title: Detection of Small Pulmonary Nodules with Ultrashort Echo Time Sequences in Oncology Patients by Using a PET/MR System.
abstract: OBJECTIVE
  To investigate the utility of a free-breathing ultrashort echo time (UTE) sequence for the evaluation of small pulmonary nodules in oncology patients by using a hybrid positron emission tomography (PET)/magnetic resonance (MR) imaging system and to compare the nodule detection rate between UTE and a conventional three-dimensional gradient-recalled-echo (GRE) technique.
  
  
  METHODS
  In this HIPAA-compliant, institutional review board-approved prospective study, 82 pulmonary nodules were identified in eight patients with extrathoracic malignancies. Patients underwent free-breathing UTE and dual-echo three-dimensional GRE imaging of the lungs in a hybrid PET/MR imaging unit immediately after clinical PET/computed tomography (CT). CT was considered the reference standard for nodule detection. Two reviewers identified nodules and obtained measurements on MR images. The McNemar test was used to evaluate differences in nodule detection rate between MR techniques, and interrater agreement was assessed by using Bland-Altman plots.
  
  
  RESULTS
  Mean nodule diameter ± standard deviation was 6.2 mm ± 2.7 (range, 3-17 mm). The detection rate was higher for UTE imaging than for dual-echo GRE imaging for nodules of at least 4 mm (82% vs 34%, respectively; P < .001), with the largest difference in detection noted in the 4-8-mm nodule group (79% vs 21%, P < .001). UTE imaging displayed a higher detection rate than dual-echo GRE imaging for nodules without fluorodeoxyglucose avidity (68% vs 22%, respectively; P < .001). Interrater reliability of nodule detection with MR imaging was high (κ = 0.90 for UTE imaging and κ = 0.92 for dual-echo GRE imaging).
  
  
  CONCLUSIONS
  A free-breathing UTE sequence has high sensitivity for the detection of small pulmonary nodules (4-8 mm) and outperformed a three-dimensional dual-echo GRE technique for the detection of small, non-fluorodeoxyglucose-avid nodules.
authors.affiliation: From the Department of Radiology (N.S.B., P.E.Z.L., M.D.H., S.C.B., T.A.H.), University of California-San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; Departments of Medical Physics (K.M.J., S.K.N.), Radiology (S.K.N.), and Pediatrics (S.K.N.), University of Wisconsin, Madison, Wis; and UCSF Graduate Program in Bioengineering, University of California-Berkeley, Berkeley, Calif (P.E.Z.L.).
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Burris
authors.affiliation: From the Department of Radiology (N.S.B., P.E.Z.L., M.D.H., S.C.B., T.A.H.), University of California-San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; Departments of Medical Physics (K.M.J., S.K.N.), Radiology (S.K.N.), and Pediatrics (S.K.N.), University of Wisconsin, Madison, Wis; and UCSF Graduate Program in Bioengineering, University of California-Berkeley, Berkeley, Calif (P.E.Z.L.).
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Johnson
authors.affiliation: From the Department of Radiology (N.S.B., P.E.Z.L., M.D.H., S.C.B., T.A.H.), University of California-San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; Departments of Medical Physics (K.M.J., S.K.N.), Radiology (S.K.N.), and Pediatrics (S.K.N.), University of Wisconsin, Madison, Wis; and UCSF Graduate Program in Bioengineering, University of California-Berkeley, Berkeley, Calif (P.E.Z.L.).
authors.forename: Peder E Z
authors.initials: PE
authors.lastname: Larson
authors.affiliation: From the Department of Radiology (N.S.B., P.E.Z.L., M.D.H., S.C.B., T.A.H.), University of California-San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; Departments of Medical Physics (K.M.J., S.K.N.), Radiology (S.K.N.), and Pediatrics (S.K.N.), University of Wisconsin, Madison, Wis; and UCSF Graduate Program in Bioengineering, University of California-Berkeley, Berkeley, Calif (P.E.Z.L.).
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hope
authors.affiliation: From the Department of Radiology (N.S.B., P.E.Z.L., M.D.H., S.C.B., T.A.H.), University of California-San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; Departments of Medical Physics (K.M.J., S.K.N.), Radiology (S.K.N.), and Pediatrics (S.K.N.), University of Wisconsin, Madison, Wis; and UCSF Graduate Program in Bioengineering, University of California-Berkeley, Berkeley, Calif (P.E.Z.L.).
authors.forename: Scott K
authors.initials: SK
authors.lastname: Nagle
authors.affiliation: From the Department of Radiology (N.S.B., P.E.Z.L., M.D.H., S.C.B., T.A.H.), University of California-San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; Departments of Medical Physics (K.M.J., S.K.N.), Radiology (S.K.N.), and Pediatrics (S.K.N.), University of Wisconsin, Madison, Wis; and UCSF Graduate Program in Bioengineering, University of California-Berkeley, Berkeley, Calif (P.E.Z.L.).
authors.forename: Spencer C
authors.initials: SC
authors.lastname: Behr
authors.affiliation: From the Department of Radiology (N.S.B., P.E.Z.L., M.D.H., S.C.B., T.A.H.), University of California-San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628; Departments of Medical Physics (K.M.J., S.K.N.), Radiology (S.K.N.), and Pediatrics (S.K.N.), University of Wisconsin, Madison, Wis; and UCSF Graduate Program in Bioengineering, University of California-Berkeley, Berkeley, Calif (P.E.Z.L.).
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Hope
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary; D049268:Positron-Emission Tomography; D055425:Respiratory-Gated Imaging Techniques