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Updated: Sep 13, 2025
Author Spotlight: Advancing 3D Modeling for Enhanced Diagnosis and Treatment of Pulmonary Nodules in Early-Stage Lung Cancer
Published on: October 13, 2023
AI-Enhanced 3D Gradient Echo MRI: A Radiation-Free Alternative to CT for Lung Nodule Detection and Lung-RADS
Alexander W Marka1, Manuel Steinhardt1, Leonie Rahn1
1Institute for Diagnostic and Interventional Radiology, School of Medicine and Health, TUM Klinikum, Technical University of Munich (TUM), Germany (A.W.M., M.S., L.R., T.L., F.T.G., T.H., A.S., M.R.M., A.T.V., D.C.K., M.G., D.P., J.G., S.Z.).
Rationale And Objectives:
This study aims to evaluate the capabilities of a 3D gradient echo MRI sequence for the detection and classification of pulmonary nodules, specifically in relation to the lung CT screening reporting and data system (Lung-RADS).
Materials And Methods:
In a prospective trial, 75 patients (mean age 65±12years; 44% women) with benign and malignant lung nodules (March 2022-July 2024) underwent chest CT and 3D gradient echo MRI using parallel imaging, compressed sensing, and AI acceleration (CSAI). Three radiologists (experience: 4, 9, and 10 years) assessed detection rates, nodule size, morphology, and Lung-RADS classification in a blinded study. Intra- and inter-rater reliability were evaluated using intraclass correlation coefficient (ICC) for size and Cohen's/Fleiss' kappa for Lung-RADS and morphology.
Results:
The CSAI gradient echo sequence achieved a detection rate of 96.3%, missing 5 out of 135 nodules across all readers. Nominal scan time was 3:53 min. MRI nodule diameter deviated from CT by 0.1 mm (1.96 SD: ±5.87mm). Excellent inter-rater agreement was observed for nodule size and morphology (Size: ICC-CT: 0.995; ICC-CSAI: 0.993; Morphology: Fleiss' kappa CT: 0.95; Fleiss' kappa MR: 0.88). Intra-rater morphology agreement between CT and MRI ranged from moderate to substantial (Cohen's-kappa: 0.55-0.71; p<.001). Lung-RADS agreement between CT and MRI was almost perfect for two readers (k=0.86, 0.90), and substantial for one (k=0.69), with near perfect inter-rater agreement (Fleiss' kappa CT:0.94; MR:0.87).
Conclusion:
Accelerated 3D gradient echo MRI showed high detection rates for pulmonary nodules with Lung-RADs scores and morphological assessments comparable to CT.
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