{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T11:41:45Z","timestamp":1760960505505,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:00:00Z","timestamp":1760745600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Lung nodules present a common diagnostic challenge, particularly when benign and malignant lesions exhibit similar imaging characteristics. Standard evaluation relies on computed tomography (CT), positron emission tomography (PET), or biopsy, all of which have limitations. Quantitative magnetic resonance (MR) relaxometry using native longitudinal relaxation time (T1) and transverse relaxation time (T2) mapping offers a radiation-free alternative reflecting tissue-specific differences. Methods: This prospective, single-center study included 64 patients with 76 histologically or radiologically confirmed lung lesions (25 primary lung cancers, 28 metastases, 9 granulomas, and 14 pneumonic infiltrates). The patients underwent T1 and T2 mapping at 3T. Two independent readers quantified the mean values for each lesion. The pre-specified primary endpoints were (1) benign versus malignant and (2) primary lung cancer versus pulmonary metastases. Results: Significant differences in T1 and T2 values were observed across lesion types. Benign lesions exhibited high T2 values (mean 213.6 ms) and low T1 values (mean 836.6 ms), whereas malignant tumors exhibited lower T2 values (~77\u201378 ms) and higher T1 values (~1460\u20131504 ms, p &lt; 0.001). Binary classification yielded 95.7% accuracy (sensitivity 93.8% for malignant, specificity 100% for benign) in an internal 70\/30 hold-out validation (no external dataset), with consistent performance confirmed by patient-level and nested cross-validation (balanced accuracy \u2248 0.92\u20130.94). However, malignant subtypes could not be reliably distinguished (p &gt; 0.05), and multiclass accuracy was 60.9%. Conclusions: Quantitative MR relaxometry allows accurate, radiation-free differentiation of benign and malignant lung lesions and may help reduce unnecessary invasive procedures.<\/jats:p>","DOI":"10.3390\/cancers17203370","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:44:10Z","timestamp":1760957050000},"page":"3370","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Morphology: Quantitative MR Relaxometry in Pulmonary Lesion Classification"],"prefix":"10.3390","volume":"17","author":[{"given":"Markus","family":"Graf","sequence":"first","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2111-8177","authenticated-orcid":false,"given":"Alexander W.","family":"Marka","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Wachter","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tristan","family":"Lemke","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4646-7532","authenticated-orcid":false,"given":"Nicolas","family":"Lenhart","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa","family":"Schredl","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3335-3331","authenticated-orcid":false,"given":"Jonathan","family":"Stelter","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4295-4585","authenticated-orcid":false,"given":"Kilian","family":"Weiss","sequence":"additional","affiliation":[{"name":"Philips GmbH, 22335 Hamburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcus","family":"Makowski","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4922-3662","authenticated-orcid":false,"given":"Dimitrios C.","family":"Karampinos","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"},{"name":"Laboratory of Magnetic Resonance Imaging Systems and Methods, Ecole Polytechnique F\u00e9d\u00e9rale de Lausanne (EPFL), 1015 Lausanne, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2002-8337","authenticated-orcid":false,"given":"Daniela","family":"Pfeiffer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0353-2523","authenticated-orcid":false,"given":"Gregor S.","family":"Zimmermann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2335-4309","authenticated-orcid":false,"given":"Seyer","family":"Safi","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keno","family":"Bressem","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Ziegelmayer","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Radiology, School of Medicine, University Hospital Rechts der Isar, Technical University of Munich, 81675 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,18]]},"reference":[{"key":"ref_1","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer 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