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Purpose: Deep learning reconstruction (DLR) has been recommended as useful for improving image quality. Moreover, compressed sensing (CS) or DLR has been proposed as useful for improving temporal resolution and image quality on MR sequences in different body fields. However, there have been no reports regarding the utility of DLR for image quality and T-factor assessment improvements on T2-weighted imaging (T2WI), short inversion time (TI) inversion recovery (STIR) imaging, and unenhanced- and contrast-enhanced (CE) 3D fast spoiled gradient echo (GRE) imaging with and without CS in comparison with thin-section multidetector-row CT (MDCT) for non-small cell lung cancer (NSCLC) patients. The purpose of this study was to determine the utility of DLR for improving image quality and the appropriate sequence for T-category assessment for NSCLC patients., Methods: As subjects for this study, 213 pathologically diagnosed NSCLC patients who underwent thin-section MDCT and MR imaging as well as T-factor diagnosis were retrospectively enrolled. SNR of each tumor was calculated and compared by paired t-test for each sequence with and without DLR. T-factor for each patient was assessed with thin-section MDCT and all MR sequences, and the accuracy for T-factor diagnosis was compared among all sequences and thin-section CT by means of McNemar's test., Results: SNRs of T2WI, STIR imaging, unenhanced thin-section Quick 3D imaging, and CE-thin-section Quick 3D imaging with DLR were significantly higher than SNRs of those without DLR (P < 0.05). Diagnostic accuracy of STIR imaging and CE-thick- or thin-section Quick 3D imaging was significantly higher than that of thin-section CT, T2WI, and unenhanced thick- or thin-section Quick 3D imaging (P < 0.05)., Conclusion: DLR is thus considered useful for image quality improvement on MR imaging. STIR imaging and CE-Quick 3D imaging with or without CS were validated as appropriate MR sequences for T-factor evaluation in NSCLC patients.

Objective: The purpose of this study was thus to compare capabilities for quantitative differentiation of non- and minimally invasive adenocarcinomas from other of pulmonary MRIs with ultra-short TE (UTE) obtained with single- and dual-echo techniques (UTE-MRI Single and UTE-MRI Dual ) and thin-section CT for stage IA lung cancer patients., Methods: Ninety pathologically diagnosed stage IA lung cancer patients who underwent thin-section standard-dose CT, UTE-MRI Single, and UTE-MRI Dual , surgical treatment and pathological examinations were included in this retrospective study. The largest dimension (D long ), solid portion (solid D long ), and consolidation/tumor (C/T) ratio of each nodule were assessed. Two-tailed Student's t-tests were performed to compare all indexes obtained with each method between non- and minimally invasive adenocarcinomas and other lung cancers. Receiver operating characteristic (ROC)-based positive tests were performed to determine all feasible threshold values for distinguishing non- or minimally invasive adenocarcinoma (MIA) from other lung cancers. Sensitivity, specificity, and accuracy were then compared by means of McNemar's test., Results: Each index showed significant differences between the two groups (p < 0.0001). Specificities and accuracies of solid D long for UTE-MRI Dual2nd echo and CT Mediastinal were significantly higher than those of solid D long for UTE-MRI Single and UTE-MRI Dual1st echo and all C/T ratios except CT Mediastinal (p < 0.05). Moreover, the specificities and accuracies of solid D long and C/T ratio were significantly higher than those of D long for each method (p < 0.05)., Conclusion: Pulmonary MRI with UTE is considered at least as valuable as thin-section CT for quantitative differentiation of non- and minimally invasive adenocarcinomas from other stage IA lung cancers., Clinical Relevance Statement: Pulmonary MRI with UTE's capability for quantitative differentiation of non- and minimally invasive adenocarcinomas from other lung cancers in stage IA lung cancer patients is equal or superior to that of thin-section CT., Key Points: • Correlations were excellent for pathologically examined nodules with the largest dimensions (D long ) and a solid component (solid D long ) for all indexes (0.95 ≤ r ≤ 0.99, p < 0.0001). • Pathologically examined D long and solid D long obtained with all methods showed significant differences between non- and minimally invasive adenocarcinomas and other lung cancers (p < 0.0001). • Solid tumor components are most accurately measured by UTE-MRI Dual2nd echo and CT Mediastinal , whereas the ground-glass component is imaged by UTE-MRI Dual1st echo and CT lung with high accuracy. UTE-MRI Dual predicts tumor invasiveness with 100% sensitivity and 87.5% specificity at a C/T threshold of 0.5., (© 2023. The Author(s), under exclusive licence to European Society of Radiology.)

Background: Amide proton transfer (APT) weighted chemical exchange saturation transfer CEST (APTw/CEST) magnetic resonance imaging (MRI) has been suggested as having the potential for assessing the therapeutic effect of brain tumors or rectal cancer. Moreover, diffusion-weighted imaging (DWI) and positron emission tomography fused with computed tomography by means of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG-PET/CT) have been suggested as useful in same setting., Purpose: To compare the capability of APTw/CEST imaging, DWI, and FDG-PET/CT for predicting therapeutic effect of chemoradiotherapy (CRT) on stage III non-small cell lung cancer (NSCLC) patients., Study Type: Prospective., Population: Eighty-four consecutive patients with Stage III NSCLC, 45 men (age range, 62-75 years; mean age, 71 years) and 39 women (age range, 57-75 years; mean age, 70 years). All patients were then divided into two groups (Response Evaluation Criteria in Solid Tumors [RECIST] responders, consisting of the complete response and partial response groups, and RECIST non-responders, consisting of the stable disease and progressive disease groups)., Field Strength/sequence: 3 T, echo planar imaging or fast advanced spin-echo (FASE) sequences for DWI and 2D half Fourier FASE sequences with magnetization transfer pulses for CEST imaging., Assessment: Magnetization transfer ratio asymmetry (MTR asym ) at 3.5 ppm, apparent diffusion coefficient (ADC), and maximum standard uptake value (SUV max, ) on PET/CT were assessed by means of region of interest (ROI) measurements at primary tumor., Statistical Tests: Kaplan-Meier method followed by log-rank test and Cox proportional hazards regression analysis with multivariate analysis. A P value <0.05 was considered statistically significant., Results: Progression-free survival (PFS) and overall survival (OS) had significant difference between two groups. MTR asym at 3.5 ppm (hazard ratio [HR] = 0.70) and SUV max (HR = 1.41) were identified as significant predictors for PFS. Tumor staging (HR = 0.57) was also significant predictors for OS., Data Conclusion: APTw/CEST imaging showed potential performance as DWI and FDG-PET/CT for predicting the therapeutic effect of CRT on stage III NSCLC patients., Level of Evidence: 2 TECHNICAL EFFICACY: Stage 1., (© 2023 International Society for Magnetic Resonance in Medicine.)

Long-term air pollution exposure has been linked to increased lung cancer mortality. However, little is known about whether day-to-day fluctuations in air pollution levels are in relation to lung cancer mortality, particularly in low-exposure settings. This study aimed to evaluate the short-term associations between air pollution and lung cancer mortality. Daily data on lung cancer mortality, fine particulate matter (PM 2.5 ), nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), carbon monoxide (CO), and weather conditions were collected from Osaka Prefecture, Japan, from 2010 to 2014. Generalized linear models were combined with quasi-Poisson regression were applied to evaluate the associations between each air pollutant and lung cancer mortality after adjusting for potential confounders. Mean (standard deviation) concentrations of PM 2.5 , NO 2 , SO 2 , and CO were 16.7 (8.6) μg/m 3 , 36.8 (14.2) μg/m 3 , 11.1 (4.0) μg/m 3 , and 0.51 (0.16) mg/m 3 , respectively. Interquartile range increases in concentrations of PM 2.5 , NO 2 , SO 2 , and CO (2-d moving average) were associated with 2.65% (95% confidence intervals [CIs]: 0.96%-4.37%), 4.28% (95% CIs: 2.24%-6.36%), 3.35% (95% CIs: 1.03%-5.73%), and 4.60% (95% CIs: 2.19%-7.05%) increased risk of lung cancer mortality, respectively. Stratified analyses showed that the associations were strongest in the older population and men. Exposure‒response curves showed a continuously increasing mortality risk from lung cancer with elevation of air pollution levels, without discernible thresholds. In summary, we found evidence of increased lung cancer mortality in relation to short-term elevations in ambient air pollution. These findings may merit further research to better understand this issue., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background/aim: Osimertinib is the first-line treatment for patients with advanced epidermal growth factor receptor (EGFR) mutation-positive non-small cell lung cancer (NSCLC). The present study aimed to determine the previously unclarified association of osimertinib plasma trough concentrations with efficacy, adverse events, and genetic polymorphisms in Japanese patients with NSCLC harboring EGFR mutations., Patients and Methods: In this prospective study, blood samples of 25 patients who received osimertinib were collected to measure plasma osimertinib concentrations and to genotypically characterize ATP-binding cassette subfamily B member 1 and ATP-binding cassette subfamily G member 2 polymorphisms. Plasma osimertinib concentrations were analyzed using validated multiple reaction monitoring mode-based liquid chromatography-tandem mass spectrometry. Osimertinib concentration necessary to achieve optimal median progression-free survival (PFS) was determined using receiver operating characteristic curve analysis. PFS and overall survival were analyzed using the Kaplan-Meier method, and between-group differences were compared using the log-rank test. Plasma osimertinib concentrations between different patient groups were compared using the Mann-Whitney U-test., Results: Patients were divided into high and low concentration groups based on a plasma osimertinib cut-off concentration of 211 ng/ml. Median PFS was longer in the high trough concentration group than that in the low trough concentration group (46.3 vs. 16.8 months, p=0.029). Plasma osimertinib concentrations adjusted for dose and body weight did not differ between the patients with and without variant polymorphisms., Conclusion: Monitoring plasma trough concentrations during maintenance might improve osimertinib treatment efficacy in patients with NSCLC harboring EGFR mutations., (Copyright © 2023 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Computed diffusion-weighted imaging (cDWI) is a mathematical computation technique that generates DWIs for any b-value by using actual DWI (aDWI) data with at least two different b-values and may improve differentiation of metastatic from nonmetastatic lymph nodes., Purpose: To determine the appropriate b-value for cDWI to achieve a better diagnostic capability for lymph node staging (N-staging) in non-small cell lung cancer (NSCLC) patients compared to aDWI, short inversion time (TI) inversion recovery (STIR) imaging, or positron emission tomography with 2-[fluorine-18] fluoro-2-deoxy-d-glucose combined with computed tomography (FDG-PET/CT)., Study Type: Prospective., Subjects: A total of 245 (127 males and 118 females; mean age 72 years) consecutive histopathologically confirmed NSCLC patients., Field Strength/sequence: A 3 T, half-Fourier single-shot turbo spin-echo sequence, electrocardiogram (ECG)-triggered STIR fast advanced spin-echo (FASE) sequence with black blood and STIR acquisition and DWI obtained by FASE with b-values of 0 and 1000 sec/mm 2 ., Assessment: From aDWIs with b-values of 0 and 1000 (aDWI 1000 ) sec/mm 2 , cDWI using 400 (cDWI 400 ), 600 (cDWI 600 ), 800 (cDWI 800 ), and 2000 (cDWI 2000 ) sec/mm 2 were generated. Then, 114 metastatic and 114 nonmetastatic nodes (mediastinal and hilar lymph nodes) were selected and evaluated with a contrast ratio (CR) for each cDWI and aDWI, apparent diffusion coefficient (ADC), lymph node-to-muscle ratio (LMR) on STIR, and maximum standard uptake value (SUV max )., Statistical Tests: Receiver operating characteristic curve (ROC) analysis, Youden index, and McNemar's test., Results: Area under the curve (AUC) of CR 600 was significantly larger than the CR 400 , CR 800 , CR 2000 , aCR 1000 , and SUV max . Comparison of N-staging accuracy showed that CR 600 was significantly higher than CR 400 , CR 2000 , ADC, aCR 1000 , and SUV max , although there were no significant differences with CR 800 (P = 0.99) and LMR (P = 0.99)., Data Conclusion: cDWI with b-value at 600 sec/mm 2 may have potential to improve N-staging accuracy as compared with aDWI, STIR, and PET/CT., Evidence Level: 2 TECHNICAL EFFICACY: Stage 2., (© 2022 International Society for Magnetic Resonance in Medicine.)

BACKGROUND. Whole-body MRI and FDG PET/MRI have shown encouraging results for staging of thoracic malignancy but are poorly studied for staging of small cell lung cancer (SCLC). OBJECTIVE. The purpose of our study was to compare the performance of conventional staging tests, FDG PET/CT, whole-body MRI, and FDG PET/MRI for staging of SCLC. METHODS. This prospective study included 98 patients (64 men, 34 women; median age, 74 years) with SCLC who underwent conventional staging tests (brain MRI; neck, chest, and abdominopelvic CT; and bone scintigraphy), FDG PET/CT, and whole-body MRI within 2 weeks before treatment; coregistered FDG PET/MRI was generated. Two nuclear medicine physicians independently reviewed conventional tests and FDG PET/CT examinations in separate sessions, and two chest radiologists independently reviewed whole-body MRI and FDG PET/MRI examinations in separate sessions. Readers assessed T, N, and M categories; TNM stage; and Veterans Administration Lung Cancer Study Group (VALSG) stage. Reader pairs subsequently reached consensus. Stages determined clinically during tumor board sessions served as the reference standard. RESULTS. Accuracy for T category was higher ( p < .05) for whole-body MRI (94.9%) and FDG PET/MRI (94.9%) than for FDG PET/CT (85.7%). Accuracy for N category was higher ( p < .05) for whole-body MRI (84.7%), FDG PET/MRI (83.7%), and FDG PET/CT (81.6%) than for conventional staging tests (75.5%). Accuracy for M category was higher ( p < .05) for whole-body MRI (94.9%), FDG PET/MRI (94.9%), and FDG PET/CT (94.9%) than for conventional staging tests (84.7%). Accuracy for TNM stage was higher ( p < .05) for whole-body MRI (88.8%) and FDG PET/MRI (86.7%) than for FDG PET/CT (77.6%) and conventional staging tests (72.4%). Accuracy for VALSG stage was higher ( p < .05) for whole-body MRI (95.9%), FDG PET/MRI (95.9%), and FDG PET/CT (98.0%) than for conventional staging tests (82.7%). Interobserver agreement, expressed as kappa coefficients, ranged from 0.81 to 0.94 across imaging tests and staging endpoints. CONCLUSION. FDG PET/CT, whole-body MRI, and coregistered FDG PET/MRI outperformed conventional tests for various staging endpoints in patients with SCLC. Whole-body MRI and FDG PET/MRI outperformed FDG PET/CT for T category and thus TNM stage, indicating the utility of MRI for assessing extent of local invasion in SCLC. CLINICAL IMPACT. Incorporation of either MRI approach may improve initial staging evaluation in SCLC.

Background Pulmonary MRI with ultrashort echo time (UTE) has been compared with chest CT for nodule detection and classification. However, direct comparisons of these methods' capabilities for Lung CT Screening Reporting and Data System (Lung-RADS) evaluation remain lacking. Purpose To compare the capabilities of pulmonary MRI with UTE with those of standard- or low-dose thin-section CT for Lung-RADS classification. Materials and Methods In this prospective study, standard- and low-dose chest CT (270 mA and 60 mA, respectively) and MRI with UTE were used to examine consecutive participants enrolled between January 2017 and December 2020 who met American College of Radiology Appropriateness Criteria for lung cancer screening with low-dose CT. Probability of nodule presence was assessed for all methods with a five-point visual scoring system by two board-certified radiologists. All nodules were then evaluated in terms of their Lung-RADS classification using each method. To compare nodule detection capability of the three methods, consensus for performances was rated by using jackknife free-response receiver operating characteristic analysis, and sensitivity was compared by means of the McNemar test. In addition, weighted κ statistics were used to determine the agreement between Lung-RADS classification obtained with each method and the reference standard generated from standard-dose CT evaluated by two radiologists who were not included in the image analysis session. Results A total of 205 participants (mean age: 64 years ± 7 [standard deviation], 106 men) with 1073 nodules were enrolled. Figure of merit (FOM) ( P < .001) had significant differences among three modalities (standard-dose CT: FOM = 0.91, low-dose CT: FOM = 0.89, pulmonary MRI with UTE: FOM = 0.94), with no evidence of false-positive findings in participants with all modalities ( P > .05). Agreements for Lung-RADS classification between all modalities and the reference standard were almost perfect (standard-dose CT: κ = 0.82, P < .001; low-dose CT: κ = 0.82, P < .001; pulmonary MRI with UTE: κ = 0.82, P < .001). Conclusion In a lung cancer screening population, ultrashort echo time pulmonary MRI was comparable to standard- or low-dose CT for Lung CT Screening Reporting and Data System classification. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Wielpütz in this issue.

Since thoracic MR imaging was first used in a clinical setting, it has been suggested that MR imaging has limited clinical utility for thoracic diseases, especially lung diseases, in comparison with x-ray CT and positron emission tomography (PET)/CT. However, in many countries and states and for specific indications, MR imaging has recently become practicable. In addition, recently developed pulmonary MR imaging with ultra-short TE (UTE) and zero TE (ZTE) has enhanced the utility of MR imaging for thoracic diseases in routine clinical practice. Furthermore, MR imaging has been introduced as being capable of assessing pulmonary function. It should be borne in mind, however, that these applications have so far been academically and clinically used only for healthy volunteers, but not for patients with various pulmonary diseases in Japan or other countries. In 2020, the Fleischner Society published a new report, which provides consensus expert opinions regarding appropriate clinical indications of pulmonary MR imaging for not only oncologic but also pulmonary diseases. This review article presents a brief history of MR imaging for thoracic diseases regarding its technical aspects and major clinical indications in Japan 1) in terms of what is currently available, 2) promising but requiring further validation or evaluation, and 3) developments warranting research investigations in preclinical or patient studies. State-of-the-art MR imaging can non-invasively visualize lung structural and functional abnormalities without ionizing radiation and thus provide an alternative to CT. MR imaging is considered as a tool for providing unique information. Moreover, prospective, randomized, and multi-center trials should be conducted to directly compare MR imaging with conventional methods to determine whether the former has equal or superior clinical relevance. The results of these trials together with continued improvements are expected to update or modify recommendations for the use of MRI in near future.

Objectives: With improvements in the outcome of treatment for non-small-cell lung cancer (NSCLC), other diseases may account for a high death rate after surgery in patients with stage I NSCLC. In the present study, we analysed the associations between the clinical factors and non-cancer death after surgery in these patients., Methods: The records of 514 patients with stage I NSCLC who underwent surgery were retrospectively reviewed; a proportional hazards model for the subdistribution of a competing risk was conducted to define the risk factors for non-cancer death., Results: The mean patient age was 67 years. A total of 367 patients (71%) underwent bilobectomy or lobectomy while 147 (29%) underwent sublobar resection. The pathological stage was IA in 386 (75%) and IB in 128 (25%) patients. Three patients (0.6%) died within 90 days after surgery, and 108 (21%) experienced postoperative complications. Until the time of writing this report, 83 patients had died during the follow-up. The cause of death was primary lung cancer in 38 (46%) patients and other diseases in 45 (54%) patients, including non-cancer causes in 29 patients, such as pneumonia, cardiac death and cerebral stroke. According to a multivariable competing risk analysis for non-cancer death age (≥70 years), sex (male), body mass index (BMI <18.5), postoperative complications and % forced expiratory volume in 1 s (<80) were identified as risk factors for postoperative non-cancer death., Conclusions: Advanced age (≥70 years), male sex, low BMI (<18.5), postoperative complications and low preoperative % forced expiratory volume in 1 s (<80) were found to be the risk factors for postoperative non-cancer death after surgery in patients with stage I NSCLC., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Purpose: To evaluate the capability of inspiratory/expiratory Xe-enhanced ADCT for assessment of changes in pulmonary function and regional ventilation of surgically treated NSCLC patients., Method and Materials: Forty consecutive surgically treated NSCLC patients underwent pre- and postoperative inspiratory/expiratory Xe-enhanced ADCT and pulmonary function tests. For each patient, pre- and post-operative data were analyzed and pre- and post-operative wash-in (WI) and wash-out (WO) indexes and ventilation ratio (VR=[WI-WO]/WI) maps generated by means of pixel-by-pixel analyses. Differences between pre- and postoperative WI (ΔWI), WO (ΔWO) and VR (ΔVR) were also determined. To determine the relationship between all ventilation index changes and pulmonary functional loss, Pearson's correlation was used to correlate each ventilation index change with the corresponding pulmonary functional parameter change. In addition, stepwise regression analysis was performed for all ventilation index changes and each corresponding pulmonary functional parameter change., Results: FEV 1 /FVC% change showed fair or good and significant correlations with ΔWI (r = 0.39, p = 0.01) and ΔVR (r = 0.68, p = 0.001), %FEV 1 change good or moderate and significant correlations with ΔWI (r = 0.56, p = 0.0001) and ΔVR (r = 0.76, p < 0.0001), and %VC change moderate yet significant correlation with ΔWI (r = 0.65, p < 0.0001) and ΔVR (r = 0.67, p < 0.0001). Stepwise regression analysis demonstrated that FEV 1 /FVC% change (r 2  = 0.56, p < 0.0001) significantly affected two factors, ΔVR (p < 0.0001) and ΔWI (p = 0.006), as did %FEV 1 change (r 2  = 0.68, p < 0.0001) [ΔVR (p < 0.0001) and ΔWI (p = 0.0001)], and %VC change (r 2  = 0.63, p < 0.0001) [ΔVR (p < 0.0001) and ΔWI (p = 0.0001)]., Conclusion: Inspiratory/expiratory Xe-enhanced ADCT has the potential to demonstrate that pre- and postoperative ventilation status of surgically treated NSCLC patients correlates with pulmonary function., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background/aim: We evaluated the efficacy of primary prophylaxis with pegfilgrastim (PEG) for febrile neutropenia (FN) in small cell lung cancer (SCLC) patients receiving amrubicin (AMR)., Patients and Methods: A retrospective cohort study was conducted in patients with SCLC receiving AMR as second-line therapy., Results: A total of 33 patients were treated with AMR (no PEG group), while 13 patients were treated with AMR plus prophylactic administration of PEG (PEG group). The severity of neutropenia was significantly reduced in the PEG group compared to the no PEG group (p=0.02). The incidence of FN in the no PEG and PEG groups was 27.3% and 7.7%, respectively. The time to development of FN tended to be longer in the PEG group compared to the no PEG group (p=0.132)., Conclusion: Primary prophylaxis with PEG may be beneficial in reducing the risk of FN in patients with SCLC receiving AMR., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

OBJECTIVE. The purpose of this study was to compare diagnostic accuracy of TNM stage for whole-body MRI and coregistered PET/MRI using 1.5-T and 3-T MRI systems and PET/CT in patients with non-small cell lung cancer (NSCLC). SUBJECTS AND METHODS. A total of 104 patients with pathologically diagnosed NSCLC underwent whole-body MRI at 1.5 T and 3T and integrated PET/CT, as well as a combination of surgical, pathologic, or follow-up examinations. Whole-body MR images obtained by the five sequences were combined with the PET part of the PET/CT using proprietary software for the PET/MRI studies. The TNM stage obtained with all methods was visually assessed. Kappa statistics were used to determine agreement between TNM stage assessment and final diagnoses, and the McNemar test was used to compare diagnostic accuracy of all methods. RESULTS. Findings of TNM stage on whole-body MRI using 3-T (κ, 0.87; p < 0.0001) and 1.5-T (κ, 0.83; p < 0.0001) systems and for coregistered PET/MRI using a 3-T system (PET/MRI 3T ; κ, 0.85; p < 0.0001) were rated as significant and almost perfect, and findings for coregistered PET/MRI using a 1.5-T system (PET/MRI 1.5T ; κ, 0.80; p < 0.0001) and PET/CT (κ, 0.73; p < 0.0001) were rated significant and substantial. Diagnostic accuracy of whole-body MRI using the 3-T system was 88.5% (92/104; p = 0.0002, and using the 1.5-T system it was 84.6% (88/104; p = 0.004); results for PET/MRI 3T and PET/MRI 1.5T were 86.5% (90/104; p = 0.001) and 81.7% (85/104; p = 0.03), respectively, which were both significantly better than accuracy of results for PET/CT at 76.0% (79/104). Moreover, diagnostic accuracy of whole-body MRI using a 3-T system was significantly higher than that of PET/MRI using a 1.5-T system ( p = 0.02). CONCLUSION. Whole-body MRI and coregistered PET/MRI using 3-T and 1.5-T systems are as accurate or more accurate than PET/CT, whereas differences between 3-T and 1.5-T MRI systems are not considered significant.

Background Deep learning may help to improve computer-aided detection of volume (CADv) measurement of pulmonary nodules at chest CT. Purpose To determine the efficacy of a deep learning method for improving CADv for measuring the solid and ground-glass opacity (GGO) volumes of a nodule, doubling time (DT), and the change in volume at chest CT. Materials and Methods From January 2014 to December 2016, patients with pulmonary nodules at CT were retrospectively reviewed. CADv without and with a convolutional neural network (CNN) automatically determined total nodule volume change per day and DT. Area under the curves (AUCs) on a per-nodule basis and diagnostic accuracy on a per-patient basis were compared among all indexes from CADv with and without CNN for differentiating benign from malignant nodules. Results The CNN training set was 294 nodules in 217 patients, the validation set was 41 nodules in 32 validation patients, and the test set was 290 nodules in 188 patients. A total of 170 patients had 290 nodules (mean size ± standard deviation, 11 mm ± 5; range, 4-29 mm) diagnosed as 132 malignant nodules and 158 benign nodules. There were 132 solid nodules (46%), 106 part-solid nodules (36%), and 52 ground-glass nodules (18%). The test set results showed that the diagnostic performance of the CNN with CADv for total nodule volume change per day was larger than DT of CADv with CNN (AUC, 0.94 [95% confidence interval {CI}: 0.90, 0.96] vs 0.67 [95% CI: 0.60, 0.74]; P < .001) and CADv without CNN (total nodule volume change per day: AUC, 0.69 [95% CI: 0.62, 0.75]; P < .001; DT: AUC, 0.58 [95% CI: 0.51, 0.65]; P < .001). The accuracy of total nodule volume change per day of CADv with CNN was significantly higher than that of CADv without CNN ( P < .001) and DT of both methods ( P < .001). Conclusion Convolutional neural network is useful for improving accuracy of computer-aided detection of volume measurement and nodule differentiation capability at CT for patients with pulmonary nodules. © RSNA, 2020 Online supplemental material is available for this article.

Purpose: To directly compare the utility for therapeutic outcome prediction of dynamic first-pass contrast-enhanced (CE)-perfusion area-detector computed tomography (ADCT), MR imaging assessed with the same mathematical method and 2-[fluorine-18]-fluoro-2-deoxy-d-glucose-positron emission tomography combined with CT (PET/CT) for non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy., Materials and Methods: Forty-three consecutive stage IIIB NSCLC patients, consisting of 25 males (mean age ± standard deviation: 66.6 ± 8.7 years) and 18 females (66.4 ± 8.2 years) underwent PET/CT, dynamic CE-perfusion ADCT and MR imaging, chemoradiotherapy, and follow-up examination. In each patient, total, pulmonary arterial, and systemic arterial perfusions were calculated from both perfusion data and SUV max on PET/CT, assessed for each targeted lesion, and averaged to determine final values. Receiver operating characteristics analyses were performed to compare the utility for distinguishing responders from non-responders using Response Evaluation Criteria in Solid Tumor (RECIST) 1.1 criteria. Overall survival (OS) assessed with each index were compared between two groups by means of the Kaplan-Meier method followed by the log-rank test., Results: Area under the curve (Az) for total perfusion on ADCT was significantly larger than that of pulmonary arterial perfusion (P < 0.05). Az of total perfusion on MR imaging was significantly larger than that of pulmonary arterial perfusion (P < 0.05). Mean OS of responder and non-responder groups were significantly different for total and systemic arterial (P < 0.05) perfusion., Conclusion: Dynamic first-pass CE-perfusion ADCT and MR imaging as well as PET/CT are useful for early prediction of treatment response by NSCLC patients treated with chemoradiotherapy.

Objectives: The objective of this study was to evaluate the validity of Eurolung risk models in a Japanese population and assess their utility as predictive indicators for the prognosis., Methods: Between 2007 and 2014, 612 anatomic lung resections were performed among 694 lung cancer patients in our institution. We analysed the cardiopulmonary morbidity and mortality and compared them with the predicted results. We also investigated the association between the Eurolung aggregate risk scores and the long-term outcomes using the Kaplan-Meier method and a multivariable analysis., Results: The percentage of cardiopulmonary complications was lower than that predicted by Eurolung 1 (22.4% vs 24.6%). The mortality rate was significantly lower than predicted by Eurolung 2 (0.7% vs 3.0%). The morbidity rate was stratified by Aggregate Eurolung 1. The stratification of the mortality rate by the Eurolung 2 aggregate score was also in line with the increase in score, although the observed number of deaths was quite small (4 cases). The 5-year overall survival was clearly separated according to the stratified Aggregate Eurolung 1 and 2 (P < 0.01 and P < 0.01, respectively). Besides pathological stage, both the Aggregate Eurolung 1 (score 0-7 vs 8-20) and 2 (score 0-8 vs 9-19) scores were shown to be independently associated with overall survival on multivariable., Conclusions: Eurolung risk models cannot be directly applied to the patients in our institution. However, Eurolung aggregate risk scores were helpful not only for stratifying morbidity and mortality after anatomic lung resection but also for predicting the long-term outcomes., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: A recent study demonstrated remarkable discrepancy between the relapse-free survival (RFS) and overall survival (OS) after pulmonary metastasectomy (PM) in the current era. As the RFS may not be a suitable parameter after PM, a more suitable parameter is needed for PM as a surrogate marker for OS., Methods: A total of 134 consecutive patients who underwent PM were retrospectively analyzed. In the present study, we introduced a new endpoint, time to local treatment failure (TLTF). This endpoint was defined as the time interval between the first PM and the first untreatable recurrence by local treatment with curative intent or death due to any cause. We analyzed the correlation between the RFS and OS and between the TLTF and OS to validate whether or not the TLTF is a better parameter than the RFS after PM., Results: Thus far, 78 patients have experienced relapse. Of these, 37 patients (47%) underwent local therapy with curative intent, 29 of whom are alive without local treatment failure. The 5-year OS, RFS and TLTF were 70.9%, 36.5%, and 57.6%, respectively. The concordance proportions for the RFS and OS and for the TLTF and OS were 0.634 and 0.851 for all patients, respectively. The Spearman's rank correlation coefficient for the RFS and OS was 0.639, while that for the TLTF and OS was 0.875., Conclusions: The TLTF may be a good surrogate parameter for the OS after PM in the current era.

Objectives: Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) represent the first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer. Afatinib is a second-generation EGFR-TKI with excellent therapeutic effects. However, severe diarrhea and skin disorders are observed at high frequencies, often leading to treatment interruption because of low quality of life (QOL). The relationship between individual variations and the onset of these side effects remains to be elucidated. This study aimed to reveal the association among these side effects, pharmacokinetics, and related genetic polymorphisms., Materials and Methods: In total, 33 patients were recruited between July 2014 and June 2017. Afatinib plasma concentrations were measured at day 9 when the concentrations reached a steady state (early phase) and when the prescription dose was stable for more than 1 month (stable phase). We analyzed single nucleotide polymorphisms in the genes ATP-binding cassette sub-family B member 1 (ABCB1), ABCG2, and flavin-containing monooxygenase 3., Results: The incidences of both diarrhea and acneiform eruption were greater than 80%. Afatinib plasma concentration and the severity of diarrhea in the early phase were correlated. Pharmacokinetics-related genetic polymorphisms influenced the severity of diarrhea. Particularly, the afatinib plasma concentration was higher and diarrhea was more severe in patients carrying the A allele of ABCG2 C421A. Onset of side effects, genetic polymorphisms, and diarrhea in the maintenance phase or acneiform eruption in the early or maintenance phases were not correlated. The severity of diarrhea is influenced by drug plasma concentrations in the early phase and genetic polymorphisms related to afatinib pharmacokinetics., Conclusion: Particular genetic polymorphisms can be screened before afatinib administration and the dose adapted to individual patients can be controlled, leading to reduced side effects, improved QOL, and better patient compliance to maintain the therapeutic effects., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Purpose: To prospectively compare the capability of dynamic first-pass contrast-enhanced (CE) perfusion MR imaging with ultra-short TE and area-detector CT (ADCT), analyzed with the same mathematical methods, and that of FDG-PET/CT for diagnosis and management of solitary pulmonary nodules (SPNs)., Methods and Materials: Our institutional review board approved this study and written informed consent was obtained from all subjects. A total 57 consecutive patients with 71 nodules prospectively underwent dynamic CE-perfusion ADCT and MR imaging with ultra-short TE, FDG-PET/CT, as well as microbacterial and/or pathological examinations. The nodules were classified into malignant nodules (n = 45) and benign nodules (n = 26). Pulmonary arterial, systemic arterial and total perfusions were determined by means of dual-input maximum slope models on ADCT and MR imaging and maximum values of standard uptake values (SUV max ) on PET/CT. Receiver operating characteristic (ROC) analysis was performed for each index, and sensitivity, specificity and accuracy were compared by McNemar's test., Results: Areas under the curve (Azs) of total perfusion on ADCT (Az = 0.89) and MR imaging (Az = 0.88) were significantly larger than those of systemic arterial perfusion and MR imaging (p<0.05). Accuracy of total perfusion on ADCT (87.3% [62/71]) and MR imaging (87.3% [62/71]) was significantly higher than that of systemic arterial perfusion for both methods (77.5% [55/71] p = 0.02) and SUV max (78.9% [56/71], p = 0.03)., Conclusion: Dynamic CE-perfusion MR imaging with ultra-short TE and ADCT and have similar potential capabilities, and are superior to FDG-PET/CT in this setting., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Multimodality imaging measurements of treatment response are critical for clinical practice, oncology trials, and the evaluation of new treatment modalities. The current standard for determining treatment response in non-small cell lung cancer (NSCLC) is based on tumor size using the RECIST criteria. Molecular targeted agents and immunotherapies often cause morphological change without reduction of tumor size. Therefore, it is difficult to evaluate therapeutic response by conventional methods. Radiomics is the study of cancer imaging features that are extracted using machine learning and other semantic features. This method can provide comprehensive information on tumor phenotypes and can be used to assess therapeutic response in this new age of immunotherapy. Delta radiomics, which evaluates the longitudinal changes in radiomics features, shows potential in gauging treatment response in NSCLC. It is well known that quantitative measurement methods may be subject to substantial variability due to differences in technical factors and require standardization. In this review, we describe measurement variability in the evaluation of NSCLC and the emerging role of radiomics.

Objective: The purpose of this study was to compare the diagnostic accuracy of whole-body MRI, coregistered FDG PET/MRI, integrated FDG PET/CT, and conventional imaging examination including bone scintigraphy, contrast-enhanced brain MRI, and CT for malignant pleural mesothelioma (MPM) staging according to the new International Association for the Study of Lung Cancer (IASLC) system., Subjects and Methods: The study subjects were 23 consecutively registered patients with MPM (15 men, eight women; mean age, 68 years for both sexes) who had prospectively undergone whole-body FDG PET/CT, whole-body MRI, conventional radiologic examination, surgical or conventional treatments, pathologic examination, and follow-up conventional imaging examinations between January 2011 and December 2017. TNM staging was evaluated by two independent readers. Kappa statistics and chi-square tests were used for evaluation agreements on each factor and clinical stage between each method and final diagnosis. The diagnostic accuracy of each method was statistically compared by use of McNemar test., Results: The kappa values for each factor between each method and final diagnosis were significant (p < 0.0001) and ranged between 0.33 and 0.91. Kappa values between final diagnosis and stage evaluation were also significant (p < 0.0001) and ranged between 0.57 and 0.91. The diagnostic accuracy of N and stage assessment of whole-body MRI and FDG PET/MRI was significantly higher than that of conventional imaging examination (N factor, p < 0.05; stage, p < 0.05)., Conclusion: The diagnostic accuracy of whole-body MRI, FDG PET/MRI, and FDG PET/CT for TNM stage assessment based on the new IASLC MPM staging system is greater than that of conventional imaging examination.

Objective: The purpose of this study is to directly compare the capability of gadolinium-based blood volume (BV) mapping from MRI (BV-MRI) with ultrashort TE (UTE) with that of CT and perfusion SPECT in predicting the postoperative lung function of patients with non-small cell lung cancer (NSCLC)., Subjects and Methods: Unenhanced and contrast-enhanced MRI with UTE, thin-section CT, and perfusion SPECT examinations and measurements of the percentage of forced expiratory volume in 1 second (FEV 1 ) before and after lung resection were performed for 29 patients with NSCLC (16 men [mean age, 66 years] and 13 women [mean age, 66 years]). BV-MRI with UTE was generated as a percentage of the signal change between unenhanced and contrast-enhanced MRI. The postoperative percentage of FEV 1 was predicted from perfusion fractions derived from BV-MRI with UTE and from SPECT. Quantitatively and qualitatively predicted postoperative percentages of FEV 1 from CT were calculated from the functional lung volumes and the number of segments. Each predicted postoperative percentage of FEV 1 was then correlated with the actual postoperative percentage of FEV 1 , and the limits of agreement for each actual and predicted postoperative percentage of FEV 1 were evaluated by Bland-Altman analysis., Results: Correlations between actual and predicted postoperative percentages of FEV 1 for all methods were strong and significant (0.88 ≤ r ≤ 0.95). The limits of agreement (mean ± 1.96 × SD) for BV-MRI with UTE (4.2% ± 6.5%) and quantitatively assessed CT (4.1% ± 6.5%) were smaller than those for qualitatively assessed CT (4.2% ± 9.8%) and perfusion SPECT (5.7% ± 8.7%)., Conclusion: BV-MRI with UTE has the potential to predict the postoperative lung function of patients with NSCLC more accurately than qualitatively assessed CT and SPECT, and it can be considered to be at least as useful as quantitatively assessed CT.

Malignant mesothelioma (MM) has a poor prognosis and is largely resistant to standard treatments, so it is important to seek novel therapeutic strategies for this disease. Cancer-initiating cells (CICs) were previously identified in MM using stem cell-associated markers in combination with spheroid cultures. However, the mechanisms underlying the induction and maintenance of CICs in MM remain to be fully explored. Here we showed that the CICs, which had high aldehyde dehydrogenase levels (ALDH bright ) and stem cell-associated genes, were expanded in MM cells cultured under sphere-forming conditions. The MM spheroids also initiated tumors in immunodeficient mice more efficiently than did conventional adherent MM cells. In the MM spheroids, the expression of hyaluronan (HA) synthases was upregulated. Inhibiting the HA synthesis or CD44 functions by gene knockdown or neutralizing antibody abolished the formation of large-sized spheroids and the expansion of ALDH bright CICs. The expression of activin-A was also increased in the spheroids, and type I activin-A receptor subunit (ALK4) was upregulated in the ALDH bright CICs. The neutralization of activin-A or functional inactivation of ALK4 diminished the ALDH bright CICs without affecting spheroid formation. The knockdown of CD44 or ALK4 strongly suppressed the tumor growth in immunodeficient mice. These results together suggest that the HA-CD44 and activin-A-ALK4 pathways differentially regulate the spheroid formation and maintenance of ALDH bright CICs in MM cells, and that both pathways play critical roles in tumor growth in immunodeficient hosts. Our findings provide a novel therapeutic option for MM that targets signaling pathways that promote the CIC compartment through CD44 and ALK4.

Objective: The purpose of this study was to prospectively compare the capabilities of integrated FDG PET/CT and conventional staging for identification of TNM factors, evaluation of the TNM and Veterans Administration Lung Study Group (VALSG) stages, and selection of patients with stage I small cell lung carcinoma (SCLC)., Subjects and Methods: Fifty-nine patients (mean age, 69.6 ± 7.8 [SD] years; range, 40-84 years) with pathologically diagnosed SCLC underwent integrated 18 F-FDG PET/CT and conventional staging with enhanced brain MRI. TNM and VALSG stages were evaluated by two different reader groups. Kappa statistics and chi-square test result were determined for evaluations of interobserver agreement of all factors and for each clinical stage for both methods. Diagnostic accuracy of identification of each factor and clinical stage was statistically compared by McNemar test., Results: Interobserver agreements for all factors and each clinical stage were assessed as almost perfect for PET/CT (0.83 ≤ κ ≤ 0.93; p < 0.001) and substantial and almost perfect (0.63 ≤ κ ≤ 0.96; p < 0.001) for conventional staging plus enhanced brain MRI. The diagnostic accuracy of PET/CT for N factor and TNM stage (N, 89.8% [53/59]; TNM stage, 88.1% [52/59]) was significantly higher than that of conventional staging plus enhanced brain MRI (N, 67.8% [40/59], p = 0.0002; TNM stage, 72.9% [43/59], p = 0.004)., Conclusion: Integrated FDG PET/CT with contrast-enhanced brain MRI is potentially equal to or more effective than conventional staging plus enhanced brain MRI for T, N, and M assessment and TNM and VALSG staging of SCLC.

Since the clinical introduction of magnetic resonance imaging (MRI), the chest has been one of its most challenging applications, and many physicists and radiologists have tried since the 1980s to use MR for assessment of different lung diseases as well as mediastinal and pleural diseases. Since then, however, technical advances in sequencing, scanners, and coils, adaptation of parallel imaging techniques, utilization of contrast media, and development of postprocessing tools have been reported by many basic and clinical researchers. As a result, state-of-the-art thoracic MRI is now substituted for traditional imaging techniques and/or plays a complementary role in the management of patients with various chest diseases, and especially in the detection of pulmonary nodules and in thoracic oncology. In addition, MRI has continued to be developed to help overcome the limitations of computed tomography (CT) and nuclear medicine examinations. It can currently provide not only morphological, but also functional, physiological, pathophysiological, and molecular information at 1.5T with a gradual shift from 1.5T to 3T MR systems. In this review, we focus on these recent advances in MRI for pulmonary nodule detection and pulmonary nodule and mass evaluation by using noncontrast-enhanced and contrast-enhanced techniques as well as new molecular imaging methods such as chemical exchange saturation transfer imaging for a comparison with other modalities such as single or multidetector row CT, 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and/or PET/CT., Level of Evidence: 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1437-1458., (© 2018 International Society for Magnetic Resonance in Medicine.)

Objective: Ultrashort TE (UTE) MRI has been shown to deliver high-resolution images comparable to CT images. Here we evaluate the potential of UTE-MRI for precise lung nodule characterization., Subjects and Methods: Fifty-one patients (mean [± SD] age, 68.7 ± 10.8 years) with 119 nodules or masses (mean size, 17.4 ± 16.3 mm; range, 4-88 mm) prospectively underwent CT (1-mm slice thickness) and UTE-MRI (TE, 192 μs; 1 mm 3 resolution). Two radiologists assessed nodule dimensions and morphologic features (i.e., attenuation, margins, and internal lucencies), in consensus for CT and in a blinded fashion for UTE-MRI. Sensitivity, specificity, and kappa statistics were calculated in reference to CT., Results: Readers 1 and 2 underestimated the nodules' long axial diameter with UTEMRI by 1.2 ± 3.4 and 2.1 ± 4.2 mm, respectively (p < 0.001). The sensitivity and specificity of UTE-MRI for subsolid attenuation were 95.9% and 70.3%, respectively, for reader 1 and 97.1% and 71.4%, respectively, for reader 2 (κ = 0.71 and 0.68). With regard to margin characteristics, for lobulation, sensitivity was 70.6% and 54.9%, and specificity was 93.2% and 96.3% for readers 1 and 2, respectively; for spiculation, sensitivity was 61.5% and 48.0%, and specificity was 95.2% and 95.0%; and for pleural tags, sensitivity was 87.0% and 73.3%, and specificity was 93.8% and 95.0%. Finally, for internal lucencies, sensitivity was 72.7% and 61.3%, and specificity was 96.1% and 97.3% for readers 1 and 2, respectively (κ = 0.64-0.81 for reader 1 and 0.48-0.72 for reader 2). Interreader agreement for attenuation, margin characteristics, and lucencies was substantial to almost perfect with few exceptions (κ = 0.51-0.90)., Conclusion: UTE-MRI systematically underestimated dimension measurements by approximately 1-2 mm but otherwise showed high diagnostic properties and interreader agreement, yet unprecedented by MRI, for nodule morphologic assessment.

Since MR imaging was introduced for the assessment of thoracic and lung diseases, various limitations have hindered its widespread adoption in clinical practice. Since 2000, various techniques have been developed that have demonstrated the usefulness of MR imaging for lung cancer evaluation, and it is now reimbursed by health insurance companies in many countries. This article reviews recent advances in lung MR imaging, focusing on its use for lung cancer evaluation, especially with regard to pulmonary nodule detection, pulmonary nodule and mass assessment, lung cancer staging and detection of recurrence, postoperative lung function prediction, and therapeutic response evaluation and prediction., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Purpose: To compare the capability of amide proton transfer-weighted (APTw) imaging, diffusion-weighted imaging (DWI), and FDG-PET/CT for the differentiation of malignant from benign pulmonary nodules., Materials and Methods: In all, 82 consecutive patients with pulmonary nodules underwent APTw imaging and DWI with a 3T system, and FDG-PET/CT. All nodules were divided as either malignant (n = 49) or benign (n = 39) groups based on pathological and follow-up examinations. To evaluate the capability for differentiation of malignant from benign nodules, magnetization transfer ratio asymmetry (MTR asym )(3.5ppm) on APTw imaging, apparent diffusion coefficient (ADC), and maximum value of standard uptake value (SUV max ) were assessed. Receiver operating characteristic (ROC) analyses were performed to computationally determine each feasible threshold value. Next, McNemar's test was used for comparing diagnostic performance with each other as well as with a combination of the significant factors determined by multivariate logistic regression analysis., Results: Although sensitivity of ADC was significantly higher than that of MTR asym (3.5 ppm) (P = 0.002) and SUV max (P = 0.004), specificity of MTR asym (3.5 ppm) and SUV max was significantly higher than that of ADC (P < 0.05). Sensitivity of combined MTR asym (3.5ppm) with SUV max was significantly higher than that of MTR asym (3.5ppm) (P = 0.001) and SUV max (P = 0.002) alone. Moreover, specificity and accuracy of combined MTR asym (3.5ppm) with SUV max were significantly higher than that of ADC (specificity: P = 0.002, accuracy: P = 0.008)., Conclusion: APTw imaging appears to be as useful as DWI and FDG-PET/CT for differentiation of malignant from benign nodules., Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1013-1021., (© 2017 International Society for Magnetic Resonance in Medicine.)

Purpose: To directly compare the effect of a reconstruction algorithm on nodule detection capability of the computer-aided detection (CADe) system using standard-dose, reduced-dose and ultra-low dose chest CTs with and without adaptive iterative dose reduction 3D (AIDR 3D)., Materials and Methods: Our institutional review board approved this study, and written informed consent was obtained from each patient. Standard-, reduced- and ultra-low-dose chest CTs (250 mA, 50 mA and 10 mA) were used to examine 40 patients, 21 males (mean age ± standard deviation: 63.1 ± 11.0 years) and 19 females (mean age, 65.1 ± 12.7 years), and reconstructed as 1 mm-thick sections. Detection of nodule equal to more than 4 mm in dimeter was automatically performed by our proprietary CADe software. The utility of iterative reconstruction method for improving nodule detection capability, sensitivity and false positive rate (/case) of the CADe system using all protocols were compared by means of McNemar's test or signed rank test., Results: Sensitivity (SE: 0.43) and false-positive rate (FPR: 7.88) of ultra-low-dose CT without AIDR 3D was significantly inferior to those of standard-dose CTs (with AIDR 3D: SE, 0.78, p < .0001, FPR, 3.05, p < .0001; and without AIDR 3D: SE, 0.80, p < .0001, FPR: 2.63, p < .0001), reduced-dose CTs (with AIDR 3D: SE, 0.81, p < .0001, FPR, 3.05, p < .0001; and without AIDR 3D: SE, 0.62, p < .0001, FPR: 2.95, p < .0001) and ultra-low-dose CT with AIDR 3D (SE, 0.79, p < .0001, FPR, 4.88, p = .0001)., Conclusion: The AIDR 3D has a significant positive effect on nodule detection capability of the CADe system even when radiation dose is reduced., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To compare the diagnostic performance of positron emission tomography with [18F] fluoro-2-deoxy-glucose (FDG-PET) coregistered with magnetic resonance imaging (FDG-PET/MRI), MRI with and without diffusion-weighted imaging (DWI), FDG-PET fused with computed tomography (FDG-PET/CT) with brain contrast-enhanced (CE-) MRI, and routine radiological examination for assessment of postoperative recurrence in nonsmall-cell lung cancer (NSCLC) patients., Materials and Methods: 96 consecutive postoperative NSCLC patients (52 men, 44 women; mean age 72 years) prospectively underwent whole-body 3T MRI with and without DWI; PET/CTs and routine radiological examinations consisted of CE-brain MRI, whole-body CE-CT, and bone scintigraphy. The patients were divided into a recurrence (n = 17) and a nonrecurrence (n = 79) group based on pathological and follow-up examinations. All coregistered PET/MRIs were generated by proprietary software. The probability of recurrence was visually assessed on a per-patient basis. Receiver operating characteristic analyses were used to compare the diagnostic performance of all methods. Finally, diagnostic capabilities were compared by means of McNemar's test., Results: Areas under the curves (Azs) were significantly larger for PET/MRI and whole-body MRI with DWI (Az = 0.99) than for PET/CT (Az = 0.92, P < 0.05) and conventional radiological examination (Az = 0.91, P < 0.05). Specificity and accuracy of PET/MRI and MRI with and without DWI were significantly higher than those of PET/CT (P < 0.05) and routine radiological examination (P < 0.05)., Conclusion: Whole-body FDG-PET/MRI and MRI with DWI were found to be more specific and accurate than FDG-PET/CT and routine radiological examinations for assessment of recurrence in NSCLC patients, although MRI with and without DWI demonstrated slightly lower sensitivity than PET/CT., Level of Evidence: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1707-1717., (© 2017 Wiley Periodicals, Inc.)

Objective: The objective of our study was to directly compare the capability of dynamic first-pass contrast-enhanced (CE) perfusion area-detector CT (ADCT) and FDG PET/CT for differentiation of metastatic from nonmetastatic lymph nodes and assessment of N stage in patients with non-small cell lung carcinoma (NSCLC)., Subjects and Methods: Seventy-seven consecutive patients, 45 men (mean age ± SD, 70.4 ± 5.9 years) and 32 women (71.2 ± 7.7 years), underwent dynamic first-pass CE-perfusion ADCT at two or three different positions for covering the entire thorax, FDG PET/CT, surgical treatment, and pathologic examination. From all ADCT data for each of the subjects, a whole-chest perfusion map was computationally generated using the dual- and single-input maximum slope and Patlak plot methods. For quantitative N stage assessment, perfusion parameters and the maximum standardized uptake value (SUV max ) for each lymph node were determined by measuring the relevant ROI. ROC curve analyses were performed for comparing the diagnostic capability of each of the methods on a per-node basis. N stages evaluated by each of the indexes were then statistically compared with the final pathologic diagnosis by means of chi-square and kappa statistics., Results: The area under the ROC curve (A z ) values of systemic arterial perfusion (A z = 0.89), permeability surface (A z = 0.78), and SUV max (A z = 0.85) were significantly larger than the A z values of total perfusion (A z = 0.70, p < 0.05) and distribution volume (A z = 0.55, p < 0.05). For each of the threshold values, agreement for systemic arterial perfusion calculated using the dual-input maximum slope model was substantial (κ = 0.70, p < 0.0001), and agreement for SUV max was moderate (κ = 0.60, p < 0.0001)., Conclusion: Dynamic first-pass CE-perfusion ADCT is as useful as FDG PET/CT for the differentiation of metastatic from nonmetastatic lymph nodes and assessment of N stage in patients with NSCLC.

Rationale and Objectives: This study aimed to compare sub-solid nodule detection performances (SSNDP) on chest computed tomography (CT) with Adaptive Iterative Dose Reduction using Three Dimensional Processing (AIDR 3D) between 7 mAs (0.21 mSv) and 42 mAs (1.28 mSv) in total and in subgroups classified by nodular size, characteristics, and location, and analyze the association of SSNDP with size-specific dose estimate (SSDE)., Materials and Methods: As part of the Area-detector Computed Tomography for the Investigation of Thoracic Diseases Study, a Japanese multicenter research project, 68 subjects underwent chest CT with 120 kV, 0.35 seconds per rotation, and three tube currents: 240 mA (84 mAs), 120 mA (42 mAs), and 20 mA (7 mAs). The research committee of the study project outlined and approved our study protocols. The institutional review board of each institution approved this study. Axial 2-mm-thick CT images were reconstructed using AIDR 3D. Standard reference was determined by CT images at 84 mAs. Four radiologists recorded SSN presence by continuously distributed rating on CT at 7 mAs and 42 mAs. Receiver operating characteristic analysis was used to evaluate SSNDP at both doses in total and in subgroups classified by nodular longest diameter (LD) (≥5 mm), characteristics (pure and part-solid), and locations (ventral, intermediate, or dorsal; central or peripheral; and upper, middle, or lower). Detection sensitivity was compared among five groups of SSNs classified based on particular SSDE to nodule on CT with AIDR 3D at 7 mAs., Results: Twenty-two part-solid and 86 pure SSNs were identified. For larger SSNs (LD ≥ 5 mm) as well as subgroups classified by nodular locations and part-solid nodules, SSNDP was similar in both methods (area under the receiver operating characteristics curve: 0.96 ± 0.02 in CT at 7 mAs and 0.97 ± 0.01 in CT at 42 mAs), with acceptable interobserver agreements in five locations. For larger SSNs (LD ≥ 5 mm), on CT at 42 mAs, no significant differences in detection sensitivity were found among the five groups classified by SSDE, whereas on CT with 7 mAs, four groups with SSDE of 0.65 or higher were superior in detection sensitivity to the other group, with SSDE less than 0.65 mGy., Conclusions: For SSNs with 5 mm or more in cases with normal range of body habitus, CT at 7 mAs was demonstrated to have comparable SSNDP to CT at 42 mAs regardless of nodular location and characteristics, and SSDE higher than 0.65 mGy is desirable to obtain sufficient SSNDP., (Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.)

Purpose To compare the capability of pulmonary thin-section magnetic resonance (MR) imaging with ultrashort echo time (UTE) with that of standard- and reduced-dose thin-section computed tomography (CT) in nodule detection and evaluation of nodule type. Materials and Methods The institutional review board approved this study, and written informed consent was obtained from each patient. Standard- and reduced-dose chest CT (60 and 250 mA) and MR imaging with UTE were used to examine 52 patients; 29 were men (mean age, 66.4 years ± 7.3 [standard deviation]; age range, 48-79 years) and 23 were women (mean age, 64.8 years ± 10.1; age range, 42-83 years). Probability of nodule presence was assessed for all methods with a five-point visual scoring system. All nodules were then classified as missed, ground-glass, part-solid, or solid nodules. To compare nodule detection capability of the three methods, consensus for performances was rated by using jackknife free-response receiver operating characteristic analysis, and κ analysis was used to compare intermethod agreement for nodule type classification. Results There was no significant difference (F = 0.70, P = .59) in figure of merit between methods (standard-dose CT, 0.86; reduced-dose CT, 0.84; MR imaging with UTE, 0.86). There was no significant difference in sensitivity between methods (standard-dose CT vs reduced-dose CT, P = .50; standard-dose CT vs MR imaging with UTE, P = .50; reduced-dose CT vs MR imaging with UTE, P >.99). Intermethod agreement was excellent (standard-dose CT vs reduced-dose CT, κ = 0.98, P < .001; standard-dose CT vs MR imaging with UTE, κ = 0.98, P < .001; reduced-dose CT vs MR imaging with UTE, κ = 0.99, P < .001). Conclusion Pulmonary thin-section MR imaging with UTE was useful in nodule detection and evaluation of nodule type, and it is considered at least as efficacious as standard- or reduced-dose thin-section CT. © RSNA, 2017 Online supplemental material is available for this article.

We report two cases of melanomas in patients who developed intestinal metastasis despite other metastatic sites responding to nivolumab and despite the patients having favorable findings such as vitiligo and normal lactate dehydrogenase. The first case is an 85-year-old man who had been administrated nivolumab for lung/cutaneous metastases. After 22 courses of nivolumab therapy, fever and anorexia had appeared and his bodyweight had decreased. An intussusception on the ileocecal valve was revealed by computed tomography, and emergency surgery revealed metastatic lesions on the colon. The second case is an 87-year-old woman treated with nivolumab for lymph node metastases. After 10 courses, laboratory tests had revealed anemia and positive fecal occult blood. Her bodyweight had decreased. Capsule endoscopy showed scattered tumors and clots, indicating metastases of melanoma. The frequency of symptomatic intestinal metastasis of melanoma is very low. Further, intestinal metastasis of melanoma is difficult to detect through routine examinations. Our cases suggest that fecal occult blood test and decreased bodyweight are indications of intestinal metastases., (© 2017 Japanese Dermatological Association.)

The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 13, 2017.

Purpose: To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy., Materials and Methods: Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR+PR) and 2) stable or progressive disease (SD+PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUV max , and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared., Results: The step-wise regression test showed that therapeutic effect (r 2 =0.63, p=0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUV max . Mean overall survival showed a significant difference for total perfusion (p=0.003) and systemic arterial perfusion (p=0.04)., Conclusion: Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

A new randomized Phase III trial, the Japan Clinical Oncology Group (JCOG) 1408, which compares two dose fractionations (JCOG 0403 and JCOG 0702) for medically inoperable Stage IA NSCLC or small lung lesions clinically diagnosed as primary lung cancer, involves the introduction of a prescribed dose to the D 95% of the planning target volume (PTV) using a superposition/convolution algorithm. Therefore, we must determine the prescribed dose in the D 95% prescribing method to begin JCOG1408. JCOG 0702 uses density correction and the D 95% prescribing method. However, JCOG 0403 uses no density correction and isocenter- prescribing method. The purpose of this study was to evaluate the prescribed dose to the D 95% of the PTV equivalent to a dose of 48 Gy to the isocenter (JCOG 0403) using a superposition algorithm. The peripheral isodose line, which has the highest conformity index, and the D 95% of the PTV were analyzed by considering the weighting factor, i.e. the inverse of the difference between the doses obtained using the superposition and Clarkson algorithms. The average dose at the isodose line of the highest conformity index and the D 95% of the PTV were 41.5 ± 0.3 and 42.0 ± 0.3 Gy, respectively. The D 95% of the PTV had a small correlation with the target volume (r 2  = 0.0022) and with the distance between the scatterer and tumor volumes (r 2  = 0.19). Thus, the prescribed dose of 48 Gy using the Clarkson algorithm (JCOG0403) was found to be equivalent to the prescribed dose of 42 Gy to the D 95% of the PTV using the superposition algorithm., (© The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.)

With the development of functional imaging modalities we now have the ability to study the microenvironment of lung cancer and its genomic instability. Radiomics is defined as the use of automated or semi-automated post-processing and analysis of large amounts of quantitative imaging features that can be derived from medical images. The automated generation of these analytical features helps to quantify a number of variables in the imaging assessment of lung malignancy. These imaging features include: tumor spatial complexity, elucidation of the tumor genomic heterogeneity and composition, subregional identification in terms of tumor viability or aggressiveness, and response to chemotherapy and/or radiation. Therefore, a radiomic approach can help to reveal unique information about tumor behavior. Currently available radiomic features can be divided into four major classes: (a) morphological, (b) statistical, (c) regional, and (d) model-based. Each category yields quantitative parameters that reflect specific aspects of a tumor. The major challenge is to integrate radiomic data with clinical, pathological, and genomic information to decode the different types of tissue biology. There are many currently available radiomic studies on lung cancer for which there is a need to summarize the current state of the art., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

While the inauguration of national low dose computed tomographic (LDCT) lung cancer screening programs has started in the USA, other countries remain undecided, awaiting the results of ongoing trials. The continuous technical development achieved by stronger gradients, parallel imaging and shorter echo time has made lung magnetic resonance imaging (MRI) an interesting alternative to CT. For the detection of solid lesions with lung MRI, experimental and clinical studies have shown a threshold size of 3-4mm for nodules, with detection rates of 60-90% for lesions of 5-8mm and close to 100% for lesions of 8mm or larger. From experimental work, the sensitivity for infiltrative, non-solid lesions would be expected to be similarly high as that for solid lesions, but the published data for the MRI detection of lepidic growth type adenocarcinoma is sparse. Moreover, biological features such as a longer T2 time of lung cancer tissue, tissue compliance and a more rapid uptake of contrast material compared to granulomatous diseases, in principle should allow for the multi-parametric characterization of lung pathology. Experience with the clinical use of lung MRI is growing. There are now standardized protocols which are easy to implement on current scanner hardware configurations. The image quality has become more robust and currently ongoing studies will help to further contribute experience with multi-center, multi-vendor and multi-platform implementation of this technology. All of the required prerequisites have now been achieved to allow for a dedicated prospective large scale MRI based lung cancer screening trial to investigate the outcomes from using MRI rather than CT for lung cancer screening. This is driven by the hypothesis that MRI would reach a similarly high sensitivity for the detection of early lung cancer with fewer false positive exams (better specificity) than LDCT. The purpose of this review article is to discuss the potential role of lung MRI for the early detection of lung cancer from a technical point of view and to discuss a few of the possible scenarios for lung cancer screening implementation using this imaging modality. There is little doubt that MRI could play a significant role in lung cancer screening, but how and when will depend on the threshold needed for positive screens (e.g. lesion volume and required diagnostic accuracy), cost-effectiveness and improved patient outcomes from a reduction in the need to follow up benign nodules. Potential applications range from lung MRI as the first choice screening modality to the role of an ad hoc on site test for the detailed evaluation of a subgroup of positive screening results., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

A simultaneous, selective, sensitive and rapid liquid chromatography/tandem mass spectrometry method was developed and validated for the quantification of gefitinib, erlotinib and afatinib in 250 μL samples of human blood plasma. Diluted plasma samples were extracted using a liquid-phase extraction procedure with tert-butyl methyl ether. The three drugs were separated by high-performance liquid chromatography using a C18 column and an isocratic mobile phase running at a flow rate of 0.2 mL/min for 5 min. The drugs were detected using a tandem mass spectrometer with electrospray ionization using imatinib as an internal standard. Calibration curves were generated over the linear concentration range of 0.05-100 nm in plasma with a lower limit of quantification of 0.01 or 0.05 nm for all compounds. Finally, the validated method was applied to a clinical pharmacokinetic study in patients with nonsmall-cell lung cancer (NSCLC) following the oral administration of afatinib. These results indicate that this method is suitable for assessing the risks and benefits of chemotherapy in patients with NSCLC and is useful for therapeutic drug monitoring for NSCLC treatment. As far as we know, this is the first report on LC-MS/MS method for the simultaneous quantification of NSCLC tyrosine kinase inhibitor plasma concentrations including afatinib. Copyright © 2015 John Wiley & Sons, Ltd., (Copyright © 2015 John Wiley & Sons, Ltd.)

Tumor, lymph node, and metastasis (TNM) classification of lung cancer is typically performed with the TNM staging system, as recommended by the Union Internationale Contre le Cancer (UICC), the American Joint Committee on Cancer (AJCC), and the International Association for the Study of Lung Cancer (IASLC). Radiologic examinations for TNM staging of lung cancer patients include computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography with 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG-PET), and FDG-PET combined with CT (FDG-PET/CT) and are used for pretherapeutic assessments. Recent technical advances in MR systems, application of fast and parallel imaging and/or introduction of new MR techniques, and utilization of contrast media have markedly improved the diagnostic utility of MRI in this setting. In addition, FDG-PET can be combined or fused with MRI (PET/MRI) for clinical practice. This review article will focus on these recent advances in MRI as well as on PET/MRI for lung cancer staging, in addition to a discussion of their potential and limitations for routine clinical practice in comparison with other modalities such as CT, FDG-PET, and PET/CT.

Purpose: To prospectively evaluate the capability of amide proton transfer-weighted chemical exchange saturation transfer magnetic resonance (MR) imaging for characterization of thoracic lesions., Materials and Methods: The institutional review board approved this study, and written informed consent was obtained from 21 patients (13 men and eight women; mean age, 72 years) prior to enrollment. Each patient underwent chemical exchange saturation transfer MR imaging by using respiratory-synchronized half-Fourier fast spin-echo imaging after a series of magnetization transfer pulses. Next, a magnetization transfer ratio asymmetry at 3.5 ppm map was computationally generated. Pathology examinations resulted in a diagnosis of 13 malignant and eight benign thoracic lesions. The malignant lesions were further diagnosed as being nine lung cancers, comprising six adenocarcinomas, three squamous cell carcinomas, and four other thoracic malignancies. The Student t test was used to evaluate the capability of magnetization transfer ratio asymmetry (at 3.5 ppm), as assessed by means of region of interest measurements, for differentiating benign and malignant lesions, lung cancers and other thoracic lesions, and adenocarcinomas and squamous cell carcinomas., Results: Magnetization transfer ratio asymmetry (at 3.5 ppm) was significantly higher for malignant tumors (mean ± standard deviation, 3.56% ± 3.01) than for benign lesions (0.33% ± 0.38, P = .008). It was also significantly higher for other thoracic malignancies (6.71% ± 3.46) than for lung cancer (2.16% ± 1.41, P = .005) and for adenocarcinoma (2.88% ± 1.13) than for squamous cell carcinoma (0.71% ± 0.17, P = .02)., Conclusion: Amide proton transfer-weighted chemical exchange saturation transfer MR imaging allows characterization of thoracic lesions., ((©) RSNA, 2015.)

Background: Endobronchial ultrasonography (EBUS) facilitates a lung cancer diagnosis. However, qualitative tissue characterization of lung tumors is difficult using EBUS. Integrated backscatter (IBS) is an ultrasound technique that calculates the power of the ultrasound signal to characterize tissue components in coronary arteries. We hypothesized that qualitative diagnosis of lung tumors is possible using the IBS technique. The aim of the present study was to elucidate whether the IBS technique can be used in lung tissue diagnoses., Methods: Thirty-five consecutive patients who underwent surgery for lung cancer were prospectively enrolled. Surgical specimens of the lung and the tumor tissue were obtained, and the IBS values were measured within 48 h after surgery. Histologic images of lung and tumor tissues were compared with IBS values, and the relative interstitial area according to results of Masson's trichrome staining were determined by using an imaging processor., Results: The IBS values in tumor tissue were significantly lower than those in normal lung tissue (-50.9 ± 2.6 dB and -47.6 ± 2.6 dB, respectively; P < .001). The IBS values of adenocarcinomas associated with a good 5-year survival rate were higher than those of non-adenocarcinomas (-48.1 ± 1.6 dB and -52.6 ± 1.4 dB; P < .001). There were significant correlations between the IBS values and the relative interstitial area or micro air area in tumor (r = 0.53 and r = 0.67; P < .01). After combining normal lung tissue and adenocarcinomas with a good prognosis, the sensitivity and specificity for establishing the presence of lung tumors were 84% and 85%., Conclusions: Qualitative diagnosis of lung tumors was possible, with a sensitivity of 84% and a specificity of 85%, using the ultrasound IBS technique., (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

We investigated the efficacy and safety of albumin-bound paclitaxel (nab-PTX) and carboplatin (CBDCA) with concurrent radiotherapy for unresectable locally advanced non-small-cell lung cancer (NSCLC). Patients with Stage III NSCLC and an Eastern Cooperative Oncology Group performance status of 0 or 1 were eligible. Concurrent chemoradiotherapy consisted of weekly administration of nab-PTX (40 mg/m(2)) plus CBDCA (area under the plasma concentration time curve (AUC) 2) and thoracic radiotherapy (60 Gy/30 fractions) for a total of 6 weeks. After concurrent chemoradiotherapy, patients received an additional two cycles of consolidation phase chemotherapy that consisted of 4-week cycles of nab-PTX (100 mg/m(2) on Days 1, 8 and 15)/CBDCA (AUC 5 mg/ml/min on Day 1). Response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors. Progression-free survival and overall survival were estimated using the Kaplan-Meier method. Toxicity was graded using the National Cancer Institute Common Terminology Criteria for Adverse Events. A total of 10 patients were enrolled in this trial between September 2013 and January 2014 from three institutes. The overall response rate was 40.0% and the median progression-free survival was 6.7 months. Treatment-related death occurred in two patients. Grade 2 or worse severe radiation pneumonitis was observed in all three patients that had the volume of lung receiving at least 20 Gy (V20) >30%. The results of this study indicate that no further investigation is warranted into nab-PTX and CBDCA with concurrent thoracic radiation for Stage III NSCLC with V20 > 30% due to severe toxicity., (© The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.)

Purpose: To determine the capability and influence of the mathematical method on dynamic contrast-enhanced (CE-) perfusion area detector CT (ADCT) for early prediction of treatment response as well as progression free and overall survival (PFS and OS) of non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy., Materials and Methods: Sixty-six consecutive stage III NSCLC patients underwent dynamic CE-perfusion ADCT examinations, chemoradiotherapy and follow-up examinations. Response Evaluation Criteria in Solid Tumors (RECIST) criteria were used to divide all patients into responders and non-responders. Differences in each of the indices for all targeted lesions between measurements obtained 2 weeks prior to the first and the third course of chemotherapy were determined for all patients. ROC analyses were employed to determine the capability of perfusion indices as markers for distinguishing RECIST responders from non-responders. To evaluate their capability for early prediction of therapeutic effect, OS of perfusion index-based responders and non-responders were compared by using the Kaplan-Meier method followed by log-rank test., Results: Area under the curve (Az) for total perfusion by means of the dual-input maximum slope method was significantly larger than that of pulmonary arterial perfusion using the same method (p=0.007) and of perfusion with the single-input maximum slope method (p=0.007). Mean OS demonstrated significantly difference between responder- and non-responder groups for total perfusion (p=0.02)., Conclusion: Mathematical models have significant influence on assessment for early prediction of treatment response, disease progression and overall survival using dynamic CE-perfusion ADCT for NSCLC patients treated with chemoradiotherapy., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To directly compare the capability of hybrid-type iterative reconstruction (i.e., adaptive iterative dose reduction using 3D processing: AIDR 3D) and filter back projection (FBP) for radiation dose reduction during dynamic contrast-enhanced (CE-) perfusion area-detector CT (ADCT) for lung and nodule perfusion assessment., Materials and Methods: Thirty-six patients with lung cancers who underwent perfusion ADCT (SD-ADCT) at 120 mA and were enrolled in this study. ADCT data at 80 mA (reduced-dose ADCT: RD-ADCT), 60 mA (low-dose ADCT: LD-ADCT) and 40 mA (very low-dose ADCT: VLD-ADCT) were computationally simulated using SD-ADCT data, and reconstructed with and without AIDR 3D. Image noise and lung and nodule perfusion parameters were evaluated using ROI measurements. To determine the utility of AIDR 3D for dose reduction, image noise was compared between each protocol with and without AIDR 3D by means of the t-test. Correlations and limits of agreement for parameters obtained with SD-ADCT and other protocols were also evaluated., Results: Image noise of all protocols with AIDR 3D was significantly lower than that of LD-ADCT and VLD-ADCT without AIDR 3D (p<0.05). Significant correlations for image noise between SD-ADCT and all protocols with AIDR 3D (0.45 ≤ r ≤ 0.99, p<0.0001) were equal to or better than that without AIDR 3D (0.28 ≤ r ≤ 0.99, p<0.0001). The limits of agreement for perfusion parameters with AIDR 3D were smaller than those without AIDR 3D for each tube current., Conclusion: AIDR 3D is more effective than FBP for dose reduction of perfusion ADCT while maintaining image quality and reducing measurement errors., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To prospectively compare the diagnostic capability of diffusion-weighted MR imaging obtained with fast advantage spin-echo sequence (FASE-DWI) and echo planar imaging sequence (EPI-DWI), short inversion time inversion recovery fast advanced spin-echo (STIR FASE) imaging and FDG PET/CT for N-stage assessment of non-small cell carcinoma (NSCLC) patients., Materials and Methods: 95 consecutive operable NSCLC patients underwent STIR FASE imaging, FASE-DWI and EPI-DWI with a 3T system, integrated PET/CT, surgical treatment and pathological and follow-up examinations. Probability of lymph node metastasis was visually assessed using a 5-point visual scoring system. ROC analyses were used to compare diagnostic capability of all methods, while their diagnostic performance was also compared by means of McNemar's test on a per node basis. Finally, McNemar's test was also used for statistical comparison of accuracy of N-stage assessment., Results: Areas under the curve (Azs) for STIR FASE imaging (Az=0.95) and FASE-DWI (Az=0.92) were significantly larger than those for EPI-DWI (Az=0.78; p<0.0001 for STIR FSE imaging and FASE-DWI) and PET/CT (Az=0.85; p=0.0001 for STIR FSE imaging, p=0.03 for FASE-DWI) on a per node basis analysis. Accuracy of N-stage assessment using STIR FASE imaging (84.2% [80/95]) and FASE-DWI (83.2% [79/95]) was significantly higher than that using EPI-DWI (76.8% [73/95]; p=0.02 for STIR FASE imaging, p=0.03 for FASE-DWI) and PET/CT (73.7% [70/95]; p=0.002 for STIR FSE imaging, p=0.004 for FASE-DWI)., Conclusion: Qualitative N-stage assessments of NSCLC patients obtained with FASE-DWI as well as STIR FASE imaging are more sensitive and/or accurate than those obtained with EPI-DWI and FDG PET/CT., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To compare predictive capabilities of non-contrast-enhanced (CE)- and dynamic CE-perfusion MRIs, thin-section multidetector computed tomography (CT) (MDCT), and perfusion scan for postoperative lung function in non-small cell lung cancer (NSCLC) patients., Materials and Methods: Sixty consecutive pathologically diagnosed NSCLC patients were included and prospectively underwent thin-section MDCT, non-CE-, and dynamic CE-perfusion MRIs and perfusion scan, and had their pre- and postoperative forced expiratory volume in one second (FEV1 ) measured. Postoperative percent FEV1 (po%FEV1 ) was then predicted from the fractional lung volume determined on semiquantitatively assessed non-CE- and dynamic CE-perfusion MRIs, from the functional lung volumes determined on quantitative CT, from the number of segments observed on qualitative CT, and from uptakes detected on perfusion scans within total and resected lungs. Predicted po%FEV1 s were then correlated with actual po%FEV1 s, which were %FEV1 s measured postoperatively. The limits of agreement were also determined., Results: All predicted po%FEV1 s showed significant correlation (0.73 ≤ r ≤ 0.93, P < 0.0001) and limits of agreement with actual po%FEV1 (non-CE-perfusion MRI: 0.3 ± 10.0%, dynamic CE-perfusion MRI: 1.0 ± 10.8%, perfusion scan: 2.2 ± 14.1%, quantitative CT: 1.2 ± 9.0%, qualitative CT: 1.5 ± 10.2%)., Conclusion: Non-CE-perfusion MRI may be able to predict postoperative lung function more accurately than qualitatively assessed MDCT and perfusion scan., (© 2014 Wiley Periodicals, Inc.)

Positron emission tomography / computed tomography (PET/CT), with its metabolic data of (18) F-fluorodeoxyglucose (FDG) cellular uptake in addition to morphologic CT data, is an established technique for staging of lung cancer and has higher sensitivity and accuracy for lung nodule characterization than conventional approaches. Its strength extends outside the chest, with unknown metastases detected or suspected metastases excluded in a significant number of patients. Lastly, PET/CT is used in the assessment of therapy response. Magnetic resonance imaging (MRI) in the chest has been difficult to establish, but with the advent of new sequences is starting to become an increasingly useful alternative to conventional approaches. Diffusion-weighted MRI (DWI) is useful for distinguishing benign and malignant pulmonary nodules, has high sensitivity and specificity for nodal staging, and is helpful for evaluating an early response to systemic chemotherapy. Whole-body MRI/PET promises to contribute additional information with its higher soft-tissue contrast and much less radiation exposure than PET/CT and has become feasible for fast imaging and can be used for cancer staging in patients with a malignant condition., (© 2014 Wiley Periodicals, Inc.)