Accuracy of MRI on Diagnosis of Solitary Pulmonary Nodule

Document Type : Original Article


1 Associate Professor of Radiology.Department of Radiology, Medical Imaging Research Center (MIRC), Shiraz University of Medical Sciences, Shiraz, Iran.

2 General Practitioner.General Practitioner, Shiraz University of Medical Sciences, Shiraz, Iran.

3 General Practitioner,General Practitioner, Shiraz University of Medical Sciences, Shiraz, Iran.


Background and Objective: Solitary pulmonary nodule (SPN) is defined as a discrete, well margined opacity up to 3cm in diameter that is surrounded by normal lung tissue and is not associated with any other abnormality in the lung or nearby lymph nodes. CT scan is the modality of choice for detection of SPN. Lack of ionizing radiation and high spatial resolution are the main benefits of MRI, nevertheless the usefulness of this imaging modality on diagnosis of lung nodules has not been well established. Aim of this study was to determine the accuracy of MRI on diagnosis of SPNs that their presence have been confirmed by CT scan.
Subjects and Methods: A total of 32 patients, confirmed for SPN according to CT scan findings and 11 patient with normal CT scan were included in this prospective study were allocated as case and control groups respectively. Sensitivity, specificity and positive and negative predictive values of MRI were determinated. Site and size of pulmonary nodules as well as different MRI sequences were the investigated parameters.
Results: Statistical analysis showed the least diagnostic sensitivity for T1w sequences (27%). T2w images and Fat-sat slices had 55% and 36% sensitivity respectively. Specificity of 97% for T1w images, 90% for T2w slices and 90% in Fat-sat sequences were the other results.
Conclusion: Although specificity of different sequences of MRI was ≥90% , low sensitivity and breath holding technique precludes its routine usage for the suspected patients with SPN and early detection of pulmonary nodules in high risk patients.


1-Carden KA, Ernst A. Management of Tracheobronchomalacia. In: Simoff MJ, Sterman DH, Ernst A. Thoracic Endoscopy: Advances in Interventional Pulmonology. Malden, MA: Blackwell Futura; 2006.Vol 1.P. 344-51.
2-Dozaki T, Imai K, Mizukami S. [Biphasic (ulcer-forming and ulcer-preventing) effect of adrenaline in rats]. Nippon YakurigakuZasshi 1975 Jul; 71(5): 405-14.
3-Naidich DP, Webb WR, Granier PA, Harkin TJ, Gefter WB. Imaging of the Airways. Functional and Radiological Correlations. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005.
4-GuytoncC, Hall John E. Guyton and Hall Textbook of Medical physiology.12th ed. Philadelphia: Saunders Elsevier;  2011. P. 465-504.
5-Rhoades R,  Bell D. Medical physiology principles for clinical medicine. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2009.p. 319-47.
6-Wahidi MM,  Govert JA,  Goudar RK . Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?:  ACCP evidence-based clinical practice guidelines. Chest 2007 Sep; 132(3 Suppl):108S-30S.
8-Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP, "et al". Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd ed). Chest 2007 Sep; 132(Suppl 3):108S-130S.
9-Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics 2001 Mar-Apr; 21(2): 403-17.
10-Cahan WG, Shah JP, Castro EB. Benign solitary lung lesions in patients with cancer. Ann Surg 1978 Mar; 187(3): 241–44.
11-Gribetz AR, Damsker B, Bottone EJ, Kirschner PA, Teirstein AS. Solitary pulmonary nodules due to nontuberculous mycobacterial infection. Am J Med 1981 Jan; 70(1): 39-43.
12-Gjevre JA, Myers JL, Prakash UB. Pulmonary hamartomas. Mayo ClinProc 1996 Jan; 71(1): 14-20.
13- Nicholson CP, Allen MS, Trastek VF, Tazelaar HD, Pairolero PC. Dirofilariaimmitis: a rare, increasing cause of pulmonary nodules. Mayo ClinProc 1992 Jul; 67(7): 646-50.
14-Mountain CF. A new international staging system for lung cancer. Chest1986 Apr; 89(Suppl 4): 225S-33S.
15-Williams DE, Pairolero PC, Davis CS, Bernatz PE, Payne WS, Taylor WF, "et al". Survival of patients surgically treated for stage I lung cancer. J Thorac Cardiovasc Surg 1981 Jul; 82(1): 70-6.
16-Trunk G, Gracey DR, Byrd RB. The management and evaluation of the solitary pulmonary nodule. Chest 1974; 66(3): 236-9.
17-Toomes H, Delphendahl A,  Manke HG, Vogt-Moykopf I. The coin lesion of the lung. A review of 955 resected coin lesions. Cancer 1983 Feb 1; 51(3): 534-7.
18-MacMahon H, Austin JH, Gamsu G, Herold ChJ, Jett JR, Naidich DP, "et al". Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005; 237(2): 395.
19-Siegelman SS, Zerhouni EA, Leo FP, Khouri NF, Stitik FP. CT of the solitary pulmonary nodule. AJR Am J Roentgenol 1980 Jul; 135(1):1-13.
20-Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med 2003 Jun 19; 348(25): 2535-42.
21-Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001 Feb 21; 285(7): 914-24.
22-Vansteenkiste JF, Stroobants SS. PET scan in lung cancer: current recommendations and innovation. J Thorac Oncol 2006 Jan; 1(1): 71-3.
23-Wallace JM, Deutsch AL. Flexible fiberoptic bronchoscopy and percutaneous needle lung aspiration for evaluating the solitary pulmonary nodule. Chest 1982 Jun; 81(6): 665-71.
24-Berquist TH, Bailey PB, Cortese DA, Miller WE. Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion. Mayo ClinProc 1980 Aug; 55(8): 475-81.
25-Loubeyre P, Copercini M, Dietrich PY. Percutaneous CT-guided multisampling core needle biopsy of thoracic lesions. AJR Am J Roentgenol 2005 Nov; 185(5): 1294-8.
26-Bernard A. Resection of pulmonary nodules using video-assisted thoracic surgery. The Thorax Group. Ann ThoracSurg 1996 Jan; 61(1): 202-4.
27-Biederer J, Schoene A, Freitag S, Reuter M, Heller M. Simulated pulmonary nodules implanted in a dedicated porcine chest phantom: sensitivity of MR imaging for detection. Radiology 2003 May; 227(2): 475-83.
28-Vogt FM, Herborn CU, Hunold P, Lauenstein TC, Schröder T, Debatin JF, "et al". HASTE MRI versus chest radiography in the detection of pulmonary nodules: comparison with MDCT. AJR Am J Roentgenol 2004 Jul; 183(1): 71-8.
29-Bruegel M, Gaa J, Woertler K. MRI of the lung: value of different turbo spin-echo, single-shot turbo spin-echo, and 3D gradient-echo pulse sequences for the detection of pulmonary metastases. J Magn Reson Imaging 2007 Jan; 25(1): 73-81.
30-Schaefer JF, Vollmar J, Schick F, Vonthein R, Seemann MD, Aebert H, "et al". Solitary pulmonary nodules: dynamic contrast-enhanced MR imaging—perfusion differences in malignant and benign lesions. Radiology2004 Aug; 232(2): 544-53.
31-Ohno Y, Hatabu H, Takenaka D, Adachi S, Kono M, Sugimura K. Solitary pulmonary nodules: potential role of dynamic MR imaging in management initial experience. Radiology 2002 Aug; 224(2): 503-11.