The value of diffusion kurtosis imaging, diffusion weighted imaging and (18)F-FDG PET for differentiating benign and malignant solitary pulmonary lesions and predicting pathological grading

OBJECTIVE: To explore the value of PET/MRI, including diffusion kurtosis imaging (DKI), diffusion weighted imaging (DWI) and positron emission tomography (PET), for distinguishing between benign and malignant solitary pulmonary lesions (SPLs) and predicting the histopathological grading of malignant SPLs. MATERIAL AND METHODS: Chest PET, DKI and DWI scans of 73 patients with SPL were performed by PET/MRI. The apparent diffusion coefficient (ADC), mean diffusivity (MD), mean kurtosis (MK), maximum standard uptake value (SUV(max)), metabolic total volume (MTV) and total lesion glycolysis (TLG) were calculated. Student’s t test or the Mann–Whitney U test was used to analyze the differences in parameters between groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy. Logistic regression analysis was used to evaluate independent predictors. RESULTS: The MK and SUV(max) were significantly higher, and the MD and ADC were significantly lower in the malignant group (0.59 ± 0.13, 10.25 ± 4.20, 2.27 ± 0.51[×10(-3) mm(2)/s] and 1.35 ± 0.33 [×10(-3) mm(2)/s]) compared to the benign group (0.47 ± 0.08, 5.49 ± 4.05, 2.85 ± 0.60 [×10(-3) mm(2)/s] and 1.67 ± 0.33 [×10(-3) mm(2)/s]). The MD and ADC were significantly lower, and the MTV and TLG were significantly higher in the high-grade malignant SPLs group (2.11 ± 0.51 [×10(-3) mm(2)/s], 1.35 ± 0.33 [×10(-3) mm(2)/s], 35.87 ± 42.24 and 119.58 ± 163.65) than in the non-high-grade malignant SPLs group (2.46 ± 0.46 [×10(-3) mm(2)/s], 1.67 ± 0.33[×10(-3) mm(2)/s], 20.17 ± 32.34 and 114.20 ± 178.68). In the identification of benign and malignant SPLs, the SUV(max) and MK were independent predictors, the AUCs of the combination of SUV(max) and MK, SUV(max), MK, MD, and ADC were 0.875, 0.787, 0.848, 0.769, and 0.822, respectively. In the identification of high-grade and non-high-grade malignant SPLs, the AUCs of MD, ADC, MTV, and TLG were 0.729, 0.680, 0.693, and 0.711, respectively. CONCLUSION: DWI, DKI, and PET in PET/MRI are all effective methods to distinguish benign from malignant SPLs, and are also helpful in evaluating the pathological grading of malignant SPLs.