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Small Peripheral Pulmonary Carcinomas Evaluated with Dynamic MR Imaging: Correlation with Tumor Vascularity and Prognosis¹

¹ From the Depts of Radiology (K.F., T.A., H.T., J.S., R.K., O.E., N.H.), Pathology (S.K.), Environmental Medicine (T.I.), and Surgery (A.H.) and First Dept of Internal Medicine (T.R.), Kurume Univ School of Med, 67 Asahimachi, Kurume, Fukuoka 830-0011, Japan; and Dept of Radiology, Vancouver Gen Hosp, Univ of British Columbia, Canada (N.L.M.). From the 2001 RSNA scientific assembly. Received Apr 18, 2002; revision requested Jun 19; final revision received Nov 4; accepted Nov 27. Address correspondence to K.F. (e-mail: kimichan@med.kurume-u.ac.jp).

PURPOSE: To correlate the findings at contrast material–enhanced dynamic magnetic resonance (MR) imaging of small peripheral pulmonary carcinomas with tumor vascularity and prognosis.

MATERIALS AND METHODS: Ninety-four patients with small peripheral pulmonary carcinomas who underwent surgical resection were examined retrospectively. Pathologic specimens were stained with hematoxylin-eosin and elastin–van Gieson. CD34 and vascular endothelial growth factor (VEGF) were assessed immunohistochemically. Delineated CD34-positive cells were counted as microvessels. Dynamic MR imaging was performed prior to and at 1, 2, 3, 4, 5, 6, and 8 minutes after injection of a bolus of gadopentetate dimeglumine. The two observers reviewed all images, and two pathologists performed all histologic analyses; a decision was determined with consensus. The maximum enhancement ratio (MER), the time lapse between the completion of the injection and the point of maximum signal intensity (T_max), the washout ratio, and the slope value of the time–signal intensity curve were correlated with the microvessel density. VEGF-positive and VEGF-negative tumors were compared. All statistical analyses were performed by using nonparametric methods.

RESULTS: The MER and the slope value were positively correlated, and the T_max was negatively correlated (Spearman rank test, P < .0001, all comparisons) with the microvessel counts. The distribution of elastic and collagen fibers correlated with the washout ratio (Kruskal-Wallis test, P < .001). There was a statistically significant difference between the slope value of VEGF-positive tumors and that of VEGF-negative tumors (Mann-Whitney U test, P < .0001). Patients with VEGF-positive tumors had a significantly shorter overall survival than did those with VEGF-negative tumors (log-rank test, P < .0001).

CONCLUSION: Dynamic MR imaging findings correlate with tumor vascularity and may be helpful in the prediction of prognosis.

© RSNA, 2003

Index terms: Lung neoplasms, 60.31 • Lung neoplasms, diagnosis • Lung neoplasms, MR, 60.12143, 60.12144

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