Dynamic contrast-enhanced MRI perfusion parameters are imaging biomarkers for angiogenesis in lung cancer

Background Quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) may have the potential to reflect angiogenesis and proliferation of pulmonary neoplasms. Purpose To verify whether DCE-MRI can identify pulmonary neoplasm property and evaluate the correlation of DCE-MRI perfusion parameters with microvessel density (MVD) and Ki-67 in lung cancer. Material and Methods This study enrolled 65 patients with one pulmonary neoplasm who underwent computed tomography-guided percutaneous lung biopsy with pathological diagnosis (43 malignant, 22 benign; mean age = 59.71 +/- 11.72 years). All patients did DCE-MRI before biopsy. Quantitative MRI parameters including endothelial transfer constant (K-trans), flux rate constant (K-ep), and fractional extravascular extracellular space (EES) volume (V-e) were calculated by extended Tofts linear model. MVD was evaluated by CD34-expressing tumor vessels. Proliferation was assessed by Ki-67 staining. The correlations of parameters with MVD and Ki-67 expression were analyzed. Results K-trans and K-ep values were significantly increased in malignant lesions compared to benign lesions (P = 0.001 and 0.022, respectively), whereas no statistical difference in V-e was found. The CD34 expression was positively correlated to K-trans (r = 0.608; P = 0.004) and K-ep (r = 0.556; P = 0.001). Subsequent subtype analyses also showed positive correlations of K-trans and K-ep with MVD in adenocarcinoma group (r = 0.550 and 0.563; P = 0.012 and 0.015, respectively). No significant correlation was found between these parameters and Ki-67. Conclusion K-trans and K-ep may distinguish benign and malignant pulmonary neoplasm. K-trans and K-ep, with their positive correlation to MVD, can be used as non-invasive parameters reflecting lung cancer angiogenesis.