Solitary pulmonary nodules: Association between signal characteristics in dynamic contrast enhanced MRI and tumor angiogenesis

• Published in: Lung cancer (Amsterdam, Netherlands) Netherlands), 2006-07, Vol.53 (1), p.39-49
• Main Authors: Schaefer, Juergen F., Schneider, Vincent, Vollmar, Joachim, Wehrmann, Manfred, Aebert, Hermann, Friedel, Godehard, Vonthein, Reinhard, Schick, Fritz, Claussen, Claus D.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - blood supply; Adenocarcinoma - diagnosis; Adenocarcinoma - secondary; Adult; Aged; Angiogenesis; Biological and medical sciences; Carcinoma, Squamous Cell - blood supply; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - secondary; Contrast Media; Female; Gadolinium DTPA; Humans; Lung disease; Lung neoplasm; Lung Neoplasms - blood supply; Lung Neoplasms - diagnosis; Lung Neoplasms - pathology; Lung nodule; Lymph Nodes - pathology; Magnetic resonance (MR); Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Neovascularization, Pathologic - diagnosis; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Solitary Pulmonary Nodule - diagnosis; Solitary Pulmonary Nodule - radiotherapy; Solitary Pulmonary Nodule - secondary; Tumors of the respiratory system and mediastinum
• ISSN: 0169-5002; 1872-8332
• DOI: 10.1016/j.lungcan.2006.03.010

To estimate the association between signal characteristic of dynamic enhanced MRI using curve types and angiogenesis in solitary pulmonary nodules. Thirty-six patients with a solitary pulmonary nodule (SPN) ranging in size from 6 to 37 mm (median 17 mm) underwent dynamic contrast enhanced MRI with a time interval of 10 s over a total period of 4 min. Resulting from the time–intensity curves four different enhancement curve profiles (A–D) were defined: type A with strong increase followed by early washout, type B with strong increase without washout, type C with slow increase and type D without relevant increase. Maximum peak ( P max), slope of the first bolus transit (slope) and washout were calculated. Microvessel densities (MVD) were counted at the margins and at the center of the nodules. The mean MVD of each nodule was calculated. Enhancement characteristics were correlated with MVD grouped by diagnosis and by curve types. Curve types were correlated with the score of vascular endothelial growth factor (VEGF). The frequency of malignancy was 55% (20/36). Using curve types for differentiation between malignant and benign SPN, the sensitivity, specificity and accuracy were 100%, 75% and 89%, respectively. The correlation between P max and MVD mean for all nodules was moderate ( r s = 0.4, P = 0.02). A relevant correlation was found between P max and MVD margin in curve type A ( r s = 0.63; P = 0.04) and P max and MVD mean in curve type C ( r s = 0.86; P = 0.006). No positive correlation was found between P max and MVD (mean, center and margin) in curve type B. No significant correlation was found for slope and washout. VEGF score correlated positively with curve types ( r s = 0.67; P < 0.001). A relevant association between perfusion curve profiles and angiogenesis was found in malignant nodules having early washout and in benign lesion with a slow increase of enhancement. In cases of strong signal increase without washout additional factors for enhancement must be considered. The use of curve profiles could allow for the estimation of the extent of VEGF.