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Egyptian Journal of Radiology and Nuclear Medicine
Fig. 9 | Egyptian Journal of Radiology and Nuclear Medicine

Fig. 9

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. 9

A 25-year-old male patient complained of chronic cough and dyspnea. A Axial contrast-enhanced chest CT cut (mediastinal window) showed bilateral upper lobar peri-hilar lung masses and scattered peripheral lung nodules. B Axial chest PET-CT image showing high bilateral 18F-FDG uptake. C, D Axial T2WI shows the low signal intensity of the lesion. After placing two ROIs within the largest lesion and the spinal cord, the lesion-to-spinal cord signal intensity ratio was calculated = 1.4. E Axial DWI showing low signal intensity denoting non-restricted diffusion and lesion-to-spinal cord signal intensity ratio was calculated = 0.1–0.4. F ADC mapping images showing low signal intensity with minimum ADC (1.4 × 10−3 mm2/s) and mean ADC (1.6 × 10−3 mm2/s). Referring to the estimated cutoff values, only the T2WI L-to-SC SI ratio concerned malignant nature; meanwhile, the DWI L-to-SC SI ratio, minimum ADC, and mean ADC suggested a benign process. Pathologically proven fibrosing parenchymal sarcoidosis. (Example for truly positive DWI parameters and false positive T2WI ratio and PET-CT)

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