Answer
Answer
CT scanning is best in demonstrating bony destruction (see the image below). MRI appears to be superior in demonstrating chest wall invasion. Also, the anatomy above the lung apex is better demonstrated on multiplanar MRI, because the nerves of the brachial plexus and blood vessels follow a horizontal and parallel course, meeting above the apex of the lung. In a study of 31 patients with superior pulmonary sulcus tumors, [10] CT scanning had a sensitivity of 60% and a specificity of 65%, with an overall accuracy of 63% in the evaluation of the extent of disease.
Pancoast tumor. Axial nonenhanced CT image of the upper dorsal spine demonstrates a soft tissue mass destroying the vertebra on the right and the right posterior elements, including the pedicle and part of the posterior spinous process.
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Media Gallery
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Pancoast tumor. A 53-year-old man with a 50 pack-year history of smoking began experiencing upper back pain for several weeks. PA chest radiograph shows asymmetry of the apices (superior sulcus). The right apex is more opaque than the left. When the image is enlarged, the partially destroyed second and third right posterior ribs near the costovertebral junction can be seen.
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Pancoast tumor. Axial nonenhanced CT image of the upper dorsal spine demonstrates a soft tissue mass destroying the vertebra on the right and the right posterior elements, including the pedicle and part of the posterior spinous process.
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Pancoast tumor. Sagittal fast spin-echo T2-weighted MRI shows collapsed vertebrae and cord compression at C7, T1, and T2 caused by a soft tissue mass.
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Pancoast tumor. Sagittal gradient-echo T2-weighted MRI demonstrates a soft tissue mass involving C7, T1, and T2, with collapse of the vertebrae and moderate cord compression.
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Pancoast tumor. Axial T1-weighted image shows cord compression caused by a large, enhancing mass. The right subclavian artery is not involved.
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