Cine MRI enables better therapeutic planning than CT in cases of possible lung cancer chest wall invasion

Kajiwara, Naohiro; Akata, Soichi; Uchida, Osamu; Usuda, Jitsuo; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

doi:10.1016/j.lungcan.2009.10.016

« Previous Next »Lung Cancer
Volume 69, Issue 2 , Pages 203-208, August 2010

Cine MRI enables better therapeutic planning than CT in cases of possible lung cancer chest wall invasion

Naohiro Kajiwara
- Department of Thoracic Surgery, Tokyo Medical University, Japan
- Corresponding author at: Department of Thoracic Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. Tel.: +81 3 3342 6111x5070; fax: +81 3 3349 0326.
Soichi Akata
- Department of Radiology, Tokyo Medical University, Japan
Osamu Uchida
- Department of Thoracic Surgery, Tokyo Medical University, Japan
Jitsuo Usuda
- Department of Thoracic Surgery, Tokyo Medical University, Japan
Tatsuo Ohira
- Department of Thoracic Surgery, Tokyo Medical University, Japan
Norihiko Kawate
- Department of Health Science and Social Welfare, Waseda University School of Human Sciences, Japan
Norihiko Ikeda
- Department of Thoracic Surgery, Tokyo Medical University, Japan

Received 26 May 2009; received in revised form 1 September 2009; accepted 27 October 2009. published online 30 November 2009.

Abstract

The objective

To evaluate the hypothesis that lung cancer treatment planning (whether or not to use induction therapy) can be improved if respiratory dynamic cine magnetic resonance imaging (RD MR) is used.

Method

We studied 100 lung cancer patients, 76 men and 21 women, scheduled for thoracotomies between May 1997 and December 2006 wherein it was unclear preoperatively whether chest wall invasion would be found. We evaluated the accuracy of RD MR as compared with the findings at operation and postoperative pathology. The accuracy of RD MRI for evaluating chest wall invasion was compared with the efficacy of CT and MRI within our own group of patients and with data from the studies of other investigators.

Results

Concerning the evaluation of chest wall invasion, conventional computed tomography (CT) had 43.9% specificity, 60.0% sensitivity and 47.1% accuracy, while RD MR had 68.5% specificity, 100.0% sensitivity and 77.0% accuracy. RD MRI was particularly useful in the evaluation of cancers around 5cm in diameter that were located adjacent to the diaphragm. Postoperative evaluation of superior sulcus tumor cases that had received induction therapy also showed that the RD MR procedure enabled an accurate decision in 87.5% of cases, and there were no false negative cases.

Conclusions

RD MR is more useful than CT or standard MRI for evaluating thoracic wall invasion. This noninvasive method enhances the reliability of deciding whether induction therapy should be employed.

Abbreviations: CT, computed tomography, ED CT, expiratory dynamic computer tomography, Ef, therapeutic effect, FDG-PET, 18F-fluorodeoxyglucose-positron emission tomography, MRI, magnetic resonance image, NPV, negative predictive value, PPV, positive predictive value, RD MR, respiratory dynamic cine MRI, SST, superior sulcus tumor, SUV, standard uptake value, US, ultrasound