What is the role of MRI in the workup of non-small cell lung cancer (NSCLC)?

Updated: Aug 27, 2019
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Eugene C Lin, MD  more...
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MRI is an imaging modality with several advantages, including a lack of ionizing radiation, the ability to image vascular structures without contrast media, the ability to image in any plane, and superior contrast resolution. MRI is not useful as an initial imaging tool, but it may be superior to CT in the evaluation of local invasion and detection of hilar lymphadenopathy.

In particular, MRI is useful in the evaluation of apical or superior sulcus lung tumors. Invasion of the brachial plexus, subclavian vessels, and adjacent vertebral bodies can be demonstrated with MRI. Compared with other techniques, MRI may be slightly more accurate in detecting extranodal tumor extension into the mediastinum.

The multiplanar capability of MRI enables a more accurate evaluation of hilar lymph nodes, aortopulmonary window lymph nodes, and subcarinal region lymph nodes than does CT scanning.

In addition, MRI can be helpful in identifying the relationship of the tumor to the central pulmonary artery, aorta, carina, and main bronchi.

MRI depends on size criteria for the detection of mediastinal metastases. MRI is limited in detecting small lymph nodes containing microscopic deposits. MRI is superior in detecting invasion of the chest wall, vertebral body, subclavian vessels, and brachial plexus. For the detection of chest wall invasion, a sensitivity of approximately 90% and a specificity of 96-100% have been reported.

MRI is not able to depict calcification. Blood vessels with low flow may be misdiagnosed as lymph nodes or masses. Respiratory or other motion may cause blurring of images, leading to a missed diagnosis of lymphadenopathy.

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