Diffusion-weighted MRI for lung cancer could prevent unnecessary surgery

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A newer type of MRI scan, diffusion-weighted MRI, can better differentiate benign lung lesions from those which are cancerous, and therefore, could be used to prevent unnecessary surgery by enabling more accurate diagnosis of the disease, based on a study presented Sept. 25 at the European Respiratory Society's annual congress in Amsterdam.

Belgian researchers found that the new technique can more accurately determine whether people have the disease when compared with the current method of PET/CT scans—which are used to determine whether the detected lung lesions are cancerous and the of  the cancer.
While PET/CT is the gold standard, the research has demonstrated superiority for diffusion-weighted MRI, which 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 non-invasive technique does not require any radiation exposure, according to the researchers.

The research assessed 50 people who were due to be operated on and had been diagnosed with lung cancer or suspected lung cancer assessed by PET/CT scan. One day before their operation, the same group also underwent a diffusion-weighted MRI scan.

The results showed 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 five incorrectly. The 10 undetermined cases with PET/CT were correctly diagnosed using a diffusion-weighted MRI scan.

“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,” the study’s lead author Johan Coolen, MD, from University Hospitals Leuven in Belgium, said in a statement.

"PET/CT scans can wrongly diagnose cancer as they can misinterpret inflammation in the lungs as a malignant lesion,” Coolen said. “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."

In response to the study results, Marc Decramer, MD, PhD, 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 this week 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."