European Journal of Radiology 84 (2015) 185–192 Contents lists available at ScienceDirect European Journal of Radiology journal homepage: www.elsevier.com/locate/ejrad Contrast-enhanced magnetic resonance imaging of pulmonary lesions: Description of a technique aiming clinical practice Marcel Koenigkam-Santos a,b,c,∗ , Elzbieta Optazaite d,3 , Gregor Sommer e , Seyer Safi f , Claus Peter Heussel d,g,3 , Hans-Ulrich Kauczor a,g,1 , Michael Puderbach b,d,2 a Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany b Radiology Department, German Cancer Research Center (Deutsches Krebsforschungszentrum – DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany c Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, Sao Paulo, Brazil d Diagnostic and Interventional Radiology with Nuclear Medicine, Chest Clinic (Thoraxklinik), University of Heidelberg, Amalienstraße 5, 69126 Heidelberg, Germany e Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland f Surgery Department, Chest Clinic (Thoraxklinik), University of Heidelberg, Amalienstraße 5, 69126 Heidelberg, Germany g Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg, Germany article info Article history: Received 30 July 2014 Received in revised form 4 October 2014 Accepted 8 October 2014 Keywords: Chest Pulmonary nodules Lung neoplasms Magnetic resonance imaging Dynamic study abstract Objective: To propose a technique for evaluation of pulmonary lesions using contrast-enhanced MRI; to assess morphological patterns of enhancement and correlate quantitative analysis with histopathology. Material and methods: Thirty-six patients were prospectively studied. Volumetric-interpolated T1W images were obtained during consecutive breath holds after bolus triggered contrast injection. Vol- ume coverage of first three acquisitions was limited (higher temporal resolution) and last acquisition obtained at 4th min. Two radiologists individually evaluated the patterns of enhancement. Region-of- interest-based signal intensity (SI)-time curves were created to assess quantitative parameters. Results: Readers agreed moderately to substantially concerning lesions’ enhancement pattern. SI-time curves could be created for all lesions. In comparison to benign, malignant lesions showed higher values of maximum enhancement, early peak, slope and 4th min enhancement. Early peak >15% showed 100% sensitivity to detect malignancy, maximum enhancement >40% showed 100% specificity. Conclusions: The proposed technique is robust, simple to perform and can be applied in clinical scenario. It allows visual evaluation of enhancement pattern/progression together with creation of SI-time curves and assessment of derived quantitative parameters. Perfusion analysis was highly sensitive to detect malignancy, in accordance to what is recommended by most recent guidelines on imaging evaluation of pulmonary lesions. © 2014 Elsevier Ireland Ltd. All rights reserved. ∗ Corresponding author at: Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Avenida Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, Sao Paulo, Brazil. Tel.: +55 16 36022640/+49 6221 56 6410/42 2563; fax: +55 16 36022648/+49 6221 56 5730. E-mail addresses: marcelk46@yahoo.com.br, marcelk46@usp.br (M. Koenigkam-Santos), optazaite@andrulis.eu (E. Optazaite), gregor.sommer@usb.ch (G. Sommer), seyer.safi@gmail.com (S. Safi), heussel@uni-heidelberg.de (C.P. Heussel), hans-ulrich.kauczor@med.uni-heidelberg.de (H.-U. Kauczor), m.puderbach@gmail.com (M. Puderbach). 1 Tel.: +49 6221 56 6410; fax: +49 6221 56 5730. 2 Tel.: +49 6221 42 2563. 3 Tel.: +49 6221 396 1501; fax: +49 6221 396 1502. 1. Introduction In patients with focal pulmonary lesions, paramount is to dif- ferentiate benign from malignant disease. Some lesions may have necrotic or cystic/cavitary components, for which the determi- nation of viable solid tissue adequate to biopsy sample are very important. In patients with established malignant disease, ade- quate staging defines therapy. Also in malignancies, secondary changes related to the tumor, like adjacent pneumonia or atelec- tasis, may hinder surgical or radiotherapy planning. Furthermore, serial treatment control is necessary for most tumors [1]. For all these situations, different imaging modalities have been proven to be valuable, and computed tomography (CT) is the most fre- quently used imaging method in clinical routine [2]. Single-phase http://dx.doi.org/10.1016/j.ejrad.2014.10.007 0720-048X/© 2014 Elsevier Ireland Ltd. All rights reserved.