title: Non-contrast-enhanced preoperative assessment of lung perfusion in patients with non-small-cell lung cancer using Fourier decomposition magnetic resonance imaging.
abstract: OBJECTIVE
  To investigate non-contrast-enhanced Fourier decomposition MRI (FD MRI) for assessment of regional lung perfusion in patients with Non-Small-Cell Lung Cancer (NSCLC) in comparison to dynamic contrast-enhanced MRI (DCE MRI).
  
  
  METHODS
  Time-resolved non-contrast-enhanced images of the lungs were acquired prospectively in 15 patients using a 2D balanced steady-state free precession (b-SSFP) sequence. After non-rigid registration of the native image data, perfusion-weighted images were calculated by separating periodic changes of lung proton density at the cardiac frequency using FD. DCE MRI subtraction datasets were acquired as standard of reference. Both datasets were analyzed visually for perfusion defects. Then segmentation analyses were performed to describe perfusion of pulmonary lobes semi-quantitatively as percentages of total lung perfusion. Overall FD MRI perfusion signal was compared to velocity-encoded flow measurements in the pulmonary trunk as an additional fully quantitative reference.
  
  
  RESULTS
  Image quality ratings of FD MRI were significantly inferior to those of DCE MRI (P<0.0001). Sensitivity, specificity, and accuracy of FD MRI for visual detection of perfusion defects were 84%, 92%, and 91%. Semi-quantitative evaluation of lobar perfusion provided high agreement between FD MRI and DCE MRI for both entire lungs and upper lobes, but less agreement in the lower parts of both lungs. FD perfusion signal showed high linear correlation with pulmonary arterial blood flow.
  
  
  CONCLUSIONS
  FD MRI is a promising technique that allows for assessing regional lung perfusion in NSCLC patients without contrast media or ionizing radiation. However, for being applied in clinical routine, image quality and robustness of the technique need to be further improved.
authors.affiliation: Department of Radiology (E010), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031 Basel, Switzerland. Electronic address: gregor.sommer@usb.ch.
authors.forename: Gregor
authors.initials: G
authors.lastname: Sommer
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Bauman
authors.forename: Marcel
authors.initials: M
authors.lastname: Koenigkam-Santos
authors.forename: Christopher
authors.initials: C
authors.lastname: Draenkow
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Heussel
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.forename: Michael
authors.initials: M
authors.lastname: Puderbach
mesh_terms: D000368:Aged; D000465:Algorithms; D001783:Blood Flow Velocity; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000503:physiopathology*; D003287:Contrast Media; D005260:Female; D005583:Fourier Analysis; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011652:Pulmonary Circulation; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014692:Ventilation-Perfusion Ratio
chemical_list: D003287:Contrast Media
keywords: Dynamic contrast-enhanced MRI; Fourier decomposition MRI; Lung cancer; Lung perfusion; Perfusion-weighted imaging