Diffusion-weighted magnetic resonance imaging in preoperative assessment of non– small cell lung cancer Hiroaki Nomori, MD, Yue Cong, MD, Masaru Abe,

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Diffusion-weighted magnetic resonance imaging in preoperative assessment of non– small cell lung cancer Hiroaki Nomori, MD, Yue Cong, MD, Masaru Abe, MD, Hiroshi Sugimura, MD, Yoshiaki Kato, RT The Journal of Thoracic and Cardiovascular Surgery Volume 149, Issue 4, Pages 991-996 (April 2015) DOI: 10.1016/j.jtcvs.2015.01.019 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Pulmonary adenocarcinoma with faint-homogenous pattern on diffusion-weighted magnetic resonance imaging. A, Computed tomography image. B, Diffusion-weighted image. The tumor is indicated in a circle. The maximum signal intensity of the tumor is 15 and the mean signal intensity of the spinal cord is 65; that is, 0.23 of signal intensity contrast ratio. C, Fluorodeoxyglucose-positron emission tomography. The tumor is indicated in a circle. The maximum standardized uptake values of the tumor and contralateral lung are 1.2 and 0.52, respectively; that is, 2.3 of the standardized uptake value contrast ratio. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 991-996DOI: (10.1016/j.jtcvs.2015.01.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Pulmonary adenocarcinoma with dark-homogenous pattern on diffusion-weighted magnetic resonance imaging. A, Computed tomography image. B, Diffusion-weighted image. The maximum signal intensity of the tumor is 94 and the mean signal intensity of the spinal cord is 62; that is, 1.52 of signal intensity contrast ratio. C, Fluorodeoxyglucose-positron emission tomography. The maximum standardized uptake values of tumor and contralateral lung are 4.3 and 0.67, respectively; that is, 6.3 of the standardized uptake value contrast ratio. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 991-996DOI: (10.1016/j.jtcvs.2015.01.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Pulmonary adenocarcinoma with heterogeneous pattern on diffusion-weighted magnetic resonance imaging. A, computed tomography image. B, Diffusion-weighted image. The maximum signal intensity of the tumor is 73 and the mean signal intensity of the spinal cord is 58; that is, 1.26 of signal intensity contrast ratio. The signal intensity contrast ratio of the dark area and faint area were 1.26 and 0.69, respectively. C, Fluorodeoxyglucose-positron emission tomography. The maximum standardized uptake values of tumor and contralateral lung are 5.8 and 0.52, respectively; that is, 11.2 of the standardized uptake ratio contrast ratio. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 991-996DOI: (10.1016/j.jtcvs.2015.01.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 The distributions of signal intensity contrast ratio (SI-CR) in tumors with lymphatic, vascular, or pleural invasion, or lymph node metastasis and those without. The 25th percentile, median, and 75th percentile values of the former were 1.1, 1.5, and 2.23, respectively, whereas those of the latter were 0.36, 0.61, and 1.02, respectively. A central large arrow in each distribution shows median value, and the top and bottom small arrows show 75th and 25th percentile values, respectively. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 991-996DOI: (10.1016/j.jtcvs.2015.01.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 The distributions of signal intensity contrast ratio (SI-CR) on diffusion-weighted magnetic resonance imaging in faint-homogenous (Faint-HOM), dark-homogenous (Dark-HOM), and heterogeneous (HET) tumors. The 25th percentile, median, and 75th percentile values of the faint-HOM tumors were 0.22, 0.27, and 0.36, respectively. Images that appeared dark-HOM were 0.61, 0.95, and 1.34, respectively, and those that were HET were 1.1, 1.58, and 2.42, respectively. A central large arrow in each distribution shows median value, and the top and bottom small arrows show 75th and 25th percentile values, respectively. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 991-996DOI: (10.1016/j.jtcvs.2015.01.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 The distributions of 18F-fluorodeoxyglucose positron emission tomography uptake in faint-homogenous (Faint-HOM), dark-homogenous (Dark-HOM), and heterogeneous (HET) tumors. The 25th percentile, median, and 75th percentile values of the faint-HOM tumors were 1.4, 2.3, and 3.0, respectively. Those of dark-HOM tumors were 2.2, 4.4, and 6.5, respectively. HET tumors were 5.3, 11.2, and 16.4, respectively. A central large arrow in each distribution shows median value, and the top and bottom small arrows show 75th and 25th percentile values. The Journal of Thoracic and Cardiovascular Surgery 2015 149, 991-996DOI: (10.1016/j.jtcvs.2015.01.019) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions