J Korean Soc Radiol.  2010 Mar;62(3):227-234. 10.3348/jksr.2010.62.3.227.

MR Differentiation of Lung Cancer from Progressive Massive Fibrosis in Patients with Coal Worker's Pneumoconiosis

• Kim YJ
• Jung JI
• Lim Y
• Koo JW
• Park SH

• KMID: 2208917
• DOI: http://doi.org/10.3348/jksr.2010.62.3.227

Abstract

PURPOSE
To analyze the potential of MR to distinguish lung cancer from progressive massive fibrosis (PMF) in patients with coal worker's pneumoconiosis.
MATERIALS AND METHODS
The study consisted of 9 patients with pathologically proven lung cancer and 26 PMFs in 17 patients. All the patients had radiologic evidence of pneumoconiosis. T1-weighted FLASH images were obtained before and 0.5, 1, 2, 3, 4, 5, 7.5, 10, 12.5, and 15 minutes after injection of Gd-DTPA. T2-weighted fast spin-echo images were obtained. The imaging findings were evaluated for enhancement time curve, contrast uptake equivalent (CE), and enhancement factor (EF).
RESULTS
On T1WI, there was no significant signal intensity difference between lung cancer and PMF. On T2WI, all lung cancer showed high signal intensity, as opposed to all PMFs which showed low signal intensity except for one PMF. Only one PMF showed high signal intensity on T2WI. For the dynamic contrast study, lung cancer showed faster and slightly stronger enhancement than PMFs. For a delayed image, most of the lung cancers (78%) showed washout, as opposed to a plateau in most of PMFs (73%) (p=0.0153). However, no difference was detected between the EFmax of lung cancer and PMFs (p=0.349).
CONCLUSION
MR is potentially a useful tool in distinguishing lung cancer from PMFs in patients with coal worker's pneumoconiosis.

MeSH Terms

Anthracosis
Coal
Fibrosis
Gadolinium DTPA
Humans
Lung
Lung Neoplasms
Magnetic Resonance Imaging
Pneumoconiosis
Coal
Gadolinium DTPA

Figure

• 

  Fig. 1 A 56-year-old man had worked as a coal miner for 15 years. Lung cancer (poorly differentiated adenocarcinoma) in right lower lobe shows iso signal intensity relative to muscle signal intensity on T1-weighted image (left) and shows high signal intensity on T2-weighted image (right). Note the mass invading the chest wall (arrow).

• 

  Fig. 2 A 56-year-old man had worked as a coal miner for 20 years. PMF in right upper lobe shows iso signal intensity relative to muscle signal intensity on T1-weighted image (left) and shows dark signal intensity on T2-weighted image (right). Thin threadlike high signal intensity rim (arrows) distinguish the lesion.

• 

  Fig. 3 Atypical PMF in a 66-year-old man had worked as a coal miner for 23 years. A. A round mass shows iso signal intensity on T1-weighted image (left) and high signal intensity on T2-weighted image (right). A small area (arrow) with low signal intensity on T1-weighted image and bright signal intensity on T2-weighted image is seen at the peripheral portion of the mass. The small lesion (arrow) indicates the liquefactive necrosis. B. After contrast infusion, persistent rim enhancement of the mass is seen (displayed from the left image to the right image - precontrast, 1 minute, 3 minutes, 7.5 minutes and 15 minutes). Nonenhancing large central portion of the mass (arrows) represents necrotic tissue with little liquefaction. Biopsy reveals PMF.

• 

  Fig. 4 Average contrast uptake equivalent (CE: mmol/L) time curve of lung cancer (solid line) and PMF (dotted line). Lung cancer demonstrates fast increase of signal intensity up to 2 minutes, and then a washout up to 15 minutes. PMF shows gradual increase of signal intensity up to 7.5 minutes, and then a plateau up to 15 minutes.

• 

  Fig. 5 Lung cancer in a 65-year-old man had worked as a coal miner for 20 years. A. After Gd-DTPA infusion, lung cancer shows fast enhancement on early phase and washout on the delayed phase. (displayed from the left image to the right image-precontrast, 30 seconds, 1 minute, 3 minutes, 7.5 minutes, 10 minutes and 15 minutes). Signal intensity of the lesion is described on the images. B. The time enhancement curve of lung cancer shows fast enhancement and delayed washout.

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  Fig. 6 PMF in a 80-year-old man had worked as a coal miner for 20 years. A. After Gd-DTPA infusion, PMF shows gradual and persistent enhancement up to 15 minutes (displayed from the left image to the right image-precontrast, 30 seconds, 1 minute, 3 minutes, 7.5 minutes, 10 minutes and 15 minutes). Signal intensity of the lesion is described on the images. B. The time enhancement curve of PMF shows gradual and persistent enhancement.

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