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European Radiology

Open Access 13-04-2025 | Magnetic Resonance Imaging | Chest

Longitudinal MRI in comparison to low-dose CT for follow-up of incidental pulmonary nodules in patients with COPD—a nationwide multicenter trial

Authors: Lin Zhu, Qian Li, Oyunbileg von Stackelberg, Simon M. F. Triphan, Jürgen Biederer, Oliver Weinheimer, Monika Eichinger, Claus F. Vogelmeier, Rudolf A. Jörres, Hans-Ulrich Kauczor, Claus P. Heußel, Bertram J. Jobst, Hong Yu, Mark O. Wielpütz, for the COSYCONET study group

Published in: European Radiology

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Abstract

Purpose

This multicenter trial was conducted to evaluate MRI for the longitudinal management of incidental pulmonary nodules in heavy smokers.

Materials and methods

239 participants (63.9 ± 8.4 years, 43–82 years) at risk of or with COPD GOLDI-IV from 16 centers prospectively underwent two rounds of same-day low-dose computed tomography (LDCT1&2) and MRI1&2 at an interval of three years in the nationwide COSYCONET trial. All exams were independently assessed for incidental pulmonary nodules in a standardized fashion by two blinded readers, incl. axis measurements and Lung-RADS categorization, with consensual LDCT results serving as the standard of reference. A change in diameter ≥ 2 mm was rated as progress. 11 patients underwent surgery for suspicious nodules after the first round.

Results

Two hundred twenty-four of two hundred forty nodules (93.3%) persisted from LDCT1 to LDCT2, with a sensitivity of MRI2 of 82.8% and 81.5% for readers 1 and 2, respectively. Agreement in Lung-RADS categories between LDCT2 and MRI2 was substantial in per-nodule (κ = 0.62–0.70) and excellent in a per-patient (κ = 0.86–0.88) approach for both readers, respectively. Concordance between LDCT2 and MRI2 for growth was excellent to almost perfect (κ = 0.88–1.0). The accuracy of LDCT1 and MRI1 for lung cancer was 87.5%. Lung-RADS ≥ 3 category on MRI1 had higher accuracy for predicting progress (23.1% and 21.4%, respectively) than LDCT1 (15.8%).

Conclusion

Compared to LDCT, MRI shows similar capabilities for the longitudinal evaluation of incidental nodules in heavy smokers. Decision-making for nodule management guided by Lung-RADS seems feasible based on longitudinal MRI.

Key Points

Question Can MRI serve as an alternative to low-dose CT (LDCT) for the longitudinal management of pulmonary nodules in heavy smokers, addressing concerns over radiation exposure?
Findings MRI demonstrated substantial agreement with LDCT in detecting nodule growth, accurately categorizing Lung-RADS, and comparable accuracy in identifying malignancy over a three-year follow-up.
Clinical relevance Longitudinal MRI demonstrates high consistency with LDCT in assessing the growth of incidental pulmonary nodules and categorizing per-patient Lung-RADS, offering a reliable, radiation-free alternative for monitoring and early malignancy detection in high-risk populations.

Graphical Abstract

Appendix
Available only for authorised users
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Metadata
Title
Longitudinal MRI in comparison to low-dose CT for follow-up of incidental pulmonary nodules in patients with COPD—a nationwide multicenter trial
Authors
Lin Zhu
Qian Li
Oyunbileg von Stackelberg
Simon M. F. Triphan
Jürgen Biederer
Oliver Weinheimer
Monika Eichinger
Claus F. Vogelmeier
Rudolf A. Jörres
Hans-Ulrich Kauczor
Claus P. Heußel
Bertram J. Jobst
Hong Yu
Mark O. Wielpütz
for the COSYCONET study group
Publication date
13-04-2025
Publisher
Springer Berlin Heidelberg
Published in
European Radiology
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-025-11567-4