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Pulmonary Nodule Detection in Patients with a Primary Malignancy Using Hybrid PET/MRI: Is There Value in Adding Contrast-Enhanced MR Imaging?

Lee KH, Park CM, Lee SM, Lee JM, Cho JY, Paeng JC, Ahn SY, Goo JM - PLoS ONE (2015)

Bottom Line: In the second session, the average detection rate was 53.3% for all nodules, 97.7% for FDG-avid, 35.0% for non-FDG-avid nodules, 85.5% for nodules≥5 mm and 30.9% for nodules<5 mm.The average JAFROC figure-of-merit was 0.837 in the first session and 0.848 in the second session.There were no significant differences in detection performance between sessions (P=0.48).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

ABSTRACT

Purpose: To investigate the added value of post-contrast VIBE (volumetric-interpolated breath-hold examination) to PET/MR imaging for pulmonary nodule detection in patients with primary malignancies.

Materials and methods: This retrospective institutional review board-approved study, with waiver of informed consent, included 51 consecutive patients who underwent 18F-fluorodeoxyglucose (FDG) PET/MR followed by PET/CT for cancer staging. In all patients, the thorax was examined with pre-and post-contrast VIBE MR with simultaneous PET acquisition. Two readers blinded to the patients' data independently recorded their level of suspicion for pulmonary nodules based on PET, pre-contrast VIBE, and fused PET/MR images (first session), and reassessed them 4-weeks later after addition of post-contrast VIBE (second session). Jackknife alternative free-response receiver-operating-characteristic (JAFROC) analysis was performed, with PET/CT as the reference standard.

Results: A total of 151 pulmonary nodules (44 FDG-avid, 107 non-FDG-avid nodules) were detected on PET/CT, including 62 nodules≥5 mm in diameter and 89 nodules<5 mm. In the first session, the average nodule detection rate was 53.3% for all nodules, 97.7% for FDG-avid, 35.0% for non-FDG-avid nodules, 87.9% for nodules≥5 mm and 29.2% for nodules<5 mm. In the second session, the average detection rate was 53.3% for all nodules, 97.7% for FDG-avid, 35.0% for non-FDG-avid nodules, 85.5% for nodules≥5 mm and 30.9% for nodules<5 mm. The average JAFROC figure-of-merit was 0.837 in the first session and 0.848 in the second session. There were no significant differences in detection performance between sessions (P=0.48).

Conclusion: The addition of post-contrast VIBE to hybrid PET/MR imaging provided no additional value in the detection of pulmonary nodules.

No MeSH data available.


Related in: MedlinePlus

An example of the FDG-avid nodule on PET/MR images (67-year-old man with lung cancer).The primary lung cancer lesion (arrow) is seen on CT image (A), pre-contrast VIBE (B) and post-contrast VIBE (C) images. This nodule (arrow) is also well-delineated as an FDG-avid nodule in the left upper lobe on PET (D) and fused PET/MR images (E).
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pone.0129660.g002: An example of the FDG-avid nodule on PET/MR images (67-year-old man with lung cancer).The primary lung cancer lesion (arrow) is seen on CT image (A), pre-contrast VIBE (B) and post-contrast VIBE (C) images. This nodule (arrow) is also well-delineated as an FDG-avid nodule in the left upper lobe on PET (D) and fused PET/MR images (E).

Mentions: Readers demonstrated substantial agreement in nodule detection (weighted kappa = 1.00 for PET, weighted kappa = 0.81–82 for PET/MR). Nodule detection rates on PET images and PET/MR images during the first and the second sessions are shown in Table 2. All 43 patients with FDG-avid nodules were identified on PET images (Fig 2). PET had a sensitivity of 28.5% (43/151) for all nodules and a sensitivity of 97.7% (43/44) for FDG-avid nodules. Both readers missed one FDG-avid nodule measuring 11 mm in diameter with low-level FDG uptake (SUVmax, 1.1 on PET/MR images). PET did not depict any nodules that were non-FDG-avid or < 5 mm in diameter. To the contrary, PET/MR images enabled the detection of non-FDG-avid nodules and small nodules < 5 mm in diameter. In the first session, the average nodule detection rate was 53.3% for all nodules, 97.7% for FDG-avid nodules, 35.0% for non-FDG-avid nodules, 87.9% for nodules ≥ 5 mm in diameter and 29.2% for nodules < 5 mm in diameter. In the second session with the addition of a post-contrast VIBE sequence, the average nodule detection rate was 53.3% for all nodules, 97.7% for FDG-avid nodules, 35.0% for non-FDG-avid nodules, 85.5% for nodules ≥ 5 mm in diameter and 30.9% for nodules < 5 mm in diameter. PET/MR imaging improved the sensitivity for nodule detection compared with PET alone with significantly higher sensitivity for all nodules (53.3% vs 28.5%, P < 0.001), for nodules that were not FDG avid (35.0% vs 0%, P < 0.001), and for nodules that were < 5 mm in diameter (29.2–30.9% vs 0%, P < 0.001). However, there were no significant differences in nodule detection rates between the first and second sessions for both readers 1 and 2 (P = 0.86) (Fig 3). In addition, the numbers of false-positive nodules annotated by readers 1 and 2 were as follows: 41 and 8 false-positive nodules by readers 1 and 2 during the first session; 43 and 7 false-positive nodules by readers 1 and 2 during the second session, respectively.


Pulmonary Nodule Detection in Patients with a Primary Malignancy Using Hybrid PET/MRI: Is There Value in Adding Contrast-Enhanced MR Imaging?

Lee KH, Park CM, Lee SM, Lee JM, Cho JY, Paeng JC, Ahn SY, Goo JM - PLoS ONE (2015)

An example of the FDG-avid nodule on PET/MR images (67-year-old man with lung cancer).The primary lung cancer lesion (arrow) is seen on CT image (A), pre-contrast VIBE (B) and post-contrast VIBE (C) images. This nodule (arrow) is also well-delineated as an FDG-avid nodule in the left upper lobe on PET (D) and fused PET/MR images (E).
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4465933&req=5

pone.0129660.g002: An example of the FDG-avid nodule on PET/MR images (67-year-old man with lung cancer).The primary lung cancer lesion (arrow) is seen on CT image (A), pre-contrast VIBE (B) and post-contrast VIBE (C) images. This nodule (arrow) is also well-delineated as an FDG-avid nodule in the left upper lobe on PET (D) and fused PET/MR images (E).
Mentions: Readers demonstrated substantial agreement in nodule detection (weighted kappa = 1.00 for PET, weighted kappa = 0.81–82 for PET/MR). Nodule detection rates on PET images and PET/MR images during the first and the second sessions are shown in Table 2. All 43 patients with FDG-avid nodules were identified on PET images (Fig 2). PET had a sensitivity of 28.5% (43/151) for all nodules and a sensitivity of 97.7% (43/44) for FDG-avid nodules. Both readers missed one FDG-avid nodule measuring 11 mm in diameter with low-level FDG uptake (SUVmax, 1.1 on PET/MR images). PET did not depict any nodules that were non-FDG-avid or < 5 mm in diameter. To the contrary, PET/MR images enabled the detection of non-FDG-avid nodules and small nodules < 5 mm in diameter. In the first session, the average nodule detection rate was 53.3% for all nodules, 97.7% for FDG-avid nodules, 35.0% for non-FDG-avid nodules, 87.9% for nodules ≥ 5 mm in diameter and 29.2% for nodules < 5 mm in diameter. In the second session with the addition of a post-contrast VIBE sequence, the average nodule detection rate was 53.3% for all nodules, 97.7% for FDG-avid nodules, 35.0% for non-FDG-avid nodules, 85.5% for nodules ≥ 5 mm in diameter and 30.9% for nodules < 5 mm in diameter. PET/MR imaging improved the sensitivity for nodule detection compared with PET alone with significantly higher sensitivity for all nodules (53.3% vs 28.5%, P < 0.001), for nodules that were not FDG avid (35.0% vs 0%, P < 0.001), and for nodules that were < 5 mm in diameter (29.2–30.9% vs 0%, P < 0.001). However, there were no significant differences in nodule detection rates between the first and second sessions for both readers 1 and 2 (P = 0.86) (Fig 3). In addition, the numbers of false-positive nodules annotated by readers 1 and 2 were as follows: 41 and 8 false-positive nodules by readers 1 and 2 during the first session; 43 and 7 false-positive nodules by readers 1 and 2 during the second session, respectively.

Bottom Line: In the second session, the average detection rate was 53.3% for all nodules, 97.7% for FDG-avid, 35.0% for non-FDG-avid nodules, 85.5% for nodules≥5 mm and 30.9% for nodules<5 mm.The average JAFROC figure-of-merit was 0.837 in the first session and 0.848 in the second session.There were no significant differences in detection performance between sessions (P=0.48).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.

ABSTRACT

Purpose: To investigate the added value of post-contrast VIBE (volumetric-interpolated breath-hold examination) to PET/MR imaging for pulmonary nodule detection in patients with primary malignancies.

Materials and methods: This retrospective institutional review board-approved study, with waiver of informed consent, included 51 consecutive patients who underwent 18F-fluorodeoxyglucose (FDG) PET/MR followed by PET/CT for cancer staging. In all patients, the thorax was examined with pre-and post-contrast VIBE MR with simultaneous PET acquisition. Two readers blinded to the patients' data independently recorded their level of suspicion for pulmonary nodules based on PET, pre-contrast VIBE, and fused PET/MR images (first session), and reassessed them 4-weeks later after addition of post-contrast VIBE (second session). Jackknife alternative free-response receiver-operating-characteristic (JAFROC) analysis was performed, with PET/CT as the reference standard.

Results: A total of 151 pulmonary nodules (44 FDG-avid, 107 non-FDG-avid nodules) were detected on PET/CT, including 62 nodules≥5 mm in diameter and 89 nodules<5 mm. In the first session, the average nodule detection rate was 53.3% for all nodules, 97.7% for FDG-avid, 35.0% for non-FDG-avid nodules, 87.9% for nodules≥5 mm and 29.2% for nodules<5 mm. In the second session, the average detection rate was 53.3% for all nodules, 97.7% for FDG-avid, 35.0% for non-FDG-avid nodules, 85.5% for nodules≥5 mm and 30.9% for nodules<5 mm. The average JAFROC figure-of-merit was 0.837 in the first session and 0.848 in the second session. There were no significant differences in detection performance between sessions (P=0.48).

Conclusion: The addition of post-contrast VIBE to hybrid PET/MR imaging provided no additional value in the detection of pulmonary nodules.

No MeSH data available.


Related in: MedlinePlus