Differentiating inflammatory and malignant pulmonary lesions on 3T lung MRI with radiomics of apparent diffusion coefficient maps and T2w derived radiomic feature maps.

Background

Differentiating inflammatory from malignant lung lesions continues to be challenging in clinical routine, frequently requiring invasive methods like biopsy. Therefore, we aimed to investigate if inflammatory and malignant pulmonary lesions could be distinguished noninvasively using radiomics of apparent diffusion coefficient (ADC) maps and radiomic feature maps calculated from T2-weighted (T2w) 3 Tesla (3T) magnetic resonance imaging (MRI) of the lung.

Methods

Fifty-four patients with an unclear pulmonary lesion on computed tomography (CT) were prospectively included and examined by 3T MRI with T2w and diffusion-weighted sequences (b values of 50 and 800). ADC maps were calculated automatically. All patients underwent biopsy or bronchoalveolar lavage (BAL). Sixteen patients were excluded (e.g., motion artifacts), leaving 19 patients each with malignant and inflammatory pulmonary lesions. Target lesions were defined by biopsy or as the largest lesion (BAL-based pathogen detection), and two readers placed volumes of interest (VOIs) around the lesions on T2w images and ADC maps. One hundred and seven features were conventionally extracted from the ADC maps using PyRadiomics. T2w images were converted to 107 parametric feature maps per patient using a PyRadiomics-based, pretested software tool developed by our group. VOIs were copied from T2w images to T2 maps for feature quantification. Features were tested for significant differences using the Mann-Whitney U-test. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and interreader agreement by intraclass correlation coefficients (ICCs).

Results

Fifty-eight features derived from ADC maps differed significantly between malignant and inflammatory pulmonary lesions, with areas under the curve (AUCs) >0.90 for 5 and >0.80 for 27 features, compared with 67 features from T2 maps (5 features with AUCs >0.80). ICCs were excellent throughout.

Conclusions

ADC and T2 maps differentiate inflammatory and malignant pulmonary lesions with outstanding (ADC) and excellent (T2w derived feature maps) diagnostic performance. MRI could thus guide the further diagnostic workup and a timely initiation of the appropriate therapy.

Informations de copyright

2024 Journal of Thoracic Disease. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-23-1456/coif). B.H. is Grant recipient for the Department of Radiology outside the presented study. B.H. is Grant recipient from Abbott, AbbVie, Ablative Solutions, Accovion, Achogen Inc., Actelion Pharmaceuticals, ADIR, Aesculap, Agios Pharmaceuticals, INC., AGO, AIF: Arbeitsgemeinschaft industrieller Forschungsvereinigungen, AIO: Arbeitsgemeinschaft internistische Onkologie, Aktionsbündnis Partnersicherheit e.V., Alexion Pharmaceuticals, Amgen, AO Foundation, Aravive, Arena Pharmaceuticals, ARMO Biosciences, Inc., Array Biopharma Inc., Art photonics GmbH Berlin, ASAS, Ascelia Pharma AB, Ascendis, ASR Advanced sleep research, Astrellas, AstraZeneca, August Research OOF, Sofia, BG, BARD, Basiliea, Bayer Healthcare, Bayer Schering Pharma, Bayer Vital, BBraun, BerGenBioASA, Berlin-Brandenburger Centrum für regenerative Therapie (BCRT), Berliner Krebsgesellschaft, Biontech Mainz, BioNTech SE, Biotronik, Bioven, BMBF, BMS, Boehring Ingelheimer, Boston Biomedical Inc., Boston Scientific Medizintechnik GmbH, BRACCO Group, Brahms GmbH, Brainsgate, Bistol-Myers Squibb, Calithera Biosciences UK, Cantargia AB, Medicon Village, Cascadian Therapeutics, Inc., Celgene, CELLACT Pharma, Celldex Therapeutics, Cellestia Biotech AG CH, CeloNova BioSciences, Charité research organization GmbH, Chiltern, CLOVIS ONCOLOGY, INC., Covance, CRO Charité, CTI Ulm, CUBIST, CureVac AG, Tübingen, Curis, Daiichi Sankyo, Dartmouth College, Hanover, NH, USA, DC Devices, Inc. USA, Delcath Systems, Dermira Inc., Deutsche Krebshilfe, Deutsche Rheuma Liga, DZ – Deutsche Diabetes Forschungsgesellschaft e.V., Deutsches Zentrum für Luft- und Raumfahrt e.V., DFG, Dr. Falk Pharma GmbH, DSM Nutritional Products AG, Dt. Gesellschaft für muskuloskelettale Radiologie, Dt. Stiftung für Herzforschung, Dynavax, Aisai Ltd., European Knowledge Centre, Mosquito Way, Hatfield, Eli Lilly and Company Ltd., EORTC, Episurf Medical, Epizyme, Inc., Essex Pharma, EU Programmes, European society of gastrointestinal and abdominal radiology, Euroscreen S.A., F20 Biotech GmbH, Ferring Pharmaceuticals A/S, Fibrex Medical Inc., Focused Ultrasound Surgery Foundation, Fraunhofer Gesellschaft, GALA Therapeutics, US, Galena Biopharma, Galmed Research and Development Ltd., Ganymed, GBG Forschungs GmbH, GE, Gentech. Inc., Genmab A/S, Genzyme Europe B.V., GETNE (Grupo Espanol de Tumores Neuroendocrinos), Gilead Sciences, Inc., Glaxo Smith Kline, Glycotype GmbH Berlin, Goethe Uni Frankfurt, Guerbet, Guidant Europe NV, Halozyme, Hans-Böckler-Stiftung, Hewlett Packard GmbH, Holaira Inc., Horizon Therapeutics Ireland, ICON (CRO), Idera Pharmaceuticals, Inc., Ignyta, Inc., Immunomedics Inc., Immunocore, Inari Medical Europe GmbH Basel, Incyte, INC Research, Innate Pharma, InSightec Ltd., Inspiremd, InVentiv Health Clinical UK Ltd., Inventivhealth, IO Biotech ApS Copenhagen, IOMEDICO, IONIS, IPSEN Pharma, IQVIA ISA Therapeutics, Isis Pharmaceuticals Inc., ITM Solucin GmbH, Jansen-Cilag GmbH, Kantar Health GmbH (CRO), Kartos Therapeutics, Inc., Karyopharm Therapeutics, Inc., Kendle/MorphoSys AG, Kite Pharma, Kli Fo Berlin Mitte, Kura Oncology, Labcorb, La Roche, Land Berlin, Lilly GmbH, Lion Biotechnology, Lombard Medical, Loxo Oncology, Inc., LSK BioPartners, USA, Lundbeck GmbH, LUX Biosciences, LYSARC, MacroGenics, MagForce, MedImmune Inc., MedImmune Limited, Medpace, Medpace Germany GmbH (CRO), MedPass (CRO), Medtronic, Medtraveo GmbH, Merck, Merrimack Pharmaceuticals Inc., MeVis Medical Solutions AG, Millenium Pharmaceuticals Inc., Miltenyi Biomedicine GmbH, Bergisch Gladbach, miRagen Boukider, Mologen, Monika Kutzner Stiftung, MophoSys AG, MSD Sharp, Nektar Therapeutics, NeoVacs SA, Netzwerkverbund Radiologie, Neurocrine Biosciences Inc., US, Newlink Genetics Corporation, Nexus Oncology, NIH, NOGGO Berlin, Nord-Ostddeutsche Gesellschaft e.V., Novartis, Novocure, Nuvisan, Ockham oncology, Odonate Therapeutics San Diego, OHIRC Kanada, Oppilan Pharma ldt., London, Orion Corporation Orion Pharma, OSE Immunotherapeutics, Parexel CRO Service, Pentixal Pharma GmbH Perceptive, Pfizer GmbH, PharmaCept GmbH, Pharma Mar, Pharmaceutical Reseach Associates GmbH (PRA), Pharmacyclics Inc., Philipps, Philogen s.p.a. Siena, Pliant therapeutics San Francisco, PIQUR Therapeutics Ltd., Pluristem, PneuRX.Inc., Portola Pharmaceuticals, PPD (CRO), PRaint, Precision GmbH, Premier-research, Priovant Therapeutics USA, Provectus Biopharmaceuticals, Inc., psi-cro, Pulmonx International Sarl, Quintiles GmbH, Radiobotics ApS, Regeneraon Pharmaceuticals Inc., Replimune, Respicardia, Rhythm Pharmaceuticals, Inc. Boston USA, Roche, Salix Pharmaceuticals Inc., Samsung, Sanofi, sanofis-aventis S.A., Sarepta Therapeutics, Cambridge, US, Saving Patient’s Lives Medical B.V., Schumacher GmbH, Seagen, Seattle Genetics, Servier (CRO), SGS Life Science Sercives (CRO), Shape Memorial Midical Inc., USA, Shire Human Genetic Therapies, Siemens, Silena Therapeutics, SIRTEX Medical Europe GmbH, SOTIO Biotech, Boston, Spectranetics GmbH, Spectrum Pharmaceuticals, Stiftung Charite / BIH, St. Jude Medical, Stiftung Wolfgang Schulze, Syneos Health UK, Ltd., Symphogen, Taiho Oncology, Inc., Taiho Pharmaceutical Co., Target Pharma Solutions Inc., TauRx Therapeutics Ltd., Terumo Medical Corporation, Tesaro, tetec-ag, TEVA, Theorem, Theradex, Theravance, Threshold Pharmaceuticals Inc., TNS Healthcare GmbH, Toshiba, UCB Pharma, Ulrich GmbH Ulm, Uni Jena, Uni München, Uni Tübingen, Vaccibody A.S., VDI/VDE, Vertex Pharmaceuticals Incorporated, Viridian Therapeutics, US, Virtualscopis LLC, Winicker-norimed, Wyeth Pharma, Xcovery Holding Company, Zukunftsfond Berlin (TSB) for the Department of Radiology. The other authors have no conflicts of interest to declare.