Establishing a Chest MRI Practice and its Clinical Applications: Our Insight and Protocols

Abstract

Despite its nonionizing technique and exquisite soft tissue characterization, noncardiovascular, and nonmusculoskeletal magnetic resonance imaging (MRI) of the chest has been considered impractical due to various challenges such as respiratory motion, cardiac motion, vascular pulsatility, air susceptibility, and paucity of signal in the lung. With advances in MRI, it is now possible to perform diagnostically useful and good quality MRIs of the chest, but literature on subspecialized chest MRI practices is limited. The purpose of this manuscript is to describe the rationale, nuances, and logistics that went into developing such a practice in the Division of Thoracic Radiology at our institution. The topics addressed include technical and clinical considerations, support at administrative and clinical levels, protocol development, and economic considerations compared with conventional practices. Various MRI techniques are also specifically discussed to facilitate chest MRI at other sites. Although chest MRI is used in a relatively small number of patients at this point, in certain patients, chest MRI can provide additional information to optimize medical management. A few clinical cases illustrate the quality and clinical utility of chest MRI. Given recent advances in MRI techniques, it is now an opportune time to develop a chest MRI practice.

The use of chest magnetic resonance imaging in interstitial lung disease: a systematic review

“…Ventilation techniques without and with gaseous contrasts could provide important information regarding ventilation mismatch in ILD patients [30]. Active lung inflammatory tissue could be assessed with T2-weighted sequences or using diffusion weighted imaging (DWI) [31]. Perfusion studies with non-contrast and contrast-enhanced MRI techniques could be used to quantify the amount of lung fibrosis [13].…”

“…DWI has been used for lung cancer imaging [53] and more recently to detect and quantify inflammation in cystic fibrosis patient with a pulmonary exacerbation [54]. The latter application is of particular interest for ILD patients because it could be used as a potential marker of active disease and to monitor treatment response (figure 4) [31]. To date, DWI has not been tested on ILD patients.…”

“…Although echocardiography is the mainstay for imaging of the right heart in clinical practice, advances in velocity-encoded MRI as well as other cardiac magnetic resonance techniques have provided an opportunity for quantitative and qualitative assessment of haemodynamics in the pulmonary circulation and identification of right ventricular morphological changes. Phase-contrast MRI combined with cardiac MRI is now regarded as the reference standard for the assessment of right ventricle structure and function [31]. Nowadays, phase-contrast MRI is a standard subset of cardiac MRI protocols.…”

Building blocks for thoracic MRI: Challenges, sequences, and protocol design

“…A preferred alternative for mitigating respiratory motion is the use of a respiratory‐navigated sequence using radial k ‐space acquisition, commonly known as PROPELLER (GE, Milwaukee, WI), BLADE (Siemens, Erlangen, Germany), or MultiVane (Philips, Best, Netherlands). These FSE sequences are less sensitive to cardiac motion and provide excellent T 2 contrast …”

“…These FSE sequences are less sensitive to cardiac motion and provide excellent T 2 contrast. 30,31 For fat-suppressed T 2 -weighted imaging, short tau inversion recovery (STIR) can be added to an SSFSE sequence. STIR sequences provide extreme T 2 -weighting.…”