MRI Compared with Low-Dose CT for Incidental Lung Nodule Detection in COPD: A Multicenter Trial.

Purpose: To investigate morphofunctional chest MRI for the detection and management of incidental pulmonary nodules in participants with chronic obstructive pulmonary disease (COPD).
Materials and Methods: In this prospective study, 567 participants (mean age, 66 years ± 9 [SD]; 340 men) underwent same-day contrast-enhanced MRI and nonenhanced low-dose CT (LDCT) in a nationwide multicenter trial (clinicaltrials.gov: NCT01245933). Nodule dimensions, morphologic features, and Lung Imaging Reporting and Data System (Lung-RADS) category were assessed at MRI by two blinded radiologists, and consensual LDCT results served as the reference standard. Comparisons were performed using the Student t test, and agreements were assessed using the Cohen weighted κ.
Results: A total of 525 nodules larger than 3 mm in diameter were detected at LDCT in 178 participants, with a mean diameter of 7.2 mm ± 6.1 (range, 3.1-63.1 mm). Nodules were not detected in the remaining 389 participants. Sensitivity and positive predictive values with MRI for readers 1 and 2, respectively, were 63.0% and 84.8% and 60.2% and 83.9% for solid nodules ( n = 495), 17.6% and 75.0% and 17.6% and 60.0% for part-solid nodules ( n = 17), and 7.7% and 100% and 7.7% and 50.0% for ground-glass nodules ( n = 13). For nodules 6 mm or greater in diameter, sensitivity and positive predictive values were 73.3% and 92.2% for reader 1 and 71.4% and 93.2% for reader 2, respectively. Readers underestimated the long-axis diameter at MRI by 0.5 mm ± 1.7 (reader 1) and 0.5 mm ± 1.5 (reader 2) compared with LDCT ( P < .001). For Lung-RADS categorization per nodule using MRI, there was substantial to perfect interreader agreement (κ = 0.75-1.00) and intermethod agreement compared with LDCT (κ = 0.70-1.00 and 0.69-1.00).
Conclusion: In a multicenter setting, morphofunctional MRI showed moderate sensitivity for detection of incidental pulmonary nodules in participants with COPD but high agreement with LDCT for Lung-RADS classification of nodules.Clinical trial registration no. NCT01245933 and NCT02629432 Keywords: MRI, CT, Thorax, Lung, Chronic Obstructive Pulmonary Disease, Screening© RSNA, 2023 Supplemental material is available for this article.
Competing Interests: Disclosures of conflicts of interest: Q.L. No relevant relationships. L.Z. No relevant relationships. O.v.S. No relevant relationships. S.M.F.T. No relevant relationships. J.B. Siemens Healthineers helped with MRI protocol design; Bayer provided contrast material used in the study; payment for honorarium for presentation at a workshop from Roche, Boehringer Ingelheim, and Fuji; president of European Society of Thoracic Imaging 2022–2023. O.W. No relevant relationships. M.E. Honoraria to author and institution from Vertex Pharmaceutical. C.F.V. Grants or contracts from German Ministry of Education and Science (BMBF), AstraZeneca, Boehringer Ingelheim, Grifols, GlaxoSmithKline, and Novartis; consulting fees from Aerogen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Nuvaira; payment or honoraria for lectures/presentations from Aerogen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GlaxoSmithKline, Grifols, Insmed, MedUpdate, Novartis, Roche, and Sanofi; support for attending meetings or travel from Boehringer Ingelheim and Sanofi; participation on a data safety monitoring or advisory board from AstraZeneca and Sanofi; Chair of the Science Committee of GOLD, Chairman of the German Lung Foundation (DLS). R.A.J. No relevant relationships. H.U.K. Bayer provided consumables to the consortium; institution receives payment from Siemens, Philips, and Boehringer Ingelheim; consulting fees to author from Median; payment or honoraria for lectures/presentations to author from Siemens, Philips, Boehringer Ingelheim, MSD, and Sanofi. C.P.H. Grants/contracts from Siemens (2012–2014), Pfizer (2012–2014), MeVis (2012, 2013), Boehringer Ingelheim (2014), and German Center for Lung Research (2011ff); consulting fees from Schering-Plough (2009, 2010), Pfizer (2008–2014), Basilea (2008, 2009, 2010), Boehringer Ingelheim (2010–2014), Novartis (2010, 2012, 2014), Roche (2010), Astellas (2011, 2012), Gilead (2011–2015), MSD (2011–2013), Lilly (2011), Intermune (2013-2014), and Fresenius (2013, 2014); lecture fees from Gilead (2008–2014), Essex (2008, 2009, 2010), Schering-Plough (2008, 2009, 2010), AstraZeneca (2008–2014, 2022), Lilly (2008, 2009, 2012), Roche (2008, 2009), MSD (2009–2014), Pfizer (2010–2014), Bracco (2010, 2011), MEDA Pharma (2011), Intermune (2011–2014), Chiesi (2012), Siemens (2012), Covidien (2012), Pierre Fabre (2012), Boehringer Ingelheim (2012, 2013, 2022), Grifols (2012), Novartis (2013–2016), Basilea (2015, 2016), and Bayer (2016); patent: Method and Device For Representing the Microstructure of the Lungs. IPC8 Class: AA61B5055FI, PAN: 20080208038, Inventors: W Schreiber, U Wolf, AW Scholz, CP Heussel; participation on a data safety monitoring board or advisory board: Schering-Plough (2009, 2010), Pfizer (2008–2014), Basilea (2008, 2009, 2010), Boehringer Ingelheim (2010–2014, 2022ff), Novartis (2010, 2012, 2014), Roche (2010), Astellas (2011, 2012), Gilead (2011–2015), MSD (2011–2013), Lilly (2011), Intermune (2013–2014), Fresenius (2013, 2014); leadership or fiduciary roles: chest working group of the German Roentgen Society (national guidelines: bronchial carcinoma, mesothelioma, COPD, screening for bronchial carcinoma, CT and MRI of the chest, pneumonia); consultant of ECIL-3, ECCMID, EORTC/MSG (guideline for diagnosis of infections in immunocompromised hosts); founding member of the working team in infections in immunocompromised hosts of the German Society of Hematology/Oncology (guideline for diagnosis of infections in immunocompromised hosts); faculty member of European Society of Thoracic Radiology (ESTI), European Respiratory Society (ERS), and member in EIBALL (European Imaging Biomarkers Alliance); editor of Medizinische Klinik, Intensivmedizin und Notfallmedizin at Springer publishing; stock/stock options GSK. B.J.J. No relevant relationships. M.O.W. Bayer provided contrast material for MRI examinations; study grants paid to institution from Vertex Pharmaceuticals and Boehringer Ingelheim; consultancy fees paid to institution from Vertex Pharmaceuticals and Boehringer Ingelheim.
(© 2023 by the Radiological Society of North America, Inc.)