The Clinical Feasibility of Using Non-Breath-Hold Real-Time MR-Echo Imaging for the Evaluation of Mediastinal and Chest Wall Tumor Invasion

Abstract

ObjectiveWe wanted to determine the clinical feasibility of using non-breath-hold real-time MR-echo imaging for the evaluation of mediastinal and chest wall tumor invasion.Materials and MethodsMR-echo imaging was prospectively applied to 45 structures in 22 patients who had non-small cell lung cancer when the tumor invasion was indeterminate on CT. The static MR imaging alone, and the static MR imaging combined with MR-echo examinations were analyzed. The surgical and pathological findings were compared with using the Wilcoxon-signed rank test and McNemar's test.ResultsThe accuracy, sensitivity and specificity of the combined MR-echo examination and static MR imaging for determining the presence of invasion were 84%, 83% and 85%, respectively, for the first reading session and they were 87%, 83% and 87%, respectively, for the second reading session (there was substantial interobserver agreement, k = 0.74). For the static MR imaging alone, these values were 62%, 83% and 59%, respectively, for the first reader and they were 69%, 67% and 74%, respectively, for the second reader (there was moderate interobserver agreement, k = 0.49). The diagnostic confidence for tumor invasion was also higher for the combined MR-echo examination and static MR imaging than that for the static MR imaging alone (p < 0.05).ConclusionThe combined reading of a non-breath-hold real-time MR-echo examination and static MR imaging provides higher specificity and diagnostic confidence than those for the static MR imaging reading alone to determine the presence of mediastinal or chest wall tumor invasion when this was indeterminate on CT scanning.

Usefulness of thin‐section single‐shot turbo spin echo with half‐fourier acquisition in evaluation of local invasion of lung cancer

“…SS‐TSE‐HF is an imaging technique with tissue contrast similar to conventional TSE, but with a much shorter imaging time. Previous studies using TSE or TSE with half‐Fourier acquisition to evaluate the local invasion of lung cancer used 7–10‐mm slice thickness and axial images only, and did not show good diagnostic performances . However, in this study we used thin‐section SS‐TSE‐HF with 3 mm slice thickness and additional coronal and sagittal images to axial images.…”

“…Magnetic resonance imaging (MRI) can be superior to CT scanning in delineating direct tumor invasion of contact structures with higher tissue contrast (5) and previous reports have shown that the use of contrast enhancement might improve the accuracy of MRI for lung cancer invasion (6,7). Recently, several studies have reported that dynamic MRI such as electrocardiogram (ECG)-gated cardiac cine MRI or respiratory dynamic MRI can improve the prediction accuracy of adjacent mediastinal vascular structures or chest wall invasion of lung cancer (8)(9)(10)(11).…”

The Diagnostic Utility of Cardiac-Gated Magnetic Resonance Imaging for Assessing Surgical Resectability of Mediastinal Tumors

“…Given the normal minimal sliding motion of mediastinal vessels, loss of sliding motion may be difficult to demonstrate when a tumor is involved, resulting in false-negative findings [28]. Also, the mass effect of large tumors reduces sliding motion and may lead to subsequent false-positive diagnoses of tumor involvement [5,36].…”

“…In addition, the absence of sliding motion between structures does not always imply invasion as it could also be a result of fibrous adhesion (Fig. 3) [28,36,37].…”

“…More importantly, cardiac-gated MRI, which is the gold standard for evaluating the pericardium [27] and heart, can provide dynamic imaging and assess the sliding motion of the tumor throughout the cardiac cycle. Preservation of the sliding motion during cine imaging has been reported to improve the accuracy of preoperative staging for predicting cardiovascular invasion of a thoracic mass [5,6,28] with an accuracy of 94.4%, as reported by Seo et al [5]. When sliding motion between the mediastinal mass, cardiac chambers, and proximal great vessels [ascending aorta and main pulmonary artery (MPA)] is preserved, it can imply the absence of invasion [5].…”