Trial Information

The solitary pulmonary nodule (SPN) is a common finding in chest radiography. Pulmonary
nodules larger than 1cm indicative of malignancy or with indeterminate finding according to
morphology criteria have to be defined by invasive methods such as biopsy or surgical
excision, and benign pathology makes up 20-50% of those resected pulmonary lesions. The
lesions not receiving surgical intervention often need imaging follow-up on a regular basis
for a long period of time to monitor the stability of the finding.

There are many reports regarding the MRI perfusion analysis of neoplasms from many organs,
including bone marrow, liver, breast, cervix, and they stressed not only on comparison
between benignity and malignancy, but also on monitoring the treatment outcomes after
neoadjuvant chemotherapy, radiation therapy or anti-angiogenic agent therapy [7-15]. Dynamic
contrast-enhanced MRI (DCE MRI) is not a standard examination for SPN, but there have been
some data regarding the differentiation between malignant and benign SPN using DCE MRI, with
MRI offering higher specificity compared to dynamic CT scan [6, 7, 16]. It was also reported
that DCE MRI could delineate kinetic and morphologic differences in tumor angiogenesis and
perfusion characteristics between malignant and benign pulmonary lesions with relatively
high accuracy [7, 16]. The purpose of our study is to determine whether DCE MRI analysis of
tumor angiogenesis and perfusion can be used as a reliable modality to differentiate benign
from malignant SPN before surgical intervention, using kinetic model derived from DCE MRI,
and further correlate if there is any positive correlation between angiogenesis factor
(vascular endothelial growth factor VEGF, microvessel density MVD); and if the perfusion
parameters from DCE MRI can predict patients’ outcomes and survival.