Abstract
ObjectivesTo evaluate texture analysis in nonenhanced 3-T MRI for differentiating pulmonary fungal infiltrates and lymphoma manifestations in hematological patients and to compare the diagnostic performance with that of signal intensity quotients (“nonenhanced imaging characterization quotients,” NICQs).MethodsMR scans were performed using a speed-optimized imaging protocol without an intravenous contrast medium including axial T2-weighted (T2w) single-shot fast spin-echo and T1-weighted (T1w) gradient-echo sequences. ROIs were drawn within the lesions to extract first-order statistics from original images using HeterogeneityCAD and PyRadiomics. NICQs were calculated using signal intensities of the lesions, muscle, and fat. The standard of reference was histology or clinical diagnosis in follow-up. Statistical testing included ROC analysis, clustered ROC analysis, and DeLong test. Intra- and interrater reliability was tested using intraclass correlation coefficients (ICC).ResultsThirty-three fungal infiltrates in 16 patients and 38 pulmonary lymphoma manifestations in 19 patients were included. Considering the leading lesion in each patient, diagnostic performance was excellent for T1w entropy (AUC 80.2%; p < 0.005) and slightly inferior for T2w energy (79.9%; p < 0.005), T1w uniformity (79.6%; p < 0.005), and T1w energy (77.0%; p < 0.01); the best AUC for NICQs was 72.0% for T2NICQmean (p < 0.05). Intra- and interrater reliability was good to excellent (ICC > 0.81) for these parameters except for moderate intrarater reliability of T1w energy (ICC = 0.64).ConclusionsT1w entropy, uniformity, and energy and T2w energy showed the best performances for differentiating pulmonary lymphoma and fungal pneumonia and outperformed NICQs. Results of the texture analysis should be checked for their intrinsic consistency to identify possible incongruities of single parameters.Key Points• Texture analysis in nonenhanced pulmonary MRI improves the differentiation of pulmonary lymphoma and fungal pneumonia compared with signal intensity quotients.• T1w entropy, uniformity, and energy along with T2w energy show the best performances for differentiating pulmonary lymphoma from fungal pneumonia.• The results of the texture analysis should be checked for their intrinsic consistency to identify possible incongruities of single parameters.
Highlights
The differential diagnosis of pulmonary lesions can be challenging, when it becomes necessary to distinguish infections from manifestations of the underlying condition in hematological patients [1]
This study shows that first-order statistics of texture analysis from 3-T MR images provides good overall diagnostic accuracy and useful supplementary information to enhance the differentiation of fungal infiltrates and pulmonary lymphoma manifestations in hematological patients
The present results show that first-order statistics can improve the diagnostic performance of nonenhanced pulmonary MRI while maintaining a short examination time
Summary
The differential diagnosis of pulmonary lesions can be challenging, when it becomes necessary to distinguish infections from manifestations of the underlying condition in hematological patients [1]. Morphological findings are usually considered unspecific, especially that of pulmonary lymphoma and invasive bronchopulmonary aspergillosis [2,3,4]. 13 of 19 patients with pulmonary lymphoma manifestations were initially misdiagnosed as having pneumonia, lung cancer, or tuberculosis [7]. The diagnostic performance of 3-T MRI may be further enhanced by using texture analysis [16]. For this purpose, freely available software exists, e.g., HeterogeneityCAD and PyRadiomics [17, 18]
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