Diagnostic Performance of 3.0-Tesla Magnetic Resonance Imaging for Pulmonary Nodules and Masses: A Comparative Cross-Sectional Study With Multidetector Computed Tomography

Background Pulmonary nodules are increasingly detected incidentally on computed tomography (CT) scans, requiring serial follow-up examinations that carry a non-trivial cumulative radiation burden. Magnetic resonance imaging (MRI) at 3.0 Tesla (3T) offers comparable soft-tissue contrast without ionizing radiation and may represent a viable alternative for nodule surveillance. This study evaluated the diagnostic performance of 3T MRI for detecting pulmonary nodules and masses in comparison with multidetector computed tomography (MDCT), which served as the reference standard. Methodology This hospital-based, cross-sectional study enrolled 60 adult patients with CT-confirmed pulmonary nodules or masses at the Department of Radiodiagnosis. All participants underwent 3T MRI (Siemens Skyra) using multiple non-contrast sequences: half-Fourier acquisition single-shot turbo spin-echo (T2-HASTE), volumetric interpolated breath-hold examination (T1-VIBE), true fast imaging with steady-state free precession (T2-TRUFI), T2-BLADE (periodically rotated overlapping parallel lines with enhanced reconstruction), and echo planar imaging in two dimensions diffusion-weighted imaging (Ep2d DWI). Lesion number, size, location, margins, cavitation, pleural effusion, and mediastinal lymphadenopathy were recorded. Overall and size-stratified sensitivities of MRI were calculated with MDCT as a reference. Bland-Altman analysis assessed measurement agreement between the two modalities. Results MDCT identified 108 nodules or masses in 60 patients (mean age = 49.67 ± 17.80 years; female:male ratio = 1.14:1). MRI detected 94 lesions (overall sensitivity 87%). Size-stratified sensitivity was 9% for nodules <4 mm, 75% for 4-5 mm, 95.2% for 5-7 mm, and 100% for >7 mm. Bland-Altman analysis showed excellent size agreement (mean bias = 0.65 mm; limits of agreement = −1.5 to +2.5 mm). Pleural effusion, mediastinal lymphadenopathy, and cavitation were concordantly identified on both modalities. Conclusions 3T MRI demonstrated high sensitivity for pulmonary nodules exceeding 7 mm and excellent size-measurement agreement with MDCT. Given its freedom from ionizing radiation and reliable performance for clinically significant nodules, 3T MRI is a promising radiation-free alternative for surveillance of pulmonary nodules in appropriate clinical contexts, particularly for patients requiring repeated imaging.