Unnecessary Lung Cancer Surgery Could Be Prevented Using Diffusion-Weighted MR Imaging

A new type of diagnostic imaging that can better distinguish benign lung lesions from those that are cancerous could be used to prevent unnecessary surgery by enabling a more effective diagnosis of the disease.

A study by Belgian researchers, which was presented September 2011 at the European Respiratory Society’s annual congress in Amsterdam, The Netherlands, found that the new technique could more accurately determine whether people have the disease when compared with the current method of positron emission tomography-computed tomography (PET-CT) scans.

PET-CT scans are currently used to determine what stage the cancer is at and whether the detected lung lesions are cancerous. This modality involves a CT scan capturing X-ray images from around the body and a PET scan, which uses a small amount of an injected radioactive drug to show uptake within structures in your body.

While this is the current gold standard for treatment, this new research has shown that a type of magnetic resonance imaging (MRI) scan, known as diffusion-weighted MRI, is more accurate. This technique measures water movement in the tissue of the lungs and can detect the structural changes that lung cancer causes, even in the early stages of the disease. The new technique also has the advantage of being noninvasive and does not require any radiation exposure.

The research assessed 50 individuals who were due to be operated on and had been diagnosed with lung cancer or suspected lung cancer evaluated by PET-CT scan. One day before their operation, the same group also underwent a diffusion-weighted MRI scan. The study’s findings revealed that with PET-CT scans, 33 patients were diagnosed correctly, seven incorrectly, and 10 were undetermined. With diffusion-weighted MRI scans, 45 patients were diagnosed correctly and 5 incorrectly. The 10 undetermined cases with PET-CT were correctly diagnosed using diffusion-weighted MRI scan.

Dr. Johan Coolen, from University Hospitals Leuven (Belgium), said, “Our study has shown that diffusion-weighted MRI scans could become an appropriate diagnostic instrument for preoperative lung cancer patients in the near future because they have a high accuracy for differentiating benign from malignant lung lesions. PET-CT scans can wrongly diagnose cancer as they can misinterpret inflammation in the lungs as a malignant lesion. Especially in these inflammatory lesions, diffusion-weighted MR is more accurate, which could help avoid unnecessary surgical procedures for those people without malignant disease. In addition, it could help to classify patients with lung cancer to enable doctors to provide the most effective therapeutic procedures.”

Prof. Marc Decramer, president of the European Respiratory Society, said, “It is crucial that we continue to evaluate new diagnostic technologies and look at incorporating these into our management of lung cancer. A key recommendation of the European Respiratory Roadmap, which has been launched [in September 2011] to steer the future of respiratory medicine, is to focus on effective screening processes. In a bid to improve patient care, the roadmap also suggests that personalized targeted medicine will improve a patient’s quality of life. With the development and evaluation of new technologies such as the diffusion-weighted MRI scan, we can work towards achieving these goals.”

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University Hospitals Leuven