MRI Compared with Low-Dose CT for Incidental Lung Nodule Detection in COPD: A Multicenter Trial

Qian Li; Lin Zhu; Oyunbileg von Stackelberg; Simon M F Triphan; Jürgen Biederer; Oliver Weinheimer; Monika Eichinger; Claus F Vogelmeier; Rudolf A Jörres; Hans-Ulrich Kauczor; Claus P Heußel; Bertram J Jobst; Mark O Wielpütz; COSYCONET Study Group

doi:10.1148/ryct.220176

MRI Compared with Low-Dose CT for Incidental Lung Nodule Detection in COPD: A Multicenter Trial

Radiol Cardiothorac Imaging. 2023 Apr 27;5(2):e220176. doi: 10.1148/ryct.220176. eCollection 2023 Apr.

Affiliation

¹ Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany (Q.L., L.Z., O.v.S., S.M.F.T., J.B., O.W., M.E., H.U.K., C.P.H., B.J.J., M.O.W.); Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany (Q.L., L.Z., O.v.S., S.M.F.T., J.B., O.W., M.E., H.U.K., C.P.H., B.J.J., M.O.W.); Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Heidelberg, Germany (Q.L., L.Z., O.v.S., S.M.F.T., O.W., M.E., H.U.K., C.P.H., B.J.J., M.O.W.); Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Q.L.); Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China (L.Z.); University of Latvia, Faculty of Medicine, Riga, Latvia (J.B.); Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany (J.B.); Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Marburg, Germany (C.F.V.); and Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilians University (LMU) Munich, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany (R.A.J.).

^# Contributed equally.

Abstract

Purpose: To investigate morphofunctional chest MRI for the detection and management of incidental pulmonary nodules in participants with chronic obstructive pulmonary disease (COPD).

Materials and methods: In this prospective study, 567 participants (mean age, 66 years ± 9 [SD]; 340 men) underwent same-day contrast-enhanced MRI and nonenhanced low-dose CT (LDCT) in a nationwide multicenter trial (clinicaltrials.gov: NCT01245933). Nodule dimensions, morphologic features, and Lung Imaging Reporting and Data System (Lung-RADS) category were assessed at MRI by two blinded radiologists, and consensual LDCT results served as the reference standard. Comparisons were performed using the Student t test, and agreements were assessed using the Cohen weighted κ.

Results: A total of 525 nodules larger than 3 mm in diameter were detected at LDCT in 178 participants, with a mean diameter of 7.2 mm ± 6.1 (range, 3.1-63.1 mm). Nodules were not detected in the remaining 389 participants. Sensitivity and positive predictive values with MRI for readers 1 and 2, respectively, were 63.0% and 84.8% and 60.2% and 83.9% for solid nodules (n = 495), 17.6% and 75.0% and 17.6% and 60.0% for part-solid nodules (n = 17), and 7.7% and 100% and 7.7% and 50.0% for ground-glass nodules (n = 13). For nodules 6 mm or greater in diameter, sensitivity and positive predictive values were 73.3% and 92.2% for reader 1 and 71.4% and 93.2% for reader 2, respectively. Readers underestimated the long-axis diameter at MRI by 0.5 mm ± 1.7 (reader 1) and 0.5 mm ± 1.5 (reader 2) compared with LDCT (P < .001). For Lung-RADS categorization per nodule using MRI, there was substantial to perfect interreader agreement (κ = 0.75-1.00) and intermethod agreement compared with LDCT (κ = 0.70-1.00 and 0.69-1.00).

Conclusion: In a multicenter setting, morphofunctional MRI showed moderate sensitivity for detection of incidental pulmonary nodules in participants with COPD but high agreement with LDCT for Lung-RADS classification of nodules.Clinical trial registration no. NCT01245933 and NCT02629432Keywords: MRI, CT, Thorax, Lung, Chronic Obstructive Pulmonary Disease, Screening© RSNA, 2023 Supplemental material is available for this article.

Keywords: CT; Chronic Obstructive Pulmonary Disease; Lung; MRI; Screening; Thorax.