Evaluation of diffusion-weighted imaging analysis as a Prognostic Tool in pulmonary nodules

Matteo Ferrari; L. Conti; G. Marino

doi:10.5281/zenodo.22814167

Authors

Matteo Ferrari Department of Clinical Radiology, Ebro Academy of Medical Imaging Author https://orcid.org/2980-0114-6114-2033
L. Conti Department of Clinical Radiology, Amur Academy of Medical Imaging Author https://orcid.org/3391-4205-9046-1502
G. Marino Department of Clinical Radiology, Ebro Academy of Medical Imaging Author https://orcid.org/8771-3708-2516-3074

DOI:

https://doi.org/10.5281/zenodo.22814167

Keywords:

diffusion-weighted imaging, apparent diffusion coefficient, pulmonary nodule, lung cancer prognosis, FDG-PET/CT

Abstract

Graphical abstract

Background: Diffusion-weighted MRI (DWI) generates contrast from restricted water motion in densely cellular tissue, and its apparent diffusion coefficient (ADC) is consistently lower in malignant than benign pulmonary nodules.

Objective: This review evaluates DWI and ADC quantification as a prognostic tool in pulmonary nodules, covering nodal and distant staging, treatment-response prediction, survival correlation, and histogram and intravoxel incoherent motion refinements.

Methods: We synthesized diagnostic accuracy studies, prospective staging comparisons, treatment-response monitoring series, and meta-analyses addressing DWI, ADC, and IVIM parameters in pulmonary nodules and non-small cell lung cancer, benchmarked against PET/CT and CT.

Findings: ADC correlates inversely with tumor cellularity and histologic aggressiveness, performs comparably to PET/CT for nodal and metastatic staging in several head-to-head series, and early on-treatment ADC change predicts radiologic response and survival in chemoradiotherapy cohorts; histogram and radiomic refinements of mean ADC further improve discrimination.

Conclusions: DWI-derived ADC is a reproducible, radiation-free prognostic biomarker across the diagnostic, staging, and treatment-monitoring phases of pulmonary nodule management, best used alongside CT and PET/CT, with acquisition standardization remaining the principal barrier to routine prognostic adoption.

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