Progressive massive fibrosis in patients with pneumoconiosis: utility of MRI in differentiating from lung cancer
Progressive massive fibrosis in patients with pneumoconiosis: utility of MRI in differentiating from lung cancer
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DOI：
10.1177/0284185117700929
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发表时间：
2018-01-01
期刊：
影响因子：
1.3
通讯作者：
Uetani, Masataka
中科院分区：
文献类型：
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作者：
Ogihara, Yukihiro;Ashizawa, Kazuto;Uetani, Masataka
背景：在尘肺患者中，CT有时很难区分进行性大块纤维化(PMF)和肺癌。目的：评价PMF的磁共振成像(MRI)特征及其与肺癌的鉴别能力。材料和方法：2000~2014年间，对28例确诊尘肺患者的40个经CT怀疑为肺癌的肺部病变进行分析。40个病灶中有24个经病理或临床诊断为PMF。评价T2加权(T2W)图像上的信号模式、T1加权图像(T1W)上的增强后模式以及动态增强扫描的时间强度曲线(TIC)模式。结果：24个PMF病灶在T2W上均表现为低信号(敏感性为100%)，而16个肺癌病灶中有15个在T2W上呈中等或高信号(特异性为94%)。17个PMF病灶中6个呈均匀强化(敏感性为35%)，4/9个肺癌病灶呈不均匀或环状强化(特异性为44%)。16个PMF病灶中有6个表现为逐渐增强的强化(敏感性为38%)，7/9个肺癌病灶表现为快速强化(特异性为78%)。结论：当尘肺患者的PMF和肺癌在CT上难以鉴别时，额外的MRI检查，特别是T2W成像序列，可能有助于两者的鉴别。
Background: It is occasionally difficult to distinguish progressive massive fibrosis (PMF) from lung cancer on computed tomography (CT) in patients with pneumoconiosis.Purpose: To evaluate the magnetic resonance imaging (MRI) features of PMF and to assess its ability to differentiate PMF from lung cancer.Material and Methods: Between 2000 and 2014, 40 pulmonary lesions suspected to be lung cancer on the basis of CT in 28 patients with known pneumoconiosis were evaluated. Twenty-four of the 40 lesions were pathologically or clinically diagnosed as PMF. The signal pattern on T2-weighted (T2W) images, post-contrast enhancement pattern on T1-weighted (T1W) images, and the pattern of the time intensity curve (TIC) on contrast-enhanced dynamic studies were evaluated. All images were analyzed independently by two chest radiologists.Results: All 24 PMF lesions showed low signal intensity (SI) on T2W images (sensitivity, 100%), while 15 of 16 lung cancer lesions showed intermediate or high SI on T2W images (specificity, 94%) when PMF was regarded as a positive result. Six of 17 PMF lesions showed a homogeneous enhancement pattern (sensitivity, 35%), and 4/9 lung cancer lesions showed an inhomogeneous or a ring-like enhancement pattern (specificity, 44%). Six of 16 PMF lesions showed a gradually increasing enhancement pattern (sensitivity, 38%), and 7/9 lung cancer lesions showed rapid enhancement pattern (specificity, 78%).Conclusion: When differentiation between PMF and lung cancer in patients with pneumoconiosis is difficult on CT, an additional MRI study, particularly the T2W imaging sequence, may help differentiate between the two.