Sunday, March 9, 2014

JOURNAL CLUB: Comparison of Assessment of Preoperative Pulmonary Vasculature in Patients With Non-Small Cell Lung Cancer by Non-Contrast- and 4D Contrast-Enhanced 3-T MR Angiography and Contrast-Enhanced 64-MDCT.


JOURNAL CLUB: Comparison of Assessment of Preoperative Pulmonary Vasculature in Patients With Non-Small Cell Lung Cancer by Non-Contrast- and 4D Contrast-Enhanced 3-T MR Angiography and Contrast-Enhanced 64-MDCT.
AJR Am J Roentgenol. 2014 Mar;202(3):493-506
Authors: Ohno Y, Nishio M, Koyama H, Yoshikawa T, Matsumoto S, Seki S, Sugimura K

OBJECTIVE. The purpose of this article is to prospectively and directly compare the capabilities of non-contrast-enhanced MR angiography (MRA), 4D contrast-enhanced MRA, and contrast-enhanced MDCT for assessing pulmonary vasculature in patients with non-small cell lung cancer (NSCLC) before surgical treatment.

SUBJECTS AND METHODS. A total of 77 consecutive patients (41 men and 36 women; mean age, 71 years) with pathologically proven and clinically assessed stage I NSCLC underwent thin-section contrast-enhanced MDCT, non-contrast-enhanced and contrast-enhanced MRA, and surgical treatment. The capability for anomaly assessment of the three methods was independently evaluated by two reviewers using a 5-point visual scoring system, and final assessment for each patient was made by consensus of the two readers. Interobserver agreement for pulmonary arterial and venous assessment was evaluated with the kappa statistic. Then, sensitivity, specificity, and accuracy for the detection of anomalies were directly compared among the three methods by use of the McNemar test.

RESULTS. Interobserver agreement for pulmonary artery and vein assessment was substantial or almost perfect (κ = 0.72-0.86). For pulmonary arterial and venous variation assessment, there were no significant differences in sensitivity, specificity, and accuracy among non-contrast-enhanced MRA (pulmonary arteries: sensitivity, 77.1%; specificity, 97.4%; accuracy, 87.7%; pulmonary veins: sensitivity, 50%; specificity, 98.5%; accuracy, 93.2%), 4D contrast-enhanced MRA (pulmonary arteries: sensitivity, 77.1%; specificity, 97.4%; accuracy, 87.7%; pulmonary veins: sensitivity, 62.5%; specificity, 100.0%; accuracy, 95.9%), and thin-section contrast-enhanced MDCT (pulmonary arteries: sensitivity, 91.4%; specificity, 89.5%; accuracy, 90.4%; pulmonary veins: sensitivity, 50%; specificity, 100.0%; accuracy, 95.9%) (p > 0.05).

CONCLUSION. Pulmonary vascular assessment of patients with NSCLC before surgical resection by non-contrast-enhanced MRA can be considered equivalent to that by 4D contrast-enhanced MRA and contrast-enhanced MDCT.

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