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Egyptian Journal of Radiology and Nuclear Medicine
Fig. 8 | Egyptian Journal of Radiology and Nuclear Medicine

Fig. 8

From: Suspicious lung lesions for malignancy: the lesion-to-spinal cord signal intensity ratio in T2WI and DWI–MRI versus PET/CT; a prospective pathologic correlated study with accuracy and ROC analyses

Fig. 8

A 69-year-old male patient complained of dyspnea. A, B Axial chest CT cuts (lung window) showed a right main endo-bronchial lesion attenuating the lumen of the right main bronchus with distal air trapping and the peripheral sub-pleural solid lesion was also noticed. C Axial chest PET-CT image showed minimum 18F-FDG uptake. D Axial T2WI showing iso-intense signal of the central and peripheral lesions. After placing two ROIs within the peripheral lesion and the spinal cord, the lesion-to-spinal cord signal intensity ratio was calculated = 0.96. E Axial DWI showing bright signal denoting restricted diffusion and lesion-to-spinal cord signal intensity ratio was calculated = 1. F ADC mapping images showing low signal intensity with minimum ADC (0.7–0.9 × 10−3 mm2/s) and mean ADC (1–1.3 × 10−3 mm2/s). Referring to the estimated cutoff values, DWI L-to-SC SI ratio, minimum ADC, and mean ADC suggested a malignant process except for the T2WI L-to-SC SI ratio which suggested a benign nature. Pathologically proven central bronchial hyperplasia without atypia and peripheral benign nodule. (Example for truly positive T2WI ratio and false positive DWI and PET-CT)

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