Magnetic resonance imaging of the thorax
- Daniel Chernoff, MD, PhD
Daniel Chernoff, MD, PhD
- Director of MRI
- Adirondack Radiology Associates
- Paul Stark, MD
Paul Stark, MD
- Professor of Radiology
- University of California San Diego
- Section Editor
- Nestor L Muller, MD, PhD
Nestor L Muller, MD, PhD
- Section Editor — Pulmonary Imaging
- Professor of Radiology
- University of British Columbia
- Deputy Editors
- Geraldine Finlay, MD
Geraldine Finlay, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor
- Tufts University School of Medicine
- Susanna I Lee, MD, PhD
Susanna I Lee, MD, PhD
- Deputy Editor — Radiology
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
Magnetic resonance imaging (MRI) is an important tool in assessment of diseases of the heart, mediastinum, pleura, and chest wall [1,2]. Strengths of MRI include excellent tissue contrast, multiplanar imaging capability, sensitivity to blood flow, and lack of ionizing radiation. Application of MRI in intrinsic lung disease has been limited by signal loss from physiologic lung motion, a paucity of protons, and magnetic field inhomogeneities induced by the air/tissue interfaces in lung, problems that may be overcome in the future with improvements in imaging hardware and pulse sequences [3,4]. The noncardiac clinical indications for thoracic MRI will be presented here; technical aspects of thoracic and cardiac MRI are reviewed separately. (See "Principles of magnetic resonance imaging" and "Clinical utility of cardiovascular magnetic resonance imaging".)
Chest wall and diaphragm — MRI is an excellent imaging modality for assessment of primary chest wall tumors, chest wall phlegmons or abscesses, and chest wall or diaphragmatic extension of intrathoracic masses. On T1-weighted images, particularly with contrast material enhancement, the extent of invasion of normal tissues can usually be established (image 1A-C and image 2A-D and image 3A-B and image 4A-C) [5-7]. (See "Principles of magnetic resonance imaging".)
Vascular encasement or invasion is frequently well visualized on T1-weighted images. GRE (bright blood) sequences can sometimes demonstrate vascular invasion more clearly, and can regularly demonstrate the vascular supply of tumors. T2-weighted sequences play a secondary role in evaluation of the chest wall. Their primary use is in demonstrating areas of cystic degeneration, inflammation, and edema.
The ability of MRI to image in arbitrary planes of section used to be an advantage over computed tomography (CT) in assessment of the lung apices, diaphragm, and spinal column. However, the newer generation of multislice CT scanners, by enabling rapid near-isotropic imaging of the entire thorax at submillimeter resolution, has considerably narrowed this advantage. The ability to manipulate the relative signal intensities of normal and abnormal tissue through appropriate use of MRI pulse sequences remains a relative advantage of MRI over CT and achieves superior contrast resolution. Although cortical destruction is better demonstrated by CT, bone marrow involvement by tumor is better visualized on MRI.
Pleura — MRI is comparable to CT in evaluating pleural disease [8-10]. MRI may also be better at demonstrating extension of pleural lesions into the chest wall, mediastinum, and diaphragm. Imaging in sagittal and coronal planes is especially helpful in assessing the extent of malignant tumors, such as mesothelioma (image 4A-C) [11-13]. MRI can potentially characterize pleural effusions, and differentiate between exudates, transudates, and hemothoraces . However, CT remains advantageous for visualizing calcification within pleural lesions and displaying the "split pleura sign" seen in exudative pleural effusions or empyemas . Magnetic resonance imaging has proved advantageous in elucidating the source of a chylothorax by analyzing the morphology of the thoracic duct and detecting accessory lymphatic channels in patients with chylous pleural effusions .
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