Lung nodule detection in a high-risk population: Comparison of magnetic resonance imaging and low-dose computed tomography

Objective

To investigate the potential of MRI for lung nodule detection in a high-risk population in comparison to low-dose CT.

Methods

49 participants (31 men, 18 women, 51–71 years) of the German Lung Cancer Screening and Intervention Trial (LUSI) with a cancer-suspicious lung lesion in CT were examined with non-contrast-enhanced MRI of the lung at 1.5 T. Data were pseudonymized and presented at random order together with 30 datasets (23 in men, 7 in women, 18–64 years) from healthy volunteers. Two radiologists read the data for the presence of nodules. Sensitivity and specificity were calculated. Gold standard was either histology or long-term follow-up. Contrast-to-Noise-Ratio (CNR) was measured for all detected lesions in all MRI sequences.

Results

Average maximum diameter of the lesions was 15 mm. Overall sensitivity and specificity of MRI were 48% (26/54) and 88% (29/33) compared to low-dose CT. Sensitivity of MRI was significantly higher for malignant nodules (78% (12.5/16)) than for benign ones (36% (13.5/38); P = 0.007). There was no statistically significant difference in sensitivity between nodules (benign and malignant) larger or smaller than 10 mm (P = 0.7). Inter observer agreement was 84% (κ = 0.65). Lesion-to-background CNR of T2-weighted single-shot turbo-spin-echo was significantly higher for malignant nodules (89 ± 27) than for benign ones (56 ± 23; P = 0.002).

Conclusion

The sensitivity of MRI for detection of malignant pulmonary nodules in a high-risk population is 78%. Due to its inherent soft tissue contrast, MRI is more sensitive to malignant nodules than to benign ones. MRI may therefore represent a useful test for early detection of lung cancer.