Contrast-enhanced magnetic resonance imaging of pulmonary lesions: Description of a technique aiming clinical practice

•A technique to perform contrast-enhanced MRI of pulmonary lesions is proposed.•It permits visual evaluation of enhancement together with quantitative analysis.•Technique was adapted to pulmonary circulation and considered previous experiences.•Quantitative analysis was highly sensitive to detect malignancy.•A simpler and robust technique can help bring chest MRI into clinical application.

ObjectiveTo 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 methodsThirty-six patients were prospectively studied. Volumetric-interpolated T1W images were obtained during consecutive breath holds after bolus triggered contrast injection. Volume 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.ResultsReaders 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.ConclusionsThe 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.