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Published online before print April 24, 2003, 10.1148/radiol.2273020459
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Small Peripheral Pulmonary Carcinomas Evaluated with Dynamic MR Imaging: Correlation with Tumor Vascularity and Prognosis1

Kiminori Fujimoto, MD, PhD, Toshi Abe, MD, PhD, Nestor L. Müller, MD, PhD, Hiroshi Terasaki, MD, Seiya Kato, MD, PhD, Junko Sadohara, MD, Rei Kono, MD, Osamu Edamitsu, MD, PhD, Tatsuya Ishitake, MD, PhD, Akihiro Hayashi, MD, PhD, Toru Rikimaru, MD, PhD and Naofumi Hayabuchi, MD, PhD

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).



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  		Figure 1a. (a) Dynamic MR imaging enhancement protocol. After analysis of unenhanced spin-echo MR images obtained through the nodule in the lung, a bolus of 0.1 mmol of gadopentetate dimeglumine (Gd-DTPA) per kilogram of body weight was injected intravenously for 10 seconds. Actual sampling time was 16 seconds, and eight images were obtained. (b) Sagittal oblique gadopentetate dimeglumine-enhanced dynamic MR images (150/10) obtained in a 67-year-old man with squamous cell carcinoma of the upper lobe of the left lung. This nodule was 22 x 24 mm in diameter. Note placement of region of interest (ROI).

 


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  		Figure 1b. (a) Dynamic MR imaging enhancement protocol. After analysis of unenhanced spin-echo MR images obtained through the nodule in the lung, a bolus of 0.1 mmol of gadopentetate dimeglumine (Gd-DTPA) per kilogram of body weight was injected intravenously for 10 seconds. Actual sampling time was 16 seconds, and eight images were obtained. (b) Sagittal oblique gadopentetate dimeglumine-enhanced dynamic MR images (150/10) obtained in a 67-year-old man with squamous cell carcinoma of the upper lobe of the left lung. This nodule was 22 x 24 mm in diameter. Note placement of region of interest (ROI).

 


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  		Figure 2. Graph shows time-SI curve. Gadopentetate dimeglumine was the contrast agent used.

 


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  		Figure 3. Graph shows the relationship between the slope and microvessel counts (MVCs). Slope was positively correlated with the microvessel counts (y = 27.382 + 1.372x; r2 = 0.563; P < .0001).

 


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  		Figure 4. Graph shows survival according to presence or absence of lymph node metastasis. Patients with findings positive for lymph node metastasis (Positive) had a significantly shorter overall survival than did those with findings negative for lymph node metastasis (Negative) (P < .0001).

 


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  		Figure 5. Graph shows survival according to VEGF expression. Patients with VEGF-positive tumors had a significantly shorter overall survival than did those with VEGF-negative tumors (P < .0001).

 


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  		Figure 6. Graph shows survival according to MVDG. Patients with MVDG 1 had a significantly better prognosis than did those with MVDG 2 and 3 (MVDG 1 vs MVDG 2 and 3, P < .01). The difference between MVDG 2 and MVDG 3 was not significant.

 


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  		Figure 7. Graph shows survival according to high and low slope value. The cutoff value represents the median of all slope values (37.3% per minute). Patients in the slope-high (>37.3% per minute) group had a significantly worse prognosis than did those in the slope-low (<=37.3% per minute) group (P < .01).

 


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  		Figure 8. Graph shows survival as a function of zero to three independent factors (ie, VEGF-positive tumor, slope-high [>37.3% per minute] value, and findings positive for lymph node metastasis) derived by using multivariate analysis (log-rank test, P < .0001). Solid line = patients without factors, dotted line = patients with one factor, dashed line = patients with two factors, dashed and dotted line = patients with three factors.

 




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