Morphologic MRI of the lung in CF patients demonstrates comparable results to MDCT and chest x-ray. Because radiation exposure is an issue in CF patients, MRI might have the ability to be used as an appropriate alternative method for pulmonary imaging.
To evaluate and compare early therapy response according to RECIST (response evaluation criteria in solid tumours) and modified RECIST criteria using MRI techniques in patients with malignant pleural mesothelioma (MPM) in comparison with CT. Fifty patients with MPM (32 male/18 female) were included in this study. Early therapy response was evaluated after 9 weeks [three of six chemotherapy (CHT)] cycles. Additionally patients were examined before chemotherapy, 4 weeks after early therapy response evaluation and after six cycles to evaluate diagnostic follow-up. RECIST and modified RECIST criteria were applied using CT and MRI (HASTE, VIBE, T2-TSE sequences). In MRI additionally a volumetric approach measuring tumour weight (overall segmented tumour volume) was applied. Additionally vital capacity (VC) was measured for correlation. Image interpretation was performed by three independent readers independently and in consensus. The 'gold standard' was follow-up examination. Twenty-eight patients showed partial response, 12 patients stable disease and 10 patients progressive disease at early therapy response evaluation. In the follow-up these results remained. For MRI, in 46 cases patients were identically classified using RECIST and modified RECIST criteria. Modified RECIST criteria were identically classified as gold standards in all cases, whereas using RECIST criteria in four cases there was a mismatch (partial response vs. stable disease). Modified RECIST kappa values showed better interobserver variability compared with RECIST criteria (kappa=0.9-1.0 vs. 0.7-1.0). For CT, in 44 cases patients were identically classified using RECIST and modified RECIST criteria. Modified RECIST criteria were identically classified as in gold standards in 48 out of 50 patients, whereas using RECIST criteria in 6 cases there was a mismatch (partial response vs. stable disease). Modified RECIST kappa values showed better interobserver variability compared with RECIST criteria (kappa=0.9-1.0 vs. 0.6-1.0). Modified RECIST criteria especially in combination with high-resolution MRI is a very accurate and reproducible technique to correctly evaluate early therapy response in MPM.
A 53-year-old man was admitted with productive cough, chest pain, and hemoptysis. Eight months earlier, he had undergone radiofrequency ablation for atrial fibrillation originating from the right upper and both left pulmonary veins. Computed tomography demonstrated bronchopneumonic infiltrates in both upper lobes (Figure 1). A perfusion scintigram, performed to exclude pulmonary embolism, showed hypoperfusion of both upper lobes, despite a normal ventilation scintigram (Figure 2). Catheter angiography showed hypoperfusion of the upper lobes and no pathology of the pulmonary arteries (Figure 3). In the venous phase, both upper pulmonary veins were not visible ( Figure 4). To achieve discrimination of the arterial and venous lung vessels, a timeresolved multiphasic pulmonary magnetic resonance angiography (MRA) was performed. Despite a lower spatial resolution, MRA was able to visualize both upper pulmonary veins with high-grade stenoses. On the basis of these findings, recanalization therapy of the pulmonary veins was planned.
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