Usefulness of magnetic resonance imaging for evaluation of cardiovascular invasion: Evaluation of sliding motion between thoracic mass and adjacent structures on cine MR images

Abstract

Purpose: To determine the feasibility and usefulness of magnetic resonance imaging (MRI) for evaluating cardiovascular invasion of a thoracic mass by demonstrating the sliding motion between the mass and adjacent structures. Materials and Methods:Twenty-six patients (17 males and nine females, mean age ϭ 49 years) were included in this study. They all had thoracic masses with equivocal cardiovascular invasion on chest CT scan and/or MRI that were surgically confirmed. The pathologic diagnoses were teratoma/thymic tumor (N ϭ 12), lung cancer (N ϭ 9), and other thoracic tumor (N ϭ 5). Conventional T1/T2, contrast-enhanced, and breathheld ECG-gated cine MRI using a steady-state free precession (SSFP) technique was performed. The results were compared to the surgical reports. Results:The cine MR images showed the presence of sliding motion in 39 structures in 20 patients, which were surgically confirmed as not being invaded, and 15 structures in six patients with the absence of sliding motion noted as tumor invasion. Therefore, the accuracy of the cine MR images was 94.4% (51/54) for evaluating cardiovascular invasion of a thoracic mass. Conclusion:MRI can provide additional information and improve the accuracy of preoperative staging for predicting cardiovascular invasion of a thoracic mass by evaluating the sliding motion.

MRI of the lung – state of the art

“…Several studies relying on contrast-enhanced MR angiography and cardiac-gated sequences could show advantages of MRI over MDCT in the assessment of cardiovascular or mediastinal invasion (17). Another simple method to assess mediastinal as well as thoracic wall infiltration constitutes the use of time-resolved steady state sequences acquired dynamically in free-breathing (18).…”

Comparison of conventional magnetic resonance imaging, cine-magnetic resonance imaging, and operation findings in invasion assessment of esophageal cancer

“…As indicated in several studies, separate movement between two adjacent area is demonstration of the absence of invasion with a specificity of 100%. [19,20] In a study, performed by Seo et al, [21] to assess the separate or together movement between cine-MRI with thoracic mass and adjacent structures, evaluation of direct invasion in thoracic mass on adjacent cardiovascular structures has yielded 94.4% accuracy, 100% sensitivity, and 92.9% specificity by showing separate movement between the adjacent structures and mass. Preoperative motion is obtained with cine-MRI similar to virtual mediastinoscopy or mediastinal ultrasound image.…”

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

“…With the advent of improved and faster MRI techniques, MRI may be an alternative or complementary modality in imaging of mediastinal tumors [5,[30][31][32][33]. However, due to its higher cost, increased scan time, and reduced availability compared to CT, MRI is not routinely used [5].…”

“…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].…”

“…Criteria for diagnosing local mediastinal invasion on CT include the extent or angle of the contact area between the thoracic mass and adjacent mediastinal structures and obliteration of intervening fat [5][6][7][8]. However, the sensitivity and specificity for assessing mediastinal invasion by non-cardiac-gated CT thorax imaging vary in the literature and largely depend on the study design and patient population [5]. The sensitivity for assessing mediastinal invasion by CT ranges from 20% to 84%, while the specificity ranges from 57% to 97% [7][8][9][10][11][12][13][14][15][16][17][18][19].…”