Major complications were 5.7% and 4.4% for core biopsy and FNA, respectively (no statistical significance). Pooled complication rates for CT-guided core-needle biopsy included pneumothorax 25.3%, pneumothorax requiring intervention 5.6%, pulmonary hemorrhage 18.0%, and hemoptysis 4.1%. For FNA, complication rates were lower: 18.8%, 4.3%, 6.4%, and 1.7%, respectively [56]. A retrospective single-institution study of 550 patients found no statistical differences between pneumothorax rates between 18-G and 20-G CT-guided pulmonary nodule biopsies (25.6% versus 28.7%, respectively). Chest tube insertion rate for 18-G and 20-G was 4.8% versus 5.6%, 10 Incidentally Detected Indeterminate Pulmonary Nodule MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest in the evaluation of incidentally detected indeterminate pulmonary nodules. MRI has been increasingly studied as an alternative method in the evaluation of incidental pulmonary nodules over the last decades, with reported sensitivities ranging from 26% to 96% for various MRI sequences [54]. Major limitations for accurate nodule characterization include artifact from respiratory and cardiac motion and poor image contrast in lung MRI. Motion artifact in pulmonary MRI results from longer sequence acquisition times compared to CT. Faster sequences and techniques have been studied to address this problem [57]. A small series by Heye et al [58] using a fast sequence reported a nodule detection rate of 45.5% compared to CT, along with a high number of false-positive nodules related to motion artifact. Nodule size is another well-known limiting factor for many MRI sequences. Overall, MRI might have a future role as a complementary tool in the stratification of incidental pulmonary nodules, possibly multiparametric MRI, but further research and validation studies are required before MRI is implemented in clinical practice.
Incidentally Detected Indeterminate Pulmonary Nodule PCAs. Major complications were 5.7% and 4.4% for core biopsy and FNA, respectively (no statistical significance). Pooled complication rates for CT-guided core-needle biopsy included pneumothorax 25.3%, pneumothorax requiring intervention 5.6%, pulmonary hemorrhage 18.0%, and hemoptysis 4.1%. For FNA, complication rates were lower: 18.8%, 4.3%, 6.4%, and 1.7%, respectively [56]. A retrospective single-institution study of 550 patients found no statistical differences between pneumothorax rates between 18-G and 20-G CT-guided pulmonary nodule biopsies (25.6% versus 28.7%, respectively). Chest tube insertion rate for 18-G and 20-G was 4.8% versus 5.6%, 10 Incidentally Detected Indeterminate Pulmonary Nodule MRI Chest Without IV Contrast There is no relevant literature to support the use of MRI chest in the evaluation of incidentally detected indeterminate pulmonary nodules. MRI has been increasingly studied as an alternative method in the evaluation of incidental pulmonary nodules over the last decades, with reported sensitivities ranging from 26% to 96% for various MRI sequences [54]. Major limitations for accurate nodule characterization include artifact from respiratory and cardiac motion and poor image contrast in lung MRI. Motion artifact in pulmonary MRI results from longer sequence acquisition times compared to CT. Faster sequences and techniques have been studied to address this problem [57]. A small series by Heye et al [58] using a fast sequence reported a nodule detection rate of 45.5% compared to CT, along with a high number of false-positive nodules related to motion artifact. Nodule size is another well-known limiting factor for many MRI sequences. Overall, MRI might have a future role as a complementary tool in the stratification of incidental pulmonary nodules, possibly multiparametric MRI, but further research and validation studies are required before MRI is implemented in clinical practice.