Longitudinal MRI in comparison to low-dose CT for follow-up of incidental pulmonary nodules in patients with COPD—a nationwide multicenter trial

Zhu, Lin; Li, Qian; Stackelberg, Oyunbileg von; Triphan, Simon M. F.; Biederer, Jürgen ; Weinheimer, Oliver; Eichinger, Monika; Vogelmeier, Claus F. ; Jörres, Rudolf A. ; Kauczor, Hans-Ulrich ; Heußel, Claus P.; Jobst, Bertram J.; Yu, Hong und Wielpütz, Mark O. (2025): Longitudinal MRI in comparison to low-dose CT for follow-up of incidental pulmonary nodules in patients with COPD—a nationwide multicenter trial. In: European Radiology, Bd. 35, Nr. 10: S. 6336-6349

Abstract

Purpose: This multicenter trial was conducted to evaluate MRI for the longitudinal management of incidental pulmonary nodules in heavy smokers.

Materials and methods: 239 participants (63.9 ± 8.4 years, 43–82 years) at risk of or with COPD GOLDI-IV from 16 centers prospectively underwent two rounds of same-day low-dose computed tomography (LDCT1&2) and MRI1&2 at an interval of three years in the nationwide COSYCONET trial. All exams were independently assessed for incidental pulmonary nodules in a standardized fashion by two blinded readers, incl. axis measurements and Lung-RADS categorization, with consensual LDCT results serving as the standard of reference. A change in diameter ≥ 2 mm was rated as progress. 11 patients underwent surgery for suspicious nodules after the first round.

Results: Two hundred twenty-four of two hundred forty nodules (93.3%) persisted from LDCT1 to LDCT2, with a sensitivity of MRI2 of 82.8% and 81.5% for readers 1 and 2, respectively. Agreement in Lung-RADS categories between LDCT2 and MRI2 was substantial in per-nodule (κ = 0.62–0.70) and excellent in a per-patient (κ = 0.86–0.88) approach for both readers, respectively. Concordance between LDCT2 and MRI2 for growth was excellent to almost perfect (κ = 0.88–1.0). The accuracy of LDCT1 and MRI1 for lung cancer was 87.5%. Lung-RADS ≥ 3 category on MRI1 had higher accuracy for predicting progress (23.1% and 21.4%, respectively) than LDCT1 (15.8%).

Conclusion: Compared to LDCT, MRI shows similar capabilities for the longitudinal evaluation of incidental nodules in heavy smokers. Decision-making for nodule management guided by Lung-RADS seems feasible based on longitudinal MRI.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin > Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 1432-1084
• Sprache: Englisch