Small peripheral pulmonary carcinomas evaluated with dynamic MR imaging: correlation with tumor vascularity and prognosis.
OBJECTIVE
To correlate the findings at contrast material-enhanced dynamic magnetic resonance (MR) imaging of small peripheral pulmonary carcinomas with tumor vascularity and prognosis.


METHODS
Ninety-four patients with small peripheral pulmonary carcinomas who underwent surgical resection were examined retrospectively. Pathologic specimens were stained with hematoxylin-eosin and elastin-van Gieson. CD34 and vascular endothelial growth factor (VEGF) were assessed immunohistochemically. Delineated CD34-positive cells were counted as microvessels. Dynamic MR imaging was performed prior to and at 1, 2, 3, 4, 5, 6, and 8 minutes after injection of a bolus of gadopentetate dimeglumine. The two observers reviewed all images, and two pathologists performed all histologic analyses; a decision was determined with consensus. The maximum enhancement ratio (MER), the time lapse between the completion of the injection and the point of maximum signal intensity (Tmax), the washout ratio, and the slope value of the time-signal intensity curve were correlated with the microvessel density. VEGF-positive and VEGF-negative tumors were compared. All statistical analyses were performed by using nonparametric methods.


RESULTS
The MER and the slope value were positively correlated, and the Tmax was negatively correlated (Spearman rank test, P <.0001, all comparisons) with the microvessel counts. The distribution of elastic and collagen fibers correlated with the washout ratio (Kruskal-Wallis test, P <.001). There was a statistically significant difference between the slope value of VEGF-positive tumors and that of VEGF-negative tumors (Mann-Whitney U test, P <.0001). Patients with VEGF-positive tumors had a significantly shorter overall survival than did those with VEGF-negative tumors (log-rank test, P <.0001).


CONCLUSIONS
Dynamic MR imaging findings correlate with tumor vascularity and may be helpful in the prediction of prognosis.
Fujimoto
Kiminori
K
Department of Radiology, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan. kimichan@med.kurume-u.ac.jp
Abe
Toshi
T
Müller
Nestor L
NL
Terasaki
Hiroshi
H
Kato
Seiya
S
Sadohara
Junko
J
Kono
Rei
R
Edamitsu
Osamu
O
Ishitake
Tatsuya
T
Hayashi
Akihiro
A
Rikimaru
Toru
T
Hayabuchi
Naofumi
N
D000230:Adenocarcinoma / Q000098:blood supply / Q000401:mortality / Q000473:pathology*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000098:blood supply / Q000401:mortality / Q000473:pathology*; D003287:Contrast Media; D016228:Endothelial Growth Factors / Q000032:analysis; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000032:analysis; D008175:Lung Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology*; D008222:Lymphokines / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D020033:Protein Isoforms / Q000032:analysis; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
D003287:Contrast Media; D016228:Endothelial Growth Factors; D036341:Intercellular Signaling Peptides and Proteins; D008222:Lymphokines; D020033:Protein Isoforms; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors; D019786:Gadolinium DTPA