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
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 .
- Kircher MF, Willmann JK. Molecular body imaging: MR imaging, CT, and US. Part II. Applications. Radiology 2012; 264:349.
- Kircher MF, Willmann JK. Molecular body imaging: MR imaging, CT, and US. part I. principles. Radiology 2012; 263:633.
- Vogt FM, Goyen M, Debatin JF. MR angiography of the chest. Radiol Clin North Am 2003; 41:29.
- Hatabu H, Stock KW, Sher S, et al. Magnetic resonance imaging of the thorax. Past, present, and future. Radiol Clin North Am 2000; 38:593.
- Fortier M, Mayo JR, Swensen SJ, et al. MR imaging of chest wall lesions. Radiographics 1994; 14:597.
- Kuhlman JE, Bouchardy L, Fishman EK, Zerhouni EA. CT and MR imaging evaluation of chest wall disorders. Radiographics 1994; 14:571.
- Padovani B, Mouroux J, Seksik L, et al. Chest wall invasion by bronchogenic carcinoma: evaluation with MR imaging. Radiology 1993; 187:33.
- Schmutz GR, Fisch-Ponsot C, Regent D, Sylvestre J. Computed tomography (CT) and magnetic resonance imaging (MRI) of pleural masses. Crit Rev Diagn Imaging 1993; 34:309.
- McLoud TC. CT and MR in pleural disease. Clin Chest Med 1998; 19:261.
- Hierholzer J, Luo L, Bittner RC, et al. MRI and CT in the differential diagnosis of pleural disease. Chest 2000; 118:604.
- Patz EF Jr, Shaffer K, Piwnica-Worms DR, et al. Malignant pleural mesothelioma: value of CT and MR imaging in predicting resectability. AJR Am J Roentgenol 1992; 159:961.
- Heelan RT. CT and MR imaging in the evaluation of pleural masses. Chest Surg Clin N Am 1994; 4:431.
- Nickell LT Jr, Lichtenberger JP 3rd, Khorashadi L, et al. Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma. Radiographics 2014; 34:1692.
- Davis SD, Henschke CI, Yankelevitz DF, et al. MR imaging of pleural effusions. J Comput Assist Tomogr 1990; 14:192.
- Yu DX, Ma XX, Wang Q, et al. Morphological changes of the thoracic duct and accessory lymphatic channels in patients with chylothorax: detection with unenhanced magnetic resonance imaging. Eur Radiol 2013; 23:702.
- Link KM, Samuels LJ, Reed JC, et al. Magnetic resonance imaging of the mediastinum. J Thorac Imaging 1993; 8:34.
- Grover FL. The role of CT and MRI in staging of the mediastinum. Chest 1994; 106:391S.
- Carlsen SE, Bergin CJ, Hoppe RT. MR imaging to detect chest wall and pleural involvement in patients with lymphoma: effect on radiation therapy planning. AJR Am J Roentgenol 1993; 160:1191.
- Hoane BR, Shields AF, Porter BA, Borrow JW. Comparison of initial lymphoma staging using computed tomography (CT) and magnetic resonance (MR) imaging. Am J Hematol 1994; 47:100.
- Abdel Razek AA, Khairy M, Nada N. Diffusion-weighted MR imaging in thymic epithelial tumors: correlation with World Health Organization classification and clinical staging. Radiology 2014; 273:268.
- Pieterman RM, van Putten JW, Meuzelaar JJ, et al. Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med 2000; 343:254.
- Schwenzer NF, Schraml C, Müller M, et al. Pulmonary lesion assessment: comparison of whole-body hybrid MR/PET and PET/CT imaging--pilot study. Radiology 2012; 264:551.
- Müller NL, Mayo JR, Zwirewich CV. Value of MR imaging in the evaluation of chronic infiltrative lung diseases: comparison with CT. AJR Am J Roentgenol 1992; 158:1205.
- Couch MJ, Ball IK, Li T, et al. Pulmonary ultrashort echo time 19F MR imaging with inhaled fluorinated gas mixtures in healthy volunteers: feasibility. Radiology 2013; 269:903.
- Fain SB, Korosec FR, Holmes JH, et al. Functional lung imaging using hyperpolarized gas MRI. J Magn Reson Imaging 2007; 25:910.
- van Beek EJ, Wild JM. Hyperpolarized 3-helium magnetic resonance imaging to probe lung function. Proc Am Thorac Soc 2005; 2:528.
- Driehuys B, Martinez-Jimenez S, Cleveland ZI, et al. Chronic obstructive pulmonary disease: safety and tolerability of hyperpolarized 129Xe MR imaging in healthy volunteers and patients. Radiology 2012; 262:279.
- Niles DJ, Kruger SJ, Dardzinski BJ, et al. Exercise-induced bronchoconstriction: reproducibility of hyperpolarized 3He MR imaging. Radiology 2013; 266:618.
- Bolar DS, Levin DL, Hopkins SR, et al. Quantification of regional pulmonary blood flow using ASL-FAIRER. Magn Reson Med 2006; 55:1308.
- Rajaram S, Swift AJ, Capener D, et al. Lung morphology assessment with balanced steady-state free precession MR imaging compared with CT. Radiology 2012; 263:569.
- Wild JM, Marshall H, Xu X, et al. Simultaneous imaging of lung structure and function with triple-nuclear hybrid MR imaging. Radiology 2013; 267:251.
- Mayr B, Lenhard M, Fink U, et al. Preoperative evaluation of bronchogenic carcinoma: value of MR in T- and N-staging. Eur J Radiol 1992; 14:245.
- Webb WR, Gatsonis C, Zerhouni EA, et al. CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. Radiology 1991; 178:705.
- Templeton PA, Caskey CI, Zerhouni EA. Current uses of CT and MR imaging in the staging of lung cancer. Radiol Clin North Am 1990; 28:631.
- Torigian DA, Zaidi H, Kwee TC, et al. PET/MR imaging: technical aspects and potential clinical applications. Radiology 2013; 267:26.
- Bruzzi JF, Komaki R, Walsh GL, et al. Imaging of non-small cell lung cancer of the superior sulcus: part 1: anatomy, clinical manifestations, and management. Radiographics 2008; 28:551.
- Pichler BJ, Kolb A, Nägele T, Schlemmer HP. PET/MRI: paving the way for the next generation of clinical multimodality imaging applications. J Nucl Med 2010; 51:333.
- Ohno Y, Koyama H, Yoshikawa T, et al. Three-way Comparison of Whole-Body MR, Coregistered Whole-Body FDG PET/MR, and Integrated Whole-Body FDG PET/CT Imaging: TNM and Stage Assessment Capability for Non-Small Cell Lung Cancer Patients. Radiology 2015; 275:849.
- Chandarana H, Heacock L, Rakheja R, et al. Pulmonary nodules in patients with primary malignancy: comparison of hybrid PET/MR and PET/CT imaging. Radiology 2013; 268:874.
- Krüger S, Haage P, Hoffmann R, et al. Diagnosis of pulmonary arterial hypertension and pulmonary embolism with magnetic resonance angiography. Chest 2001; 120:1556.
- Finn JP, Baskaran V, Carr JC, et al. Thorax: low-dose contrast-enhanced three-dimensional MR angiography with subsecond temporal resolution--initial results. Radiology 2002; 224:896.
- Ingrisch M, Maxien D, Meinel FG, et al. Detection of pulmonary embolism with free-breathing dynamic contrast-enhanced MRI. J Magn Reson Imaging 2016; 43:887.
- Kalb B, Sharma P, Tigges S, et al. MR imaging of pulmonary embolism: diagnostic accuracy of contrast-enhanced 3D MR pulmonary angiography, contrast-enhanced low-flip angle 3D GRE, and nonenhanced free-induction FISP sequences. Radiology 2012; 263:271.
- van Beek EJ, Wild JM, Fink C, et al. MRI for the diagnosis of pulmonary embolism. J Magn Reson Imaging 2003; 18:627.
- Ley S, Kreitner KF, Fink C, et al. Assessment of pulmonary hypertension by CT and MR imaging. Eur Radiol 2004; 14:359.
- Levin DL, Chen Q, Zhang M, et al. Evaluation of regional pulmonary perfusion using ultrafast magnetic resonance imaging. Magn Reson Med 2001; 46:166.
- Uematsu H, Levin DL, Hatabu H. Quantification of pulmonary perfusion with MR imaging: recent advances. Eur J Radiol 2001; 37:155.
- Mai VM, Liu B, Polzin JA, et al. Ventilation-perfusion ratio of signal intensity in human lung using oxygen-enhanced and arterial spin labeling techniques. Magn Reson Med 2002; 48:341.
- van der Meer RW, Lamb HJ, Smit JW, de Roos A. MR imaging evaluation of cardiovascular risk in metabolic syndrome. Radiology 2012; 264:21.
- Bamberg F, Kauczor HU, Weckbach S, et al. Whole-Body MR Imaging in the German National Cohort: Rationale, Design, and Technical Background. Radiology 2015; 277:206.