Zhu Lin, Li Qian, von Stackelberg Oyunbileg, Triphan Simon M F, Biederer Jürgen, Weinheimer Oliver, Eichinger Monika, Vogelmeier Claus F, Jörres Rudolf A, Kauczor Hans-Ulrich, Heußel Claus P, Jobst Bertram J, Yu Hong, Wielpütz Mark O
Department of Radiology, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.
Eur Radiol. 2025 Apr 13. doi: 10.1007/s00330-025-11567-4.
This multicenter trial was conducted to evaluate MRI for the longitudinal management of incidental pulmonary nodules in heavy smokers.
239 participants (63.9 ± 8.4 years, 43-82 years) at risk of or with COPD GOLDI-IV from 16 centers prospectively underwent two rounds of same-day low-dose computed tomography (LDCT1&2) and MRI1&2 at an interval of three years in the nationwide COSYCONET trial. All exams were independently assessed for incidental pulmonary nodules in a standardized fashion by two blinded readers, incl. axis measurements and Lung-RADS categorization, with consensual LDCT results serving as the standard of reference. A change in diameter ≥ 2 mm was rated as progress. 11 patients underwent surgery for suspicious nodules after the first round.
Two hundred twenty-four of two hundred forty nodules (93.3%) persisted from LDCT1 to LDCT2, with a sensitivity of MRI2 of 82.8% and 81.5% for readers 1 and 2, respectively. Agreement in Lung-RADS categories between LDCT2 and MRI2 was substantial in per-nodule (κ = 0.62-0.70) and excellent in a per-patient (κ = 0.86-0.88) approach for both readers, respectively. Concordance between LDCT2 and MRI2 for growth was excellent to almost perfect (κ = 0.88-1.0). The accuracy of LDCT1 and MRI1 for lung cancer was 87.5%. Lung-RADS ≥ 3 category on MRI1 had higher accuracy for predicting progress (23.1% and 21.4%, respectively) than LDCT1 (15.8%).
Compared to LDCT, MRI shows similar capabilities for the longitudinal evaluation of incidental nodules in heavy smokers. Decision-making for nodule management guided by Lung-RADS seems feasible based on longitudinal MRI.
Question Can MRI serve as an alternative to low-dose CT (LDCT) for the longitudinal management of pulmonary nodules in heavy smokers, addressing concerns over radiation exposure? Findings MRI demonstrated substantial agreement with LDCT in detecting nodule growth, accurately categorizing Lung-RADS, and comparable accuracy in identifying malignancy over a three-year follow-up. Clinical relevance Longitudinal MRI demonstrates high consistency with LDCT in assessing the growth of incidental pulmonary nodules and categorizing per-patient Lung-RADS, offering a reliable, radiation-free alternative for monitoring and early malignancy detection in high-risk populations.
本多中心试验旨在评估MRI在重度吸烟者偶然发现的肺结节纵向管理中的应用。
在全国性的COSYCONET试验中，来自16个中心的239名有慢性阻塞性肺疾病（COPD）GOLD-IV风险或已患有COPD GOLD-IV的参与者（63.9±8.4岁，43 - 82岁）前瞻性地接受了两轮同日低剂量计算机断层扫描（LDCT1和LDCT2）以及MRI1和MRI2检查，间隔为三年。所有检查均由两名盲法阅片者以标准化方式独立评估偶然发现的肺结节，包括轴位测量和Lung-RADS分类，以达成共识的LDCT结果作为参考标准。直径变化≥2mm被判定为进展。第一轮检查后，11名患者因可疑结节接受了手术。
240个结节中有224个（93.3%）从LDCT1持续到LDCT2，阅片者1和阅片者2的MRI2敏感性分别为82.8%和81.5%。对于两位阅片者，LDCT2和MRI2在结节层面的Lung-RADS分类一致性较高（κ = 0.62 - 0.70），在患者层面一致性极佳（κ = 0.86 - 0.88）。LDCT2和MRI2在生长方面的一致性极佳至几乎完美（κ = 0.88 - 1.0）。LDCT1和MRI1对肺癌的诊断准确性为87.5%。MRI1上Lung-RADS≥3类在预测进展方面的准确性（分别为23.1%和21.4%）高于LDCT1（15.8%）。
与LDCT相比，MRI在重度吸烟者偶然发现的结节纵向评估中显示出相似的能力。基于纵向MRI，以Lung-RADS为指导进行结节管理的决策似乎是可行的。
问题MRI能否作为低剂量CT（LDCT）的替代方法，用于重度吸烟者肺结节的纵向管理，以解决对辐射暴露的担忧？研究结果在三年的随访中，MRI在检测结节生长、准确分类Lung-RADS以及识别恶性肿瘤方面与LDCT具有高度一致性。临床意义纵向MRI在评估偶然发现的肺结节生长和对患者的Lung-RADS分类方面与LDCT具有高度一致性，为高危人群的监测和早期恶性肿瘤检测提供了一种可靠的、无辐射的替代方法。
