title: Contrast-enhanced magnetic resonance imaging of pulmonary lesions: description of a technique aiming clinical practice.
abstract: OBJECTIVE
  To propose a technique for evaluation of pulmonary lesions using contrast-enhanced MRI; to assess morphological patterns of enhancement and correlate quantitative analysis with histopathology.
  
  
  METHODS
  Thirty-six patients were prospectively studied. Volumetric-interpolated T1W images were obtained during consecutive breath holds after bolus triggered contrast injection. Volume coverage of first three acquisitions was limited (higher temporal resolution) and last acquisition obtained at 4th min. Two radiologists individually evaluated the patterns of enhancement. Region-of-interest-based signal intensity (SI)-time curves were created to assess quantitative parameters.
  
  
  RESULTS
  Readers agreed moderately to substantially concerning lesions' enhancement pattern. SI-time curves could be created for all lesions. In comparison to benign, malignant lesions showed higher values of maximum enhancement, early peak, slope and 4th min enhancement. Early peak >15% showed 100% sensitivity to detect malignancy, maximum enhancement >40% showed 100% specificity.
  
  
  CONCLUSIONS
  The proposed technique is robust, simple to perform and can be applied in clinical scenario. It allows visual evaluation of enhancement pattern/progression together with creation of SI-time curves and assessment of derived quantitative parameters. Perfusion analysis was highly sensitive to detect malignancy, in accordance to what is recommended by most recent guidelines on imaging evaluation of pulmonary lesions.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Radiology Department, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, Sao Paulo, Brazil. Electronic address: marcelk46@yahoo.com.br.
authors.forename: Marcel
authors.initials: M
authors.lastname: Koenigkam-Santos
authors.affiliation: Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic (Thoraxklinik), University of Heidelberg, Amalienstraße 5, 69126 Heidelberg, Germany. Electronic address: optazaite@andrulis.eu.
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Optazaite
authors.affiliation: Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. Electronic address: gregor.sommer@usb.ch.
authors.forename: Gregor
authors.initials: G
authors.lastname: Sommer
authors.affiliation: Surgery Department, Chest Clinic (Thoraxklinik), University of Heidelberg, Amalienstraße 5, 69126 Heidelberg, Germany. Electronic address: seyer.safi@gmail.com.
authors.forename: Seyer
authors.initials: S
authors.lastname: Safi
authors.affiliation: Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic (Thoraxklinik), University of Heidelberg, Amalienstraße 5, 69126 Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany. Electronic address: heussel@uni-heidelberg.de.
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Heussel
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany. Electronic address: hans-ulrich.kauczor@med.uni-heidelberg.de.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Kauczor
authors.affiliation: Radiology Department, German Cancer Research Center (Deutsches Krebsforschungszentrum - DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic (Thoraxklinik), University of Heidelberg, Amalienstraße 5, 69126 Heidelberg, Germany. Electronic address: m.puderbach@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Puderbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008168:Lung / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D009942:Organometallic Compounds; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol
keywords: Chest; Dynamic study; Lung neoplasms; Magnetic resonance imaging; Pulmonary nodules