State-of-the-Art Lung MRI for Lung Nodule & Cancer Staging
Hidtake Yabuuchi1, Takeshi Kamitani1, Kouji Sagiyama1, Yuzo Yamasaki1, Tomoyuki Hida1, Takuya Hino1, and Kousei Ishigami1
1Kyushu University, Fukuoka, Japan

Synopsis

Keywords: Body: Lung

Lung MRI has been limited in clinical applications owing to its long scanning time and low signal-to-noise ratio. However, the clinical use of lung MRI for characterizing and staging cancer is increasing because of its superior tissue characterization and ability to perform without radiation exposure, including contrast-enhanced or dynamic breathing studies and diffusion-weighted images, in comparison to CT scans. I will review the role of lung MRI in the characterization of solitary pulmonary nodules and the T, N, and M staging of lung cancer.

Abstract

Lung MRI has been limited in clinical applications owing to its long scanning time and low signal-to-noise ratio. However, the clinical use of lung MRI for characterizing and staging cancer is increasing because of its superior tissue characterization and ability to perform without radiation exposure, including contrast-enhanced or dynamic breathing studies and diffusion-weighted images, in comparison to CT scans1.
Dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), and chemical shift imaging are valuable for characterizing solitary pulmonary nodules (SPNs)2-4. Tuberculomas and hamartomas must be differentiated from lung cancer on CT scans; tuberculomas exhibit ring enhancement on DCE-MRI, while chemical shift imaging can detect a small amount of fat in hamartomas. This is particularly helpful for fatless hamartomas identified on CT scans5.
Lung MRI is also useful in T and N staging in primary lung cancer. For T staging, contrast-enhanced MRI or cine MRI using dynamic breathing techniques is indicated when determining whether it is T3 (invasion of the chest wall or pericardium) or T4 (invasion into the diaphragm, mediastinum, heart and major vessels, trachea, carina, esophagus, or spine) based on enhanced CT or FDG-PET/CT6. Contrast-enhanced MRI is superior in tissue characterization and is useful in the evaluation of chest wall or mediastinal invasion. Dynamic breathing MRI can obtain dynamic chest wall motion of both the lung tumor and chest wall, mediastinum, and great vessels. When we can confirm the separate motion of the lung tumor and chest wall or mediastinum, direct invasion into the mediastinum or mediastinum can be ruled out7.
There have been many studies on the utility of lung MRI for N-staging of lung cancer. Ohno et al. reported that STIR demonstrated superior diagnostic value than FDG-PET/CT and DWI showed comparable value to FDG-PET/CT in N-staging8. Three previous meta-analyses on MRI have shown that DWI demonstrates equal or even superior diagnostic value for N-staging compared with FDG-PET/CT, and those studies showed pooled sensitivity/specificity per patient of 68％/92％, 87％/88％, and 72％/97％, respectively9-11. Shen et. al. reported that the pooled sensitivity and specificity were 72％/97％ for DWI and 65%/93% for FDG-PET/CT, although there was no significant difference11.
Contrast-enhanced CT, contrast-enhanced brain MRI, bone scintigraphy, and FDG-PET/CT are the gold standards for M staging in primary lung cancer; however, there have been several promising reports on whole-body MRI such as STIR-FACE, DWIBS, and PET-MRI for M-staging12-15. Medeiros et al. reported a meta-analysis based on four studies that showed pooled sensitivity and specificity of 92％ and 93％ for whole-body MRI, 78% and 91% for whole-body DWI, and 83% and 93% for FDG-PET/CT, respectively, and there were no statistical differences between the diagnostic odds ratio of whole-body MRI and DWI and that of PET/CT16.
In this educational lecture, I will review the role of lung MRI in the characterization of solitary pulmonary nodules and the T, N, and M staging of lung cancer.

Acknowledgements

All authors have no grant supporting and no conflict of interests in the submission of this manuscript.

References

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11) Shen G, et al. Comparison of 18F-FDG PET/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer：a meta-analysis. PLoS One 2017; 12:e0173104

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16) Medeiros TM, et al. 18F-FDG PET/CT and whole-body MRI diagnostic performance in M staging for non-small cell lung cancer: A systematic review and meta-analysis. Eur Radiol 2020; 30:3641–3649.


Figures

40’s female with atypical carcinoid tumor in the right upper lobe. DCE-MRIs (a-d) show a circumscribed nodule with rapid enhancement in the early phase and washout in the late phase.

Contrast-enhanced CT (a) shows a tumor widely in contact with right 10th rib (arrow), but no destruction. Cine MRI (b, c) under deep breathing reveal that the tumor moves separately from the right 10th rib (arrow) in chest wall. Therefore, we can determine that there is no chest wall invasion.

Contrast-enhanced CT (a) shows a tumor with bone destruction in the first and second ribs.The patient complained numbness of the right upper limb, and high-resolution fat-suppressed T2-weighted images (b, c) with partial MIP show brachial plexus invasion at a level higher than C8, and the T-factor is judged as T4.

70’s male with primary lung ca. (Ad, T1cN2M0, stage IIIA).Both STRI and DWI show high signal intensity in the right paratracheal lymph node, whereas FDG-PET/CT exhibits no high uptake of FDG in the right paratracheal lymph node. Histopathological examination of the surgical specimen reveals positive metastasis.

Proc. Intl. Soc. Mag. Reson. Med. 32 (2024)