Korean J Radiol.  2010 Feb;11(1):37-45. 10.3348/kjr.2010.11.1.37.

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

• Lee CH
• Goo JM
• Kim YT
• Lee HJ
• Park CM
• Park EA
• Lee HY
• Kang MJ
• Song IC

• KMID: 1787012
• DOI: http://doi.org/10.3348/kjr.2010.11.1.37

Abstract

OBJECTIVE
We 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 METHODS
MR-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.
RESULTS
The 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).
CONCLUSION
The 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.

Keyword

Magnetic resonance (MR), motion studies; Lung, neoplasms

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung/*pathology
*Echo-Planar Imaging
Female
Humans
Lung Neoplasms/*pathology
Male
Mediastinum/*pathology
Middle Aged
Neoplasm Invasiveness
Predictive Value of Tests
Sensitivity and Specificity
Thoracic Wall/*pathology

Figure

• 

  Fig. 1 Positive sliding sign in 54-year-old man with lung cancer. A. On CT images, fat plane loss and wide contact with left ventricle and atrial appendage (arrows) were observed. B. Non-breath hold real-time MR-echo image showing sliding sign at left atrial appendage and left ventricle. Note high signal intensity of normal pericardial fluid (white arrows) between mass and left ventricle. No invasion of left atrial appendage or ventricle was observed.

• 

  Fig. 2 Positive sliding sign in 73-year-old man with lung cancer. A. On CT images, mass encased descending aorta over 90 degrees and mass obstructed left lower lobar bronchus (white arrows). B. Non-breath-hold real-time MR-echo image showing mass sliding upwards (white arrow) over descending aorta on expiration. Left lower lobectomy was performed and no aortic invasion by mass was found during subsequent pathologic examination.

• 

  Fig. 3 Positive sliding sign in 71-year-old man with lung cancer. A, B. On CT (A), and axial fast spin-echo MR (B) images show suspicious fat obliteration and wide contact (arrows) between mass and chest wall in lower lobe. C. Sagittal MR-echo examination inspiratory and expiratory images show sliding sign or movement over posterior chest wall (white arrows). Surgeon could be confident before operation that mass could be safely removed without en-bloc resection of chest wall. There was no invasion to parietal pleura or chest wall on pathologic examination after operation.

• 

  Fig. 4 Diagnostic confidence scores were assessed for two readers. For both readers, diagnostic confidence score was significantly higher for combined MR echo and static MR images than that for static MR images alone (Reader 1 and 2: p < 0.05).

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