ORIGINAL RESEARCH article
Front. Oncol.
Sec. Thoracic Oncology
This article is part of the Research TopicAdvancing Diagnostic Excellence in Early Lung Cancer DetectionView all 10 articles
A T2-Weighted MRI Grading System for Preoperative Prediction of Visceral Pleural Invasion in Small Non-Small Cell Lung Cancers
Provisionally accepted
- The Forth Hospital of Hebei Medical university, Shijiazhuang, China
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Purpose: To evaluate the supplemental diagnostic value of T2WI for assessing VPI in NSCLC ≤3 cm with indeterminate CT features (pleural contact/tags). Materials and Methods: This prospective single-center study enrolled 138 participants with NSCLC ≤3 cm and CT-suspected pleural involvement, of whom 98 underwent surgical resection and histopathologic VPI confirmation from January 2021 to March 2023. All participants underwent thoracic MRI (3.0T), including T2WI sequences. Two radiologists independently graded tumor-pleural interface signals (Grades 0-3: absent to wedge-shaped hyperintensity). Pathologic VPI served as the reference standard. Logistic regression and ROC analysis were performed to develop a predictive model integrating tumor size and T2WI grades. Results: VPI-positive lesions (35/98, 35.7%) demonstrated larger mean tumor size (22.32±5.58 mm vs. 16.17±4.22 mm; P=0.024) and higher T2WI hyperintensity frequencies (85.71% vs. 52.38%; P=0.001). Grade 3 T2WI signals (wedge-shaped) achieved 93.65% specificity and 76.47% PPV for VPI, with a positive likelihood ratio of 5.85. Multivariate analysis identified tumor size (OR=1.126/mm, P=0.024), Grade 2 (OR=8.826, P=0.003), and Grade 3 signals (OR=29.890, P<0.001) as independent VPI predictors. The combined model achieved an AUC of 0.837 (95% CI: 0.758– 0.916), demonstrating superior diagnostic performance versus CT-based criteria. Conclusion: T2WI-based grading of tumor-pleural interface hyperintensity serves as a radiation-free method for preoperative VPI prediction in small NSCLC, offering potential as a complementary tool to CT diagnosis. While promising, these findings require multicenter validation due to the single-center design.
Keywords: Non-small cell lung cancer, Visceral pleural invasion, T2-weighted magnetic resonance imaging, Tumor staging, Preoperative prediction, Diagnostic accuracy
Received: 10 Aug 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Zhang, Liu, Feng, Li, Gu, Xu, Yang, Wang, Zhai and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Gaofeng Shi, gaofengs1962@hebmu.edu.cn
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