T, Takahashi K, Mineta M, Yamada T, Shuke N, Okizaki A, et al. Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging. Radiology 2007;243:869-876 
  15. Zhang W, Zhou Y, Xu XQ, Kong LY, Xu H, Yu TF, et al. A whole-tumor histogram analysis of apparent diffusion coefficient maps for differentiating thymic carcinoma from lymphoma. Korean J Radiol 2018;19:358-365 
  16. Ackman JB. MR imaging of mediastinal masses. Magn Reson Imaging Clin N Am 2015;23:141-164 
  17. Carter BW, Betancourt SL, Benveniste MF. MR imaging of mediastinal masses. Top Magn Reson Imaging 2017;26:153-165 
  18. Shin KE, Yi CA, Kim TS, Lee HY, Choi YS, Kim HK, et al. Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT. Eur Radiol 2014;24:677-684 
  19. Bae KT, Heiken JP, Siegel CL, Bennett HF. Renal cysts: is attenuation artifactually increased on contrast-enhanced CT images? Radiology 2000;216:792-796 
  20. Maki DD, Birnbaum BA, Chakraborty DP, Jacobs JE, Carvalho BM, Herman GT. Renal cyst pseudoenhancement: beam-hardening effects on CT numbers. Radiology 1999;213:468-472 
  21. Ho VB, Allen SF, Hood MN, Choyke PL. Renal masses: quantitative assessment of enhancement with dynamic MR imaging. Radiology 2002;224:695-700 
  22. Romeo V, Esposito A, Maurea S, Camera L, Mainenti PP, Palmieri G, et al. Correlative imaging in a patient with cystic thymoma: CT, MR and PET/CT comparison. Pol J Radiol 2015;80:22-26 
  23. Daye D, Ackman JB. Characterization of mediastinal masses by MRI: techniques and applications. Appl Radiol 2017;46:10-22