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http://dx.doi.org/10.3348/kjr.2016.17.5.684

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)
Publication Information
Korean Journal of Radiology / v.17, no.5, 2016 , pp. 684-694 More about this Journal
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
PET/MR; PET/MRI; MR/PET; Lung; Pulmonary nodule; Inspiration; Expiration;
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