Added value of DCE-MRI in the management of cystic-cavitary lung lesions

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Background and objective:We evaluated the added value of dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) to CT in the evaluation of cystic-cavitary lung lesions. We aimed to compare morphological parameters, including wall thickness and inner wall irregularity, and to determine whether DCE-MRI with morphological and dynamic parameters was useful in indeterminate lesions. We also aimed to investigate the added value of DCE-MRI in terms of whether to biopsy, and if so the site of biopsy.Methods:This prospective study included 39 consecutive patients with cystic and/or cavitary lung lesions detected by CT who then underwent additional DCE-MRI. After initial evaluation, the lesions were classified as benign, indeterminate or malignant and the findings of CT and DCE-MRI compared with each other by considering the final diagnosis that was determined by histopathological findings and clinical evaluation and follow up.Results:The mean values for wall thickness obtained by DCE-MRI were lower and the range of wall thickness for indeterminate lesions was narrower than those obtained by CT (5.50–11.50 mm and 5.75–13.50 mm for DCE-MRI and CT), and inner wall irregularity on DCE-MRI was more sensitive in malignant lesions. Also, DCE-MRI obviated biopsy in three benign patients and changed the biopsy site in two patients.Conclusion:Our study suggests that DCE-MRI is helpful in indeterminate cystic-cavitary lung lesions, with morphological and dynamic features. It narrowed the range of wall thickness used for indeterminate lesions, was more sensitive than CT in determining malignant inner wall irregularity, and was also useful in determining the need for and appropriate site of biopsy.SUMMARY AT A GLANCEDCE-MRI is helpful in the assessment of the morphological and dynamic features of cystic-cavitary lung lesions. It is more sensitive than CT in the evaluation of wall thickness and irregularity. Lesion characteristics on DCE-MRI help identify the solid component and also determine the appropriate site for biopsy.Watch the video abstract

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