title: Functional imaging with diffusion-weighted MRI for lung biopsy planning: initial experience.
abstract: BACKGROUND
  The purpose of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) and positron emission tomography/computed tomography (PET/CT) in planning transthoracic CT-guided biopsies of lung lesions.
  
  
  METHODS
  Thirteen patients with lung lesions suspicious for malignancy underwent CT-guided biopsy. Chest DW-MRI and apparent diffusion coefficient (ADC) calculation were performed to aid biopsy planning with fused images. MRI was indicated due to large heterogeneous masses, association with lung atelectasis/consolidation/necrosis, and/or divergent results of other biopsy type and histopathology versus clinical/radiological suspicion. Eight patients underwent PET/CT to identify appropriate areas for biopsy.
  
  
  RESULTS
  Mean patient (n = 9 males) age was 59 (range, 30 to 78) years. Based on DW-MRI results, biopsies targeted the most suspicious areas within lesions. All biopsied areas showed higher DW signal intensity and lower ADCs (mean, 0.79 (range, 0.54 to 1.2) × 10(-3) mm2/s), suggesting high cellularity. In patients who underwent PET/CT, areas with higher 18-fluorodeoxyglucose concentrations (standard uptake value mean, 7.7 (range, 3.6 to 13.7)) corresponded to areas of higher DW signal intensity and lower ADCs. All biopsies yielded adequate material for histopathological diagnosis.
  
  
  CONCLUSIONS
  Functional imaging is useful for lung biopsy planning. DW-MRI and PET/CT increase overall performance and enable the collection of adequate material for specific diagnosis.
authors.affiliation: Department of Imaging, AC Camargo Cancer Center, Rua Paulo Orozimbo, 726, Aclimação, Zip 01535-001, São Paulo, SP, Brazil. marcosduarte500@gmail.com.
authors.forename: Marcos D
authors.initials: MD
authors.lastname: Guimaraes
authors.forename: Edson
authors.initials: E
authors.lastname: Marchiori
authors.forename: Bruno C
authors.initials: BC
authors.lastname: Odisio
authors.forename: Bruno
authors.initials: B
authors.lastname: Hochhegger
authors.forename: Almir G V
authors.initials: AG
authors.lastname: Bitencourt
authors.forename: Charles E
authors.initials: CE
authors.lastname: Zurstrassen
authors.forename: Chiang C
authors.initials: CC
authors.lastname: Tyng
authors.forename: Jefferson L
authors.initials: JL
authors.lastname: Gross
authors.forename: Rubens
authors.initials: R
authors.lastname: Chojniak
authors.forename: Myrna C B
authors.initials: MC
authors.lastname: Godoy
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008171:Lung Diseases / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18