title: Lung nodule detection in a high-risk population: comparison of magnetic resonance imaging and low-dose computed tomography.
abstract: 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).
  
  
  CONCLUSIONS
  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.
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, Basel, Switzerland. Electronic address: gregor.sommer@usb.ch.
authors.forename: Gregor
authors.initials: G
authors.lastname: Sommer
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. Electronic address: j.tremper@dkfz.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Tremper
authors.affiliation: Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg gGmbH, Amalienstr. 5, 69126 Heidelberg, Germany; Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto - University of Sao Paulo, Av. Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, SP, Brazil. Electronic address: marcelk46@yahoo.com.br.
authors.forename: Marcel
authors.initials: M
authors.lastname: Koenigkam-Santos
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. Electronic address: s.delorme@dkfz.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Delorme
authors.affiliation: Division of Cancer Epidemiology (C020), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany. Electronic address: n.becker@dkfz.de.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Becker
authors.affiliation: Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Electronic address: juergen.biederer@uni-heidelberg.de.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Biederer
authors.affiliation: Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. Electronic address: hu.kauczor@med.uni-heidelberg.de.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
authors.affiliation: Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg gGmbH, Amalienstr. 5, 69126 Heidelberg, Germany. Electronic address: heussel@uni-heidelberg.de.
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Heussel
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. Electronic address: h.schlemmer@dkfz.de.
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Schlemmer
authors.affiliation: Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik Heidelberg gGmbH, Amalienstr. 5, 69126 Heidelberg, Germany. Electronic address: m.puderbach@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Puderbach
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D018570:Risk Assessment; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Early detection of cancer; Lung neoplasms; Magnetic resonance imaging; Radiation protection; Spiral computed tomography