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Over the past few decades, pulmonary imaging technologies have advanced from chest radiography and nuclear medicine methods to high-spatial-resolution or low-dose chest CT and MRI. It is currently possible to identify and measure pulmonary pathologic changes before these are obvious even to patients or depicted on conventional morphologic images. Here, key technological advances are described, including multiparametric CT image processing methods, inhaled hyperpolarized and fluorinated gas MRI, and four-dimensional free-breathing CT and MRI methods to measure regional ventilation, perfusion, gas exchange, and biomechanics. The basic anatomic and physiologic underpinnings of these pulmonary functional imaging techniques are explained. In addition, advances in image analysis and computational and artificial intelligence (machine learning) methods pertinent to functional lung imaging are discussed. The clinical applications of pulmonary functional imaging, including both the opportunities and challenges for clinical translation and deployment, will be discussed in part 2 of this review. Given the technical advances in these sophisticated imaging methods and the wealth of information they can provide, it is anticipated that pulmonary functional imaging will be increasingly used in the care of patients with lung disease. © RSNA, 2021 Online supplemental material is available for this article.

Pulmonary MRI provides structural and quantitative functional images of the lungs without ionizing radiation, but it has had limited clinical use due to low signal intensity from the lung parenchyma. The lack of radiation makes pulmonary MRI an ideal modality for pediatric examinations, pregnant women, and patients requiring serial and longitudinal follow-up. Fortunately, recent MRI techniques, including ultrashort echo time and zero echo time, are expanding clinical opportunities for pulmonary MRI. With the use of multicoil parallel acquisitions and acceleration methods, these techniques make pulmonary MRI practical for evaluating lung parenchymal and pulmonary vascular diseases. The purpose of this Fleischner Society position paper is to familiarize radiologists and other interested clinicians with these advances in pulmonary MRI and to stratify the Society recommendations for the clinical use of pulmonary MRI into three categories: (a) suggested for current clinical use, (b) promising but requiring further validation or regulatory approval, and (c) appropriate for research investigations. This position paper also provides recommendations for vendors and infrastructure, identifies methods for hypothesis-driven research, and suggests opportunities for prospective, randomized multicenter trials to investigate and validate lung MRI methods., (© RSNA, 2020.)

Since the clinical introduction of magnetic resonance imaging (MRI), the chest has been one of its most challenging applications, and many physicists and radiologists have tried since the 1980s to use MR for assessment of different lung diseases as well as mediastinal and pleural diseases. Since then, however, technical advances in sequencing, scanners, and coils, adaptation of parallel imaging techniques, utilization of contrast media, and development of postprocessing tools have been reported by many basic and clinical researchers. As a result, state-of-the-art thoracic MRI is now substituted for traditional imaging techniques and/or plays a complementary role in the management of patients with various chest diseases, and especially in the detection of pulmonary nodules and in thoracic oncology. In addition, MRI has continued to be developed to help overcome the limitations of computed tomography (CT) and nuclear medicine examinations. It can currently provide not only morphological, but also functional, physiological, pathophysiological, and molecular information at 1.5T with a gradual shift from 1.5T to 3T MR systems. In this review, we focus on these recent advances in MRI for pulmonary nodule detection and pulmonary nodule and mass evaluation by using noncontrast-enhanced and contrast-enhanced techniques as well as new molecular imaging methods such as chemical exchange saturation transfer imaging for a comparison with other modalities such as single or multidetector row CT, 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and/or PET/CT., Level of Evidence: 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1437-1458., (© 2018 International Society for Magnetic Resonance in Medicine.)

Objective: Pulmonary mucormycosis is an aggressive opportunistic fungal infection. We set out to evaluate the CT and MRI features of pulmonary mucormycosis., Materials and Methods: Through a search of the electronic medical record from 2007 to 2017, we identified 30 patients with definite or probable mucormycosis. Two radiologists reviewed the initial chest CT examinations for the presence of features including the "reverse halo" sign, large ground-glass halo, and peripheral lesion distribution. Additional CT and MRI studies were reviewed to evaluate evolution over time., Results: The majority (67%) of patients had lesions with the reverse halo sign at some point in the disease course. A ground-glass halo larger than the lesion was seen in 53% of patients. Notably, lesions had a peripheral predominance in 87% of cases. Through careful review of images, a perivascular ground-glass precursor lesion was identified in 20% of patients 1-2 weeks before a consolidation developed. In five (17%) patients, CT showed a multifocal pneumonia appearance. Finally, MRI of two patients showed T2-hypointense rims and central nonenhancement, a finding we refer to as the "black hole" sign., Conclusion: Large nodules or consolidations with an associated reverse halo sign or large perilesional ground-glass halos are common in mucormycosis. Lesions tend to show a peripheral predominance, and a perivascular ground-glass focus preceded nodular lesions in some cases. In some patients with severe disease, imaging features evolved to show a multifocal pneumonia pattern, and this pattern was associated with a high mortality rate.

While the inauguration of national low dose computed tomographic (LDCT) lung cancer screening programs has started in the USA, other countries remain undecided, awaiting the results of ongoing trials. The continuous technical development achieved by stronger gradients, parallel imaging and shorter echo time has made lung magnetic resonance imaging (MRI) an interesting alternative to CT. For the detection of solid lesions with lung MRI, experimental and clinical studies have shown a threshold size of 3-4mm for nodules, with detection rates of 60-90% for lesions of 5-8mm and close to 100% for lesions of 8mm or larger. From experimental work, the sensitivity for infiltrative, non-solid lesions would be expected to be similarly high as that for solid lesions, but the published data for the MRI detection of lepidic growth type adenocarcinoma is sparse. Moreover, biological features such as a longer T2 time of lung cancer tissue, tissue compliance and a more rapid uptake of contrast material compared to granulomatous diseases, in principle should allow for the multi-parametric characterization of lung pathology. Experience with the clinical use of lung MRI is growing. There are now standardized protocols which are easy to implement on current scanner hardware configurations. The image quality has become more robust and currently ongoing studies will help to further contribute experience with multi-center, multi-vendor and multi-platform implementation of this technology. All of the required prerequisites have now been achieved to allow for a dedicated prospective large scale MRI based lung cancer screening trial to investigate the outcomes from using MRI rather than CT for lung cancer screening. This is driven by the hypothesis that MRI would reach a similarly high sensitivity for the detection of early lung cancer with fewer false positive exams (better specificity) than LDCT. The purpose of this review article is to discuss the potential role of lung MRI for the early detection of lung cancer from a technical point of view and to discuss a few of the possible scenarios for lung cancer screening implementation using this imaging modality. There is little doubt that MRI could play a significant role in lung cancer screening, but how and when will depend on the threshold needed for positive screens (e.g. lesion volume and required diagnostic accuracy), cost-effectiveness and improved patient outcomes from a reduction in the need to follow up benign nodules. Potential applications range from lung MRI as the first choice screening modality to the role of an ad hoc on site test for the detailed evaluation of a subgroup of positive screening results., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

The invention of hyperpolarized (HP) noble gas MRI using helium-3 ((3)He) or xenon-129 ((129)Xe) has provided a new method to evaluate lung function. Using HP (3)He or (129)Xe for inhalation into the lung air spaces as an MRI contrast agent significantly increases MR signal and makes pulmonary ventilation imaging feasible. This review focuses on important aspects of pulmonary HP noble gas MRI, including the following: (1) functional imaging types, (2) applications for major pulmonary diseases, (3) safety considerations, and (4) future directions. Although it is still challenging to use pulmonary HP noble gas MRI clinically, the technology offers promise for the investigation of the microstructure and function of the lungs., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

The purpose of this study is to evaluate perfusion indices and pharmacokinetic parameters in solitary pulmonary nodules (SPNs). Thirty patients of 34 enrolled with SPNs (15-30 mm) were evaluated in this study. T1 and T2-weighted structural images and 2D turbo FLASH perfusion images were acquired with shallow free breathing. B-spline nonrigid image registration and optimization by χ² test against pharmacokinetic model curve were performed on dynamic contrast-enhanced MRI. This allowed voxel-by-voxel calculation of k(ep) , the rate constant for tracer transport to and from plasma and the extravascular extracellular space. Mean transit time, time-to-peak, initial slope, and maximum enhancement (E(max) ) were calculated from time-intensity curves fitted to a gamma variate function. After blinded data analysis, correlation with tissue histology from surgical resection or biopsy samples was performed. Histologic evaluation revealed 25 malignant and five benign SPNs. All benign SPNs had k(ep) < 1.0 min⁻¹. Nineteen of 25 (76%) malignant SPNs showed k(ep) > 1.0 min⁻¹. Sensitivity to diagnose malignant SPNs at a cutoff of k(ep) = 1.0 min⁻¹ was 76%, specificity was 100%, positive predictive value was 100%, negative predictive value was 45%, and accuracy was 80%. Of all indices studied, k(ep) was the most significant in differentiating malignant from benign SPNs., (Copyright © 2012 Wiley Periodicals, Inc.)

Rationale and Objectives: Quantitative measurement provides essential information about disease progression and treatment response in patients with glioblastoma multiforme (GBM). The goal of this article is to present and validate a software pipeline for semi-automatic GBM segmentation, called AFINITI (Assisted Follow-up in NeuroImaging of Therapeutic Intervention), using clinical data from GBM patients., Materials and Methods: Our software adopts the current state-of-the-art tumor segmentation algorithms and combines them into one clinically usable pipeline. Both the advantages of the traditional voxel-based and the deformable shape-based segmentation are embedded into the software pipeline. The former provides an automatic tumor segmentation scheme based on T1- and T2-weighted magnetic resonance (MR) brain data, and the latter refines the segmentation results with minimal manual input., Results: Twenty-six clinical MR brain images of GBM patients were processed and compared with manual results. The results can be visualized using the embedded graphic user interface., Conclusion: Validation results using clinical GBM data showed high correlation between the AFINITI results and manual annotation. Compared to the voxel-wise segmentation, AFINITI yielded more accurate results in segmenting the enhanced GBM from multimodality MR imaging data. The proposed pipeline could be used as additional information to interpret MR brain images in neuroradiology., (Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.)

Purpose: To investigates the impact of nonrigid motion correction on pixel-wise pharmacokinetic analysis of free-breathing DCE-MRI in patients with solitary pulmonary nodules (SPNs). Misalignment of focal lesions due to respiratory motion in free-breathing dynamic contrast-enhanced MRI (DCE-MRI) precludes obtaining reliable time-intensity curves, which are crucial for pharmacokinetic analysis for tissue characterization., Materials and Methods: Single-slice 2D DCE-MRI was obtained in 15 patients. Misalignments of SPNs were corrected using nonrigid B-spline image registration. Pixel-wise pharmacokinetic parameters K(trans) , v(e) , and k(ep) were estimated from both original and motion-corrected DCE-MRI by fitting the two-compartment pharmacokinetic model to the time-intensity curve obtained in each pixel. The "goodness-of-fit" was tested with χ(2) -test in pixel-by-pixel basis to evaluate the reliability of the parameters. The percentages of reliable pixels within the SPNs were compared between the original and motion-corrected DCE-MRI. In addition, the parameters obtained from benign and malignant SPNs were compared., Results: The percentage of reliable pixels in the motion-corrected DCE-MRI was significantly larger than the original DCE-MRI (P = 4 × 10(-7) ). Both K(trans) and k(ep) derived from the motion-corrected DCE-MRI showed significant differences between benign and malignant SPNs (P = 0.024, 0.015)., Conclusion: The study demonstrated the impact of nonrigid motion correction technique on pixel-wise pharmacokinetic analysis of free-breathing DCE-MRI in SPNs., (Copyright © 2011 Wiley-Liss, Inc.)

Rationales and Objectives: Pulmonary hypertension (PH) is a life-threatening condition, characterized by elevated pulmonary arterial pressure, which is confirmed based on invasive right heart catheterization (RHC). Noninvasive examinations may support diagnosis of PH before proceeding to RHC and play an important role in management and treatment of the disease. Although echocardiography is considered a standard tool in diagnosis, recent advances have made computed tomography (CT) and magnetic resonance (MR) imaging promising tools, which may provide morphologic and functional information. In this article, we review image-based assessment of PH with a focus on CT and MR imaging., Conclusions: CT may provide useful morphologic information for depicting PH and seeking for underlying diseases. With the accumulated technological advancement, CT and MRI may provide practical tools for not only morphologic but also functional assessment of patients with PH., (Copyright © 2011 AUR. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the capability of diffusion-weighted (DW) and contrast material-enhanced magnetic resonance (MR) imaging to provide diagnostic information on residual breast cancers following neoadjuvant chemotherapy and to assess apparent diffusion coefficients (ADCs) of the carcinoma prior to neoadjuvant chemotherapy to determine if the method could help predict response to chemotherapy., Materials and Methods: Institutional review board approval and informed consent were obtained. Three hundred ninety-eight patients underwent MR imaging of the breast, including DW MR (b values, 0 and 1500 sec/mm(2)) and contrast-enhanced MR imaging. Of these, the contralateral breast in 73 women was used as a control. Seventy-two patients with 73 lesions with malignant disease were treated by using neoadjuvant chemotherapy and were examined for residual disease following therapy. Three were excluded because of prolonged intervals between final MR imaging and surgery. Thus, 69 patients (70 lesions) with DW and contrast-enhanced MR imaging results were compared with postoperative histopathologic findings. The ADCs of the carcinoma prior to neoadjuvant chemotherapy were calculated for each patient, and those with complete response and residual disease were compared., Results: The accuracy for depicting residual tumor was 96% for DW MR imaging, compared with an accuracy of 89% for contrast-enhanced MR imaging (P = .06). There was no significant difference in prechemotherapy ADCs between pathologic complete response cases and those with residual disease., Conclusion: DW MR imaging had at least as good of accuracy as did contrast-enhanced MR imaging for monitoring neoadjuvant chemotherapy. The ADCs prior to chemotherapy did not predict response to chemotherapy. The use of DW imaging to visualize residual breast cancer without the need for contrast medium could be advantageous in women with impaired renal function., ((c) RSNA, 2010)

Hyperpolarized gas magnetic resonance imaging has been explored extensively as a promising tool for the quantitative evaluation of regional pulmonary pathophysiology. This noninvasive technique is capable of providing both structural information down to the level of the alveolar microstructure and functional information, such as dynamic ventilation, intrapulmonary partial pressure of oxygen, and alveolar surface area. This study reviews the role of hyperpolarized 3-helium and 129-xenon magnetic resonance imaging in this research.

Malignant pleural mesothelioma (MPM) is an aggressive pleural tumor with a complex growth pattern. Imaging plays a crucial role in diagnosis and management. Computed tomography (CT) has been the mainstay in the clinical evaluation of MPM; however it underestimates early chest wall invasion, peritoneal involvement, and has well-known limitations in nodal metastatic evaluation. Perfusion CT can evaluate the microvasculature of tumors; however its disadvantages, such as high radiation exposure and side effects from iodinated contrast, have limited its use to research settings. Magnetic resonance imaging (MRI) is superior to CT, both in the differentiation of malignant from benign pleural disease and in the assessment of chest wall and diaphragmatic involvement. Perfusion and diffusion MRI are promising new techniques for the assessment of tumor cellularity and microvasculature and can be used for quantitative and qualitative assessment of treatment response. Fluorodeoxyglucose positron emission tomography (FDG-PET) is useful for the differentiation of benign from malignant lesions, for staging, and for monitoring response to therapy. PET-CT is superior to other imaging modalities in detecting more extensive disease involvement and identifying unsuspected occult distant metastases. This review focuses on the practical aspects of the radiological assessment of MPM, highlighting the role of the radiologist in preoperative and postoperative evaluation with a multimodality approach.

Objective: To prospectively investigate the number, location, and size of ventilation defects and correlate these findings with pulmonary function tests (PFTs) when performing hyperpolarized helium-3 (HP 3He) magnetic resonance imaging (MRI) of the lung in healthy young adults., Materials and Methods: Six healthy adult female volunteers underwent standard PFT and MRI of the lungs after inhalation of HP 3He. HP 3He MR images were evaluated by 4 reviewers in consensus. Number, location, and size of ventilation defects were recorded. Locations of ventilation defects included the right upper lobe, right middle lobe, right lower lobe, left upper lobe, left lower lobe, and lingula. Ventilation defects were localized into central, middle, or peripheral portions of the lungs. Size of ventilation defects was categorized with a maximum diameter of either 3 cm. HP 3He MRI findings were correlated with PFT results., Results: The study cohort comprised 6 healthy, young adult female volunteers (mean age 22.5 y, range: 20-25 y) who underwent both PFT and HP 3He MRI. Five (83.3%) out of 6 volunteers had at least 1 ventilation defect (mean=2.3; range: 1-4; 95% confidence interval: 1.3-3.8 defects/patient). Among a total of 14 ventilation defects observed from 5 healthy, young adult volunteers, ventilation defects were observed in left lower lobe in 6 (42.9%), right lower lobe in 3 (21.4%), right upper lobe in 3 (21.4%), and left upper lobe in 2 (14.3%) patients. No ventilation defects were observed in the right middle lobe and lingula. All observed ventilation defects were less than 3 cm in size and peripherally located. There was no correlation between number, location, or size of ventilation defects and PFT results., Conclusions: Small (upper lobes) while sparing right middle lobe and lingula. The number, location, and size of ventilation defects on HP 3He MRI were not correlated with PFT results in the normal range, which suggests HP 3He MRI may be more sensitive than PFT for evaluating small ventilation defects in young adults.

Rationale and Objectives: The authors present their initial experience using a 3-T whole-body scanner equipped with a 128-channel coil applied to lung motion assessment. Recent improvements in fast magnetic resonance imaging (MRI) technology have enabled several trials of free-breathing three-dimensional (3D) imaging of the lung. A large number of image frames necessarily increases the difficulty of image analysis and therefore warrants automatic image processing. However, the intensity homogeneities of images of prior dynamic 3D lung MRI studies have been insufficient to use such methods. In this study, initial data were obtained at 3 T with a 128-channel coil that demonstrate the feasibility of acquiring multiple sets of 3D pulmonary scans during free breathing and that have sufficient quality to be amenable to automatic segmentation., Materials and Methods: Dynamic 3D images of the lungs of two volunteers were acquired with acquisition times of 0.62 to 0.76 frames/s and an image matrix of 128 x 128, with 24 to 30 slice encodings. The volunteers were instructed to take shallow and deep breaths during the scans. The variation of lung volume was measured from the segmented images., Results: Dynamic 3D images were successfully acquired for both respiratory conditions for each subject. The images showed whole-lung motion, including lifting of the chest wall and the displacement of the diaphragm, with sufficient contrast to distinguish these structures from adjacent tissues. The average time to complete segmentation for one 3D image was 4.8 seconds. The tidal volume measured was consistent with known tidal volumes for healthy subjects performing deep-breathing maneuvers. The temporal resolution was insufficient to measure tidal volumes for shallow breathing., Conclusion: This initial experience with a 3-T whole-body scanner and a 128-channel coil showed that the scanner and imaging protocol provided dynamic 3D images with spatial and temporal resolution sufficient to delineate the diaphragmatic domes and chest wall during active breathing. In addition, the intensity homogeneities and signal-to-noise ratio were adequate to perform automatic segmentation.

MR imaging serves as a problem-solving tool in the diagnosis of inflammatory and infectious pleural diseases and primary and secondary pleural malignancies. Knowledge of MR imaging appearance of pleural diseases, including pleural effusions and empyema, benign and malignant pleural tumors, and especially mesothelioma, helps guide treatment decisions and surgical planning.

Recent development of MR techniques has overcome many problems, such as susceptibility artifacts or motion artifact, allowing both static and dynamic MR lung imaging and providing quantitative information of pulmonary function, including perfusion, ventilation, and respiratory motion. Dynamic contrast-enhanced MR perfusion imaging is suitable for the evaluation of angiogenesis of pulmonary solitary nodules. (129)Xe MR imaging is potentially a robust technique for the evaluation of various pulmonary function and may replace (3)He. The information provided by these new MR imaging methods is proving useful in research and in clinical applications in various lung diseases.

Purpose: To test the feasibility of a method to quantify regional pulmonary parenchymal motion via nonrigid registration algorithm at small animal scales., Materials and Methods: Voxel-wise displacement vector field maps were generated between end-inspiratory and end-expiratory coronal thoracic MR images on normal mice (N = 5) to analyze the magnitude and direction of parenchymal motion in the segmented regions. The analysis was repeated before and after short-term exposure to hypoxia to demonstrate the effect of hypoxia on the respiratory motion in transgenic (Tg) mice with sickle cell disease (SCD) (N = 4)., Results: Normal mice revealed that the right and left lungs moved symmetrically but that there was greater movement in the lower regions than in the upper regions. Calculated strain was uniform in the entire lung. In the Tg mice, the pulmonary motion before hypoxia was similar to that observed in the normal mice. Upon exposure to hypoxia, the displacement magnitude reduced and the direction of motion in some areas became distorted., Conclusion: MR quantification of pulmonary motion was feasible in mice and the principle that the method could detect mechanical abnormalities due to pathologic changes was proven. Quantification of pulmonary motion has the potential to lead to earlier disease diagnosis and better monitoring of disease treatments.

Understanding how the mammalian respiratory system works and how it changes in disease states and under the influence of drugs is frequently pursued in model systems such as small rodents. These have many advantages, including being easily obtained in large numbers as purebred strains. Studies in small rodents are valuable for proof of concept studies and for increasing our knowledge about disease mechanisms. Since the recent developments in the generation of genetically designed animal models of disease, one needs the ability to assess morphology and function in in vivo systems. In this article, we first review previous reports regarding thoracic imaging. We then discuss approaches to take in making use of small rodents to increase MR microscopic sensitivity for these studies and to establish MR methods for clinically relevant lung imaging.

The majority of researchers investigating hyperpolarized gas MRI as a candidate functional lung imaging modality have used (3)He as their imaging agent of choice rather than (129)Xe. This preference has been predominantly due to, (3)He providing stronger signals due to higher levels of polarization and higher gyromagnetic ratio, as well as its being easily available to more researchers due to availability of polarizers (USA) or ease of gas transport (Europe). Most researchers agree, however, that hyperpolarized (129)Xe will ultimately emerge as the imaging agent of choice due to its unlimited supply in nature and its falling cost. Our recent polarizer technology delivers vast improvements in hyperpolarized (129)Xe output. Using this polarizer, we have demonstrated the unique property of xenon to measure alveolar surface area noninvasively. In this article, we describe our human protocols and their safety, and our results for the measurement of the partial pressure of pulmonary oxygen (pO(2)) by observation of (129)Xe signal decay. We note that the measurement of pO(2) by observation of (129)Xe signal decay is more complex than that for (3)He because of an additional signal loss mechanism due to interphase diffusion of (129)Xe from alveolar gas spaces to septal tissue. This results in measurements of an equivalent pO(2) that accounts for both traditional T(1) decay from pO(2) and that from interphase diffusion. We also provide an update on new technological advancements that form the foundation for an improved compact design polarizer as well as improvements that provide another order-of-magnitude scale-up in xenon polarizer output.

The purpose of this study was to evaluate optimal breathing maneuvers that minimize lung parenchymal movement for dynamic contrast-enhanced MRI (DCE-MRI), which requires longer scan times, beyond the limit of a single breath hold. A healthy volunteer was scanned on a 3T MR scanner using two different breathing maneuvers. In the first, the healthy volunteer was instructed to hold his breath as much as possible and breathe in between breath holds while an image was obtained. In the second, the volunteer was instructed to breathe shallowly and freely throughout the scan. On the obtained images, the excursion of the highest point of the right diaphragm and the pulmonary vessel branches located in the four different anatomic regions of the lung were measured in two orthogonal planes. A patient with a solitary pulmonary nodule (SPN) underwent DCE-MRI utilizing a 2D spoiled gradient-echo (SPGR) sequence while the patient breathed shallowly and freely during the scan. The standard deviations of the excursion of the highest point and selected pulmonary vessels were much smaller during shallow, free breathing maneuver scans than those during breath hold maneuver scans. A dynamic perfusion-fitting curve of the SPN was obtained during the DCE-MRI using shallow free breathing. Shallow, free breathing allows smaller diaphragmatic cranial caudal and lung parenchymal displacements. Therefore, it can be useful during exams where targeting of the lesion is necessary, in studies with long scan times, such as dynamic MRI. This breathing maneuver makes it possible to analyze SPN with DCE-MRI while making use of the advantages of a higher magnetic field in conjunction.

Oxygen-enhanced MR imaging is a new technique, and its physiological significance has not yet been fully elucidated. This review article covers (1) the theory of oxygen enhancement and its relationship with respiratory physiology; (2) design for oxygen-enhanced MR imaging sequencing; (3) a basic study of oxygen-enhanced MR imaging in animal models and humans; (4) a clinical study of oxygen-enhanced MR imaging; and (5) a comparison of advantages and disadvantages of this technique with those of hyperpolarized noble gas MR ventilation imaging. Oxygen-enhanced MR imaging provides not only the ventilation-related, but also respiration-related information. Oxygen-enhanced MR imaging has the potential to replace nuclear medicine studies for the identification of regional pulmonary function, and many investigators are now attempting to adapt this technique for routine clinical studies. We believe that further basic studies as well as clinical applications of this new technique will define the real significance of oxygen-enhanced MR imaging for the future of pulmonary functional imaging and its usefulness for diagnostic radiology and pulmonary medicine.

Objective: The aim of this study was to clarify the relative contributions of the amount of oxygen in the blood, and vasoconstriction/dilation responsible for changes in T1 and T2 observed in brain during hyperoxia., Methods: T1 and T2 values of the cerebral cortex and pituitary gland in mice were determined in room air. After room air was changed to either 100% oxygen (n = 8) or carbogen (n = 8), T1 and T2 values were again determined. Changes in each value with both gases were compared., Results: In both challenges, T1 values of the cerebral cortex decreased, whereas significant T2 prolongation of the cerebral cortex and pituitary gland was demonstrated. However, both cortex and pituitary gland displayed similar responses in T1 and T2 values when exposed to 100% oxygen or carbogen., Conclusions: Reduction of T1 was introduced by the increased amount of dissolved oxygen in blood, and the increased fraction of oxyhemoglobin caused T2 prolongation. The contribution of vasoconstriction/dilation by carbogen to changes in T1 and T2 may be negligible.

Purpose: To determine the appropriate concentration for quantitative assessment of dynamic contrast-enhanced pulmonary MR imaging., Materials and Methods: A total of 40 consecutive patients with small bronchioalveolar carcinoma underwent perfusion single-photon emission tomography (SPECT) and three-dimensional (3D) dynamic MR imaging with a 3D radiofrequency spoiled gradient-echo sequence. In each patient, 5 mL of contrast media with 0.1, 0.3, and 0.5 mmol/mL were administered at a rate of 5 mL/second. All patients were divided into two groups (<70 kg and > or =70 kg) for assessment of appropriate concentration to quantitatively assess regional perfusion parameter in routine clinical practice. Pulmonary blood flow (PBF) in each protocol was calculated from a signal intensity (SI)-time course curve. Differences and limits of agreement of PBF between dynamic MR imaging (PBF(MR)) using three different concentrations and perfusion SPECT (PBF(SPECT)) were statistically compared in both patient groups., Results: PBF(MR) using 0.3 mmol/mL in the <70-kg group and 0.5 mmol/mL in the > or =70-kg group showed no significant difference compared with PBF(SPECT) (P > 0.05). Limits of agreements in 0.3 mmol/mL in the <70-kg group and 0.5 mmol/mL in the > or =70-kg group were smaller than those of the other concentrations and small enough for clinical purposes., Conclusion: Appropriate concentrations provide accurate and reproducible assessments of regional pulmonary perfusion parameters on 3D dynamic MR perfusion imaging. We suggest using 5 mL of contrast media with 0.3 mmol/mL for patients weighing less than 70 kg and 0.5 mmol/mL for patients weighing 70 kg or more.

Objective: The purpose of this study was to determine whether quantitative pulmonary perfusion parameters obtained from 3D dynamic contrast-enhanced MR perfusion data can be used to assess the severity of primary pulmonary hypertension (PPH) as indicated by pulmonary vascular resistance (PVR) and mean pulmonary artery pressure (MPAP)., Conclusion: Three-dimensional dynamic contrast-enhanced MRI has potential for assessment of disease severity as indicated by PVR and MPAP in patients with PPH.

The objectives of this study were to assess the relationship between right and left hemidiaphragmatic motions during breathing in normal subjects and to investigate alterations in lung motion with changes in posture, using dynamic magnetic resonance (MR) imaging. Imaging was conducted with a 1.5-T MR scanner using fast imaging employing steady-state acquisition with a torso coil. Eight healthy subjects were instructed to breathe from end-inspiration to end-expiration as slowly and as deeply as possible. Imaging and breathing were started together to afford sequential images on the coronal plane. Imaging sequences were performed in supine, prone, left lateral decubitus and right lateral decubitus postures. The component of movement of the most cephalic point in the cephalocaudal axis was measured, and the diaphragmatic excursion (maximum hemidiaphragmatic displacement), synchrony and velocity of the right and left hemidiaphragmatic motions were calculated during the expiratory phase and the inspiratory phase, respectively. Excursion was greater in the right hemidiaphragm in most postures, except the left lateral decubitus. In supine and prone postures, both hemidiaphragms moved synchronously in both inspiratory and expiratory phases. In both lateral decubitus postures, the hemidiaphragms moved asynchronously with different velocities in the expiratory phase but with the same velocities in the inspiratory phase. The method described here allowed the assessment of diaphragmatic motions. Motions in the right and left hemidiaphragms changed with posture. In addition, diaphragmatic motion differed between expiratory and inspiratory phases. This study suggests the further potential of dynamic MR imaging for the evaluation of pulmonary functions or deficiencies.

Purpose: To retrospectively determine the effect of gestational age (GA), imaging plane, section thickness, and inter- and intraobserver variability on fetal lung volume (FLV) measurements obtained with magnetic resonance (MR) imaging in a cohort of fetuses without thoracic abnormalities., Materials and Methods: Institutional review board approval was obtained. Informed consent for this retrospective cohort study was waived, and the conduct of this study was HIPAA compliant. FLV was measured in 30 fetuses (GA, 17-36 weeks) referred for MR imaging for indications other than pulmonary abnormalities. Measurements were made on single-shot fast spin-echo images by tracing free-form regions of interest on individual consecutive sections in the transverse, sagittal, and coronal planes. Measurements were performed twice by two observers independently. Correlations between FLV and GA, imaging plane, and section thickness were assessed, as were intra- and interobserver variability. Time to perform FLV was assessed in a subset of fetuses., Results: Total FLV ranged from 2 to 110 mL. Mixed-effects regression model showed significant quadratic trend in FLV with increasing GA, with comparable strength of correlation (r = 0.89-0.91) in the three imaging planes of measurement. Intraobserver agreement was good in all three planes (r = 0.65-0.83) and was highest in the transverse plane. Interobserver agreement was good in all three planes (r = 0.68-0.76). FLV showed no significant dependence on section thickness (P = .23) or imaging plane (P = .82). Mean time to obtain FLV measurements ranged from 48 seconds at GA of 21 weeks to 77 seconds at GA of 29-30 weeks., Conclusion: GA-based FLV measurements obtained with MR images are independent of section thickness and imaging plane and can be performed with good inter- and intraobserver agreement in less than 2 minutes., (RSNA, 2006)

Purpose: To prospectively determine if lung function as assessed with oxygen-enhanced magnetic resonance (MR) imaging correlates with postsurgical lung function in patients with lung cancer, as compared with quantitative and qualitative findings of computed tomography (CT) and scintigraphy., Materials and Methods: Study received institutional review board approval, and informed patient consent was obtained. Thirty consecutive patients (16 men and 14 women, aged 44-81 years; mean age, 65 years) considered candidates for lung resection underwent oxygen-enhanced MR imaging, CT, perfusion scintigraphy, and measurement of forced expiratory volume in 1 second (FEV1). A respiratory-synchronized inversion-recovery half-Fourier single-shot turbo spin-echo MR sequence was used for data acquisition. Correlation of postsurgical lung function (postsurgical FEV1) as determined with oxygen-enhanced MR imaging (FEV1MR), quantitative assessment with CT (FEV1Quant), qualitative assessment with CT (FEV1Qual), and perfusion scintigraphy (FEV1PS) was conducted with actual postsurgical FEV1, and the limits of agreement of each were determined with Bland-Altman analysis., Results: Correlation between postsurgical FEV1MR and actual postsurgical FEV1 values was excellent (r2= 0.81, P < .001); it was better than that of FEV1Qual (r2= 0.76) and FEV1PS (r2= 0.77) and similar to that of FEV1Quant (r2= 0.81) values. The limits of agreement of FEV1MR were between -9.9% and 10.9%., Conclusion: Oxygen-enhanced MR imaging can be used to predict posturgical lung function in patients with lung cancer, similar to quantitative CT.

Purpose: To determine the prognostic value of dynamic MRI for non-small-cell lung cancer (NSCLC) patients after chemoradiotherapy., Materials and Methods: A total of 114 consecutive patients with NSCLC underwent dynamic MRI after chemoradiotherapy. The patients were divided into two groups (local control (n=22) and local failure (n=92)) according to the presence of local recurrence. From the signal intensity-time course curve in each subject, the maximum relative enhancement ratio and slope of enhancement were calculated, and compared between two groups by Student's t-test. To determine the feasible threshold values of both MR indexes for group differentiation, ROC-based positive tests were performed. Finally, the Kaplan-Meier survival curves of each group divided by the adapted threshold value were compared by log-rank test., Results: The maximum relative enhancement ratio and the slope of enhancement in the local control group were significantly lower than those in the local failure group (P<0.05). Using 0.08/sec as the threshold value of the slope of enhancement, the sensitivity and specificity for differentiation between the two groups were 90.9% and 91.3%, respectively. When the slope of enhancement was adopted for estimation of prognosis after therapy, the mean survival period of the slope of enhancement0.08/sec (P<0.0001)., Conclusion: Dynamic MRI has potential prognostic value for NSCLC patients after chemoradiotherapy., (Copyright (c) 2005 Wiley-Liss, Inc.)

The purpose of this study is to demonstrate the feasibility of kinematic MR imaging in visualizing peristaltic activity in the reconstructed gastrointestinal tract with quantitative measurements. Sixteen patients with gastrointestinal reconstruction were studied with kinematic MR imaging using HASTE and/or true FISP. Peristaltic waves were noted in the retrosternal gastric segment after gastric pull through (frequency = 3.0 +/- 0.5 times/min, velocity = 2.6 +/- 0.6 mm/s) and in the residual antrum after cardiectomy (frequency = 3 times/min, velocity = 4.0 mm/s). Peristaltic waves were not apparent in the residual fundus after distal gastrectomy and in the reconstructed jejunum after pancreatoduodenectomy and gastrojejunostomy.

Purpose: The purpose of the study presented here was to determine the improvement in image quality of oxygen-enhanced magnetic resonance (MR) subtraction imaging obtained with a centrically reordered inversion recovery half-Fourier single-shot turbo spin-echo (c-IR-HASTE) sequence compared with that obtained with a conventional sequentially reordered inversion recovery single-shot HASTE (s-IR-HASTE) sequence for pulmonary imaging., Materials and Methods: Oxygen-enhanced MR imaging using a 1.5 T whole body scanner was performed on 12 healthy, non-smoking volunteers. Oxygen-enhanced MR images were obtained with the coronal two-dimensional (2D) c-IR-HASTE sequence and 2D s-IR-HASTE sequence combined with respiratory triggering. For a 256x256 matrix, 132 phase-encoding steps were acquired including four steps for phase correction. Inter-echo spacing for each sequence was 4.0 ms. The effective echo time (TE) for c-IR-HASTE was 4.0 ms, and 16 ms for s-IR-HASTE. The inversion time (TI) was 900 ms. To determine the improvement in oxygen-enhanced MR subtraction imaging by c-IR-HASTE, CNRs of subtraction image, overall image quality, and image degradation of the c-IR-HASTE and s-IR-HASTE techniques were statistically compared., Results: CNR, overall image quality, and image degradation of c-IR-HASTE images showed significant improvement compared to those s-IR-HASTE images (P<0.05)., Conclusion: Centrically reordered inversion recovery half-Fourier single-shot turbo spin-echo (c-IR-HASTE) sequence enhanced the signal from the lung and improved the image quality of oxygen-enhanced MR subtraction imaging.

Purpose: To determine the utility of dynamic magnetic resonance imaging (MRI) in the differential subtyping of small adenocarcinomas of the lung., Materials and Methods: Twenty-nine pathologically diagnosed peripheral adenocarcinomas (less than 20 mm in diameter) underwent dynamic contrast-enhanced MRI. Maximum relative enhancement ratio, slope of enhancement, and corrected start time of enhancement were calculated from signal intensity-time curve of pulmonary lesion for each subject, and were statistically compared among bronchioloalveolar carcinoma (BAC) group (7 cases), mixed BAC group (10 cases), and adenocarcinoma group (12 cases)., Results: Maximum relative enhancement ratio (P<0.001) and slope of enhancement (P<0.001) of BAC group were significantly higher than those of mixed BAC and adenocarcinoma groups. Start times of BAC group were significantly earlier than those of mixed BAC (P=0.0001) and adenocarcinoma groups (P<0.0001). Adapting the thresholds values of MR indexes from the positive tests, sensitivity, specificity, positive predictive value, negative predictive value and accuracy for differentiating BAC from other subtypes were 85.7, 100.0, 100.0, 95.7, and 96.6%, respectively., Conclusions: Dynamic MRI is useful for differentiating subtypes of small peripheral adenocarcinoma.

Pulmonary blood flow is one of the primary determinants of gas exchange. While a number of methods can be used to evaluation pulmonary perfusion, these have substantial limitations. In this paper, we discuss the use of magnetic resonance imaging techniques for the evaluation of pulmonary blood flow. While these methods are not commonly used at present, they have the potential to contribute greatly to the evaluation of suspected pulmonary vascular disease.

Purpose: To assess regional differences in quantitative pulmonary perfusion parameters, i.e., pulmonary blood flow (PBF), mean transit time (MTT), and pulmonary blood volume (PBV) in the entire lung on a pixel-by-pixel basis in normal volunteers and pulmonary hypertension patients., Materials and Methods: Three-dimensional ultrafast dynamic contrast-enhanced MR imaging was performed in 15 normal volunteers and 25 patients with pulmonary hypertension. From the signal intensity-time course curves, PBF, MTT and PBV maps were generated using deconvolution analysis, indicator dilution theories, and the central volume principle, on a pixel-by-pixel basis. From pulmonary perfusion parameter maps of normal volunteers and pulmonary hypertension patients, regional PBF, MTT, and PBV were statistically evaluated., Results: Regional PBF, MTT, and PBV showed significant differences in the gravitational and isogravitational directions (P < 0.05). The quantitative pulmonary perfusion parameter maps demonstrated significant differences between normal volunteers and pulmonary hypertension patients (P < 0.05)., Conclusion: Three-dimensional ultrafast dynamic contrast-enhanced MR imaging is feasible for the assessment of regional quantitative pulmonary perfusion parameters in the entire lung on a pixel-by-pixel basis in normal volunteers and pulmonary hypertension patients., (Copyright 2004 Wiley-Liss, Inc.)

Purpose: To improve the image quality of pulmonary magnetic resonance (MR) imaging using an ultra-short inter-echo spacing half-Fourier single shot rapid acquisition with relaxation enhancement (USHA-RARE) sequence., Materials and Methods: Pulmonary MR images were acquired by USHA-RARE sequence with various inter-echo spacings. The sequence parameters were as follows: repetition time (TR)/effective TE: infinite/39-41 msec; section thickness: 10 mm; acquisition matrix: 128 x 128; field of view: 450 x 450 mm. Inter-echo spacing varied (2.5 msec, 3.0 msec, 3.5 msec, 4.0 msec, 4.5 msec, 5.0 msec), and the respective phase-encoding steps were 80, 77, 75, 74, 73, and 72. Signal-to-noise ratios (SNRs), the signal ratios between lung and fat (lung-to-fat ratio: LFRs), and the signal ratios between the lung and the serratus anterior muscle (lung-to-muscle ratio: LMRs) of each inter-echo spacing were calculated, and statistically evaluated., Results: The SNRs at inter-echo spacings of < or = 3.0 msec were significantly higher than those > or = 4.0 msec (P < 0.05). The LFRs and LMRs at inter-echo spacing < or = 3.0 msec were significantly higher than those > or = 4.0 msec (P < 0.05)., Conclusion: USHA-RARE sequence does improve signal intensity from the lung., (Copyright 2004 Wiley-Liss, Inc.)

Purpose: To evaluate short inversion time inversion-recovery (STIR) turbo spin-echo (TSE) magnetic resonance (MR) imaging for detection of metastases in lymph nodes by using quantitative and qualitative analyses., Materials and Methods: One hundred ten patients (68 men and 42 women) with non-small cell lung cancer who ranged in age from 36 to 82 years (mean age, 64 years) were examined with respiratory-triggered STIR TSE MR imaging. Ratios of signal intensity in a lymph node to that in a 0.9% saline phantom (lymph node-saline ratios [LSRs]) for all lymph nodes were classified into three groups according to nodal short-axis diameter. LSRs of each group were compared by using pathologic diagnosis as the standard of reference. For quantitative analysis, the LSR threshold value for a positive test was determined on a per-node basis and tested for ability to enable a correct diagnosis on a per-patient basis. For qualitative analysis, signal intensities of lymph nodes were assessed by using a five-point visual scoring system. Results of quantitative and qualitative analyses were compared on a per-patient basis with McNemar testing., Results: In 110 patients, 92 of 802 lymph nodes were pathologically diagnosed as containing metastases, while 710 lymph nodes did not contain metastases. Mean LSR in the lymph node group with metastasis was higher than that in the group without metastasis (P <.05). When an LSR of 0.6 was used as the positive-test threshold at quantitative analysis, sensitivity was 93% (37 of 40 patients) and specificity was 87% (61 of 70 patients) on a per-patient basis. With a score of 4 as the positive-test threshold at qualitative analysis, sensitivity was 88% (35 of 40 patients) and specificity was 86% (60 of 70 patients) on a per-patient basis. There was no significant difference (P >.05) between results of quantitative and those of qualitative analysis., Conclusion: Quantitative and qualitative analyses of STIR TSE MR images enable differentiation of lymph nodes with metastasis from those without. Qualitative analysis can substitute for quantitative analysis of STIR TSE MR imaging data., (Copyright RSNA, 2004)

Whole-body magnetic resonance (MR) scanners at high field strengths (> or =3 T) have been introduced in expectation of a larger signal-to-noise ratio (SNR), which would decrease the length of scan time or improve the spatial resolution. In this paper, the advantages and disadvantages of the high field MR imaging are discussed. Although the building of the radio frequency (RF) coil, safety and the specific absorption rate (SAR) are issues, the application of high field MR imaging is promising. The optimization of all parameters including injection rate of Gd-DTPA is necessary for high field MR imaging to obtain maximal results; however, we hope that high field MR imaging can be used in routine clinical applications in the future.

Rationale and Objectives: The purpose of this study was to demonstrate the construction of voxelwise ventilation-perfusion (V/Q) ratio maps in a porcine model by nonrigidly aligning the respective ventilation and perfusion images using a multimodality registration algorithm., Materials and Methods: The first-pass contrast agent technique for a blood flow map and 3He used for ventilation imaging were performed using a normal porcine model. The registered 3He-ventilation image was then aligned to the blood flow map using a multimodality registration algorithm. The voxelwise V/Q ratios were calculated by dividing the registered 3He-ventilation image by the blood flow map. The V/Q ratios were also semi-logarithmically scatter-plotted against the number of voxels., Results: From perfusion magnetic resonance images, a voxel-by-voxel blood flow map was produced. Registered 3He ventilation image was successfully obtained as well as V/Q ratio map. Plots of the V/Q ratios obtained by this registration approach were similar to the logarithmic normal distribution., Conclusion: Registration of MR perfusion and ventilation images can potentially enable quantitative evaluation of regional pulmonary function and thus yield deeper insight into the physiology and pathophysiology of the lung.

Rationale and Objectives: The aim of this study was to investigate a method for quantifying lung motion from the registration of successive images in serial magnetic resonance imaging acquisitions during normal respiration., Materials and Methods: Estimates of pulmonary motion were obtained by summing the normalized cross-correlation over serially acquired lung images to identify corresponding locations between the images. The estimated motions were modeled as deformations of an elastic body and thus reflect to a first order approximation the true physical behavior of lung parenchyma. The Lagrangian strain, derived from the calculated motion fields, were used to quantify the tissue deformation induced in the lung over the serial acquisition., Results: The method was validated on a magnetic resonance imaging study, for which breath-hold images were acquired of a healthy volunteer at different phases of the respiratory cycle. Regional parenchymal strain was observed to be oriented toward the pulmonary hilum, with strain magnitude maximal at the midcycle of the expiratory phase., Conclusion: In vivo magnetic resonance imaging quantification of lung motion holds the potential of providing a new diagnostic dimension in the assessment of pulmonary function, augmenting the information provided by studies of ventilation and perfusion.

In this study, the potential for abdominal MR images at 4 T using a tailored coil was demonstrated using healthy volunteers. These images were compared with those obtained in the same subject at 1.5 T to discuss whether 4 T would be superior to 1.5 T in abdominal imaging. MR images at 4 T were characterized by high contrast and signal-to-noise ratios, more than 2.95 times higher than those at 1.5 T. In conclusion, abdominal MR imaging at 4 T was feasible. Furthermore, abdominal MR imaging at 4 T was superior to that at 1.5 T in qualitative and quantitative analyses.

Summary: Oxygen-enhanced magnetic resonance (MR) ventilation imaging is a new technique, and the full extent of its physiologic significance has not been elucidated. This review article includes (1) theory of oxygen enhancement; (2) respiratory physiology; (3) oxygen-enhanced MR imaging (MRI) sequence design; (4) basic study of oxygen-enhanced MRI in animal models and humans; (5) clinical study of oxygen-enhanced MRI; and (6) merits and demerits of the technique in comparison with hyperpolarized noble gas MR ventilation imaging. Oxygen-enhanced MRI provides not only ventilation-related information but also respiration-related information. Although application of oxygen-enhanced MR ventilation imaging to patients with pulmonary diseases has been limited, oxygen-enhanced MRI offers the possibility of demonstrating regional pulmonary function and substituting for nuclear medicine ventilation-perfusion study, when combined with MR perfusion imaging. We believe that further basic studies and clinical applications of this new technique will define the real significance of oxygen-enhanced MR ventilation imaging in the future of pulmonary functional imaging and its usefulness for diagnostic radiology.

Recently, more investigators have been applying higher magnetic field strengths (3-4 Tesla) in research and clinical settings. Higher magnetic field strength is expected to afford higher spatial resolution and/or a decrease in the length of total scan time due to its higher signal intensity. Besides MR signal intensity, however, there are several factors which are magnetic field dependent, thus the same set of imaging parameters at lower magnetic field strengths would provide differences in signal or contrast to noise ratios at 3 T or higher. Therefore, an outcome of the combined effect of all these factors should be considered to estimate the change in usefulness at different magnetic fields. The objective of this article is to illustrate the practical scientific applications, focusing on MR imaging, of higher magnetic field strength. First, we will discuss previous literature and our experiments to demonstrate several changes that lead to a number of practical applications in MR imaging, e.g. in relaxation times, effects of contrast agent, design of RF coils, maintaining a safety profile and in switching magnetic field strength. Second, we discuss what will be required to gain the maximum benefit of high magnetic field when the current magnetic field (< or = 1.5 T) is switched to 3 or 4 T. In addition, we discuss MR microscopy, which is one of the anticipated applications of high magnetic field strength to understand the quantitative estimation of the gain benefit and other considerations to help establish a practically available imaging protocol., (Copyright 2002 Elsevier Science Ireland Ltd.)

Introduction: Higher magnetic fields (>or=3 T) afford higher spatial and/or temporal resolution in MR imaging with contrast agents, however, studies containing direct comparisons of signal intensity among different magnetic fields are substantially sparse. Our aim was to quantify the differences in terms of signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) between higher and lower (

Purpose: We performed 3D-dynamic MRI on patients with primary lung cancer to identify its usefulness for detecting hilar adenopathy shown at surgery., Methods and Materials: 30 consecutive patients with peripheral lung cancer underwent preoperative 3D-dynamic Gd-DTPA-enhanced MRI. Two thoracic radiologists blinded to histopathologic findings reviewed those studies independently for hilar adenopathy visualization. The results were correlated with surgical and histopathologic findings. Interreader agreement for the detection of hilar adenopathy was assessed by means of the kappa statistic., Results: Dynamic MRI demonstrated hilar adenopathy, with or without metastasis revealed at surgery, in all of 15 patients. Adenopathy without metastasis was shown in four patients. Dynamic MRI also revealed metastatic adenopathy in 11 of 12 patients with pathologically proven metastasis. There was only one case with lymph node metastasis that did not have adenopathy either on MRI or even at surgery. The diagnostic accuracy of dynamic MRI for adenopathy with or without metastases revealed at surgery were as follows; sensitivity, 100%; specificity, 100%; positive predictive value, 100%; and negative predictive value, 100%, respectively. The diagnostic accuracy of dynamic MRI for hilar lymph nodes metastasis were as follows; sensitivity, 92%; specificity, 78%; positive predictive value, 73%; and negative predictive value, 93%. Interreader agreement was substantial (kappa=0.73) for detection of hilar adenopathy., Conclusion: Hilar adenopathy on 3D-dynamic MRI correlated well with that of surgical finding on patients with primary lung cancer. It may have the potential to make an accurate preoperative evaluation of hilar lymph node metastasis from lung cancer.

Since publication of the Radiologic Diagnostic Oncology Group Report in 1991, the clinical application of pulmonary magnetic resonance (MR) imaging to patients with lung cancer has been limited. Computed tomography has been much more widely available for staging of lung cancer in clinical situations. Currently, ventilation and perfusion scintigraphy is the only modality that demonstrates pulmonary function while 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography is the only modality that reveals biological glucose metabolism of lung cancer. However, recent advancements in MR imaging have made it possible to evaluate morphological and functional information in lung cancer patients more accurately and quantitatively. Pulmonary MR imaging may hold significant potential to substitute for nuclear medicine examinations. In this review, we describe recent advances in MR imaging of lung cancer, focusing on (1) characterization of solitary pulmonary nodules; (2) differentiation from secondary change; evaluation of (3) medastinal invasion, (4) chest wall invasion, (5) lymph node metastasis, and (6) distant metastasis; and (7) pulmonary functional imaging. We believe that further basic studies, as well as clinical applications of newer MR techniques, will play an important role in the management of patients with lung cancer.

Objectives: To differentiate between metastatic and non-metastatic lymph nodes in patients with non-small cell lung cancer using respiratory-triggered short inversion time inversion recovery (STIR) turbo spin-echo (SE) MR imaging., Methods and Patients: One hundred and forty mediastinal lymph nodes were detected in 25 patients with non-small cell lung cancer who underwent respiratory-triggered STIR turbo SE imaging. Ratios of signal intensity of lymph nodes to 0.9% saline phantoms (lymph node-saline ratio) were compared by Student's t-test using the pathological diagnosis as the gold standard. The threshold value of the lymph node-saline ratio was determined for a positive test, and tested for its capability to provide a differential diagnosis., Results: One hundred and forty lymph nodes were diagnosed and classified into two groups: metastatic lymph node (n=21) and non-metastatic lymph node (n=119). The mean lymph node-saline ratio in the non-metastatic lymph node group (0.42+/-0.01; mean+/-standard error) was significantly lower than that of the metastatic lymph node group (0.77+/-0.02, P<0.0001). When 0.6 was adapted as the threshold for a positive test, sensitivity, specificity, and accuracy for differentiating metastatic lymph node from non-metastatic lymph node per lymph nodes were 100, 96, and 96%, and sensitivity, specificity, and accuracy for differentiating metastatic lymph node from non-metastatic lymph node per patients were 100, 75, and 88%, respectively., Conclusions: Both metastatic and non-metastatic lymph nodes in patients with non-small cell lung cancer were well differentiated using respiratory-triggered STIR turbo SE imaging.

The aim of this study was to assess the feasibility of a new MR-pathologic correlation method utilizing a high-resolution MR technique with a 3-inch surface coil and elimination of susceptibility by replacing air in the pulmonary alveoli of lung specimens with water. Inflated cadaver lung specimens of various lung disorders were imaged using a conventional spin echo (SE) sequence in a clinical 1.5 T MR scanner. The MR images were correlated with pathologic specimens. In six out of seven specimens, MR revealed detailed images corresponding to pathological changes. MR may provide a non-invasive and non-destructive method for examining lung specimens and for image-pathologic correlation.