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MRI Evaluation of Indeterminate Pulmonary Nodules
1Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Purpose:
To evaluate MRI features for differentiating pulmonary hamartomas from other nodule pathologies, including carcinoid tumors and non-small cell lung cancer (NSCLC).
Materials And Methods:
This retrospective study analyzed chest MRIs of 48 patients with pulmonary nodules from 2017 to 2025. Patients had either pathologic diagnosis or stable follow-up confirming hamartoma. Two blinded radiologists reviewed images and recorded enhancement pattern (solid, rim, or speckled/mesh). The signal intensity index (SII) was calculated using chemical shift imaging.
Results:
Hamartomas (n=19, 40%), carcinoids (n=17, 35%), and adenocarcinomas (n=9, 19%) were the most common diagnoses. Rim and speckled/mesh enhancement patterns were nearly exclusive to hamartomas (22% and 39% vs. 0% and 4%, respectively, P <0.001). An SII >10% showed 61% sensitivity and 100% specificity for hamartomas. Combining rim or speckled/mesh enhancement patterns and SII >10% yielded 79% sensitivity and 96.6% specificity for hamartomas.
Conclusions:
Although chemical shift imaging is diagnostic for hamartomas, signal dropout is present in just over half of cases. Rim or speckled/mesh enhancement patterns are also highly suggestive. Combining these MRI features significantly improves diagnostic accuracy for pulmonary hamartomas, potentially reducing further follow-up or invasive procedures for indeterminate nodules.
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