Magnetic resonance imaging for lung cancer detection: experience in a population of more than 10,000 healthy individuals

Abstract

Background: Recent refinements of lung MRI techniques have reduced the examination time and improved diagnostic sensitivity and specificity. We conducted a study to assess the feasibility of MRI for the detection of primary lung cancer in asymptomatic individuals.

Methods: A retrospective chart review was performed on images of lung parenchyma, which were extracted from whole-body MRI examinations between October 2000 and December 2007. 11,766 consecutive healthy individuals (mean age, 50.4 years; 56.8% male) were scanned using one of two 1.5-T scanners (Sonata and Sonata Maestro, Siemens Medical Solutions, Erlangen, Germany). The standard protocol included a quick whole-lung survey with T2-weighted 2-dimensional half Fourier acquisition single shot turbo spin echo (HASTE) and 3-dimensional volumetric interpolated breath-hold examination (VIBE). Total examination time was less than 10 minutes, and scanning time was only 5 minutes. Prompt referrals and follow-ups were arranged in cases of suspicious lung nodules.

Results: A total of 559 individuals (4.8%) had suspicious lung nodules. A total of 49 primary lung cancers were diagnosed in 46 individuals: 41 prevalence cancers and 8 incidence cancers. The overall detection rate of primary lung cancers was 0.4%. For smokers aged 51 to 70 years, the detection rate was 1.4%. TNM stage I disease accounted for 37 (75.5%). The mean size of detected lung cancers was 1.98 cm (median, 1.5 cm; range, 0.5-8.2 cm). The most histological types were adenocarcinoma in 38 (77.6%).

Conclusion: Rapid zero-dose MRI can be used for lung cancer detection in a healthy population.

Figure 1

The HASTE images from MRI. The (a) coronal, (b) axial, and (c) sagittal images showed an irregular consolidated mass about 1.2 cm in diameter at the posterior segment of the right upper lobe. Under black blood preparation, the lesion easily stood out from the clear background without the appearance of any vessels. (d) The findings from chest radiography were negative. The nodule was surgically proved to be squamous cell carcinoma, stage Ia.

Figure 2

Comparison of VIBE images from MRI without and with the use of contrast. The (a) noncontrasted coronal, (b) contrasted coronal, (c) noncontrasted axial, (d) contrasted axial, (e) noncontrasted sagittal, and (f) contrasted sagittal VIBE images can display clear branches of pulmonary vessels and bronchial tree with minimal pulsation artifacts in normal lung parenchyma.

Figure 3

Comparison of VIBE images from MRI and standard-dose CT image. The (a) axial VIBE image and (b) standard-dose CT image showed a 0.3-cm subpleural nodule.