Yoshiharu Ohno MD, PhD, Presenter: Research grant, Toshiba Corporation Research grant, Koninklijke Philips Electronics NV Research grant, Bayer AG Research grant, DAIICHI SANKYO Group Research grant, Eisai Co, Ltd Research grant, Mitsubishi Chemical Holdings Corporation Research grant, Terumo Corporation

Hisanobu Koyama MD, Abstract Co-Author: Nothing to Disclose

Yumiko Onishi MD, Abstract Co-Author: Nothing to Disclose

Keiko Matsumoto MD, Abstract Co-Author: Nothing to Disclose

Daisuke Takenaka MD, Abstract Co-Author: Nothing to Disclose

Takeshi Yoshikawa MD, Abstract Co-Author: Research grant, Toshiba Corporation Research grant, Koninklijke Philips Electronics NV

Minoru Konishi RT, Abstract Co-Author: Nothing to Disclose

Takanobu Okayama RT, Abstract Co-Author: Nothing to Disclose

Sumiaki Matsumoto MD, PhD, Abstract Co-Author: Research grant, Toshiba Corporation

Kazuro Sugimura MD, PhD, Abstract Co-Author: Research grant, Toshiba Corporation Research grant, Koninklijke Philips Electronics NV Research grant, Mitsubishi Corporation Research grant, Bayer AG Research grant, Eisai Co, Ltd Research grant, DAIICHI SANKYO Group Research Consultant, Shionogi & Co, Ltd

To prospectively and directly compare the capabilities for differentiation of malignant from benign pulmonary nodules among first-pass perfusion CT on 320-detector row CT, first-pass dynamic MRI on 1.5T MR scanner and integrated FDG-PET/CT.

43 consecutive patients (24 male, 19 female; mean age 72 years) with 61 nodules underwent perfusion CT, dynamic MRI, integrated PET/CT, microbacterial and pathological examinations, and follow up examinations. According to the final diagnoses, 61 nodules were classified into two groups as follows: malignant (n=44) and benign (n=17) pulmonary nodules. All perfusion CTs were performed on a 320-detector row CT system by using volumetric cine scan. All dynamic MRIs were obtained by using 3D FFE sequence with ultra-short echo time on a 1.5 T scanner. All PET/CT examinations were performed on an integrated PET/CT scanner. For quantitative assessment of perfusion CT, nodule perfusions were calculated by single-input maximum-slope (PFS) and patlak-plot (PFP) methods. Blood volume was also determined by patlak-plot (BVP) method. On dynamic MRI, maximum relative enhancement ratio (MRER) and maximum slope of enhancement ratio (MS) were calculated according to the past literatures. On PET/CT, maximum value of SUV (SUVmax) was assessed. All indexes in each nodule were determined by ROI measurements. Then, all indexes were compared between two groups by means of Student’s t-test. ROC analyses were performed to compare diagnostic capabilities. Then, feasible threshold value of each index was also determined. Finally, sensitivity, specificity and accuracy of each index were compared by means of McNemar’s test.

All indexes except PFP and BVP had significant difference between malignant and benign nodule groups (p<0.05).  Area under the curve of PFS (Az=0.87) and MS (Az=0.81) was significantly larger than that of SUVmax (Az=0.70, p<0.05). When feasible threshold values adopted, accuracies of PFS (88.5%) and MS (86.9%) were significantly higher than that of SUVmax (73.8%, p<0.05).

First-pass perfusion CT and dynamic MRI were more accurate methods for differentiation of malignant nodules from benign nodules, when compared with FDG-PET/CT.

First-pass perfusion CT on 320-detector row CT has better potential for distinguishing malignant from benign nodules than PET/CT, and is considered at least as valuable as first-pass dynamic MRI.

Ohno, Y, Koyama, H, Onishi, Y, Matsumoto, K, Takenaka, D, Yoshikawa, T, Konishi, M, Okayama, T, Matsumoto, S, Sugimura, K, First-Pass Perfusion CT on 320-Detector Row CT versus First-Pass Dynamic MRI vs PET/CT: Capability for Differentiation of Malignant Pulmonary Nodules from Benign Pulmonary Nodules.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9007800.html