Diagnostic Efficacy and Characteristic Feature of MRI in Pulmonary Hamartoma

The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules (PN) to aid diagnosis and to discuss the differential diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, hamartoma, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging.

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“…It is important that there is no connection of the pulmonary vein, to differentiate it from a bronchogenic carcinoma. [2627]…”

Section: Single Large Pulmonary Nodulesmentioning

confidence: 99%

The calcified lung nodule: What does it mean?

et al. 2010

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“…While the diagnostic efficacy of MR imaging has occasionally been assessed for specific pathologic entities within the thorax, to our knowledge, studies evaluating the broader diagnostic efficacy of nonvascular thoracic MR imaging have not been performed (33). In a seminal article published in 1991, Fryback and Thornbury (34) described how the efficacy of diagnostic imaging can be determined by a six-level system, with level 1 referring to image quality; level 2 referring to interpretive diagnostic sensitivity, specificity, and accuracy; level 3 referring to whether the imaging findings alter the referring health care provider's diagnostic thinking; level 4 referring to whether the imaging findings change the clinical management plan; level 5 referring to the effect of diagnostic findings on patient outcomes; and level 6 referring to the costs and benefits of the imaging modality to society.…”

Section: Methodsmentioning

confidence: 99%

Impact of Nonvascular Thoracic MR Imaging on the Clinical Decision Making of Thoracic Surgeons: A 2-year Prospective Study

Ackman¹,

Gaissert²,

Lanuti³

et al. 2016

Radiology

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Purpose To determine the impact of nonvascular thoracic magnetic resonance (MR) imaging on the clinical decision making and diagnostic certainty of thoracic surgeons. Materials and Methods Seven thoracic surgeons at Massachusetts General Hospital, an academic quaternary referral hospital, participated in this 2-year, prospective, institution review board-approved, HIPAA-compliant pre- and post-MR imaging survey study after completing a one-time demographic survey. Between July 16, 2013, and July 13, 2015, each time a thoracic surgeon ordered a nonvascular thoracic MR imaging study via radiology order entry, he or she was sent a link to the pre-test survey that ascertained the clinical rationale for MR imaging, the clinical management plan if MR imaging was not an option, and pre-test diagnostic certainty. Upon completion of the MR imaging report, the surgeon was sent a link to the post-test survey assessing if/how MR imaging changed clinical management, the surgeon's comfort with the clinical management plan, and post-test diagnostic certainty. Data were analyzed with Student t, Wilcoxon, and McNemar tests. Results A total of 99 pre- and post-test surveys were completed. Most MR imaging studies (64 of 99 [65%]) were requested because of indeterminate computed tomographic findings. The use of MR imaging significantly reduced the number of planned surgical interventions (P < .001), modified the surgical approach in 54% (14 of 26) of surgical cases, and increased surgeon comfort with the patient management plan in 95% (94 of 99) of cases. Increased diagnostic certainty as a result of MR imaging was highly significant (P < .0001). In 21% (21 of 99) of cases, definitive MR imaging results warranted no further follow-up or clinical care. Conclusion In appropriate cases, assessment with nonvascular thoracic MR imaging substantially affects the clinical decision making and diagnostic certainty of thoracic surgeons. (©) RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on May 2, 2016.

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“…Chemical shift imaging has been proposed as a potentially effective means to diagnose pulmonary hamartomas not meeting CT criteria for macroscopic fat and with an absent popcorn calcification pattern. 132,136,137 Overall, the degree of suspicion for malignancy for a given pulmonary nodule must take into consideration its morphology, signal characteristics, and enhancement pattern (Fig. For example, a combination of turbo spin echo and gradient sequences was unable to detect 5 of 6 calcified nodules measuring up to 10 mm.…”

Section: Mri Characteristics Of Pulmonary Nodules Conventional Unenhamentioning

confidence: 99%

Pulmonary Nodule Characterization, Including Computer Analysis and Quantitative Features

Bartholmai

Koo

Johnson

et al. 2015

Journal of Thoracic Imaging

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Pulmonary nodules are commonly detected in computed tomography (CT) chest screening of a high-risk population. The specific visual or quantitative features on CT or other modalities can be used to characterize the likelihood that a nodule is benign or malignant. Visual features on CT such as size, attenuation, location, morphology, edge characteristics, and other distinctive "signs" can be highly suggestive of a specific diagnosis and, in general, be used to determine the probability that a specific nodule is benign or malignant. Change in size, attenuation, and morphology on serial follow-up CT, or features on other modalities such as nuclear medicine studies or MRI, can also contribute to the characterization of lung nodules. Imaging analytics can objectively and reproducibly quantify nodule features on CT, nuclear medicine, and magnetic resonance imaging. Some quantitative techniques show great promise in helping to differentiate benign from malignant lesions or to stratify the risk of aggressive versus indolent neoplasm. In this article, we (1) summarize the visual characteristics, descriptors, and signs that may be helpful in management of nodules identified on screening CT, (2) discuss current quantitative and multimodality techniques that aid in the differentiation of nodules, and (3) highlight the power, pitfalls, and limitations of these various techniques.

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Diagnostic Efficacy and Characteristic Feature of MRI in Pulmonary Hamartoma

Abstract: Magnetic resonance imaging study is a useful diagnostic tool, when a discrete pulmonary nodule demonstrates neither fat nor calcification on CT, for detecting the quite typical cleftlike structure in a pulmonary hamartoma and could provide diagnostic confidence.

Cited by 31 publications

References 12 publications

The calcified lung nodule: What does it mean?

The calcified lung nodule: What does it mean?

Impact of Nonvascular Thoracic MR Imaging on the Clinical Decision Making of Thoracic Surgeons: A 2-year Prospective Study

Pulmonary Nodule Characterization, Including Computer Analysis and Quantitative Features

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