thoracic mr imaging - ssr egyptstaging of bronchogenic carcinoma masses/ cysts lymph nodes vessels...
TRANSCRIPT
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Thoracic MR Imaging Technical Considerations and Clinical Applications
Mamdouh Mahfouz MD
Prof. of Radiology
Cairo University
www.ssregypt.com
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CLOSED MAGNET
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CLOSED MAGNET
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OPEN MAGNET
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EXTERMITY MAGNET
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H
H
H
H
H
H
K
H
H
P C
Na
N
H
O
H
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H2O
Water represents 75-80% of the human body
O H H
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MR Imaging
Magnet
Radio frequency coil
Hydrogen Atom [proton]
H H H H H H H H
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MR Imaging
Hydrogen Atom [proton]
H
H
H
H
H
H
H
H
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MR Imaging
Hydrogen Atom [proton]
H
H
H
H
H
H
H
H
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Adequate Mobile
H
SIGNAL
LOW
HIGH
INTERMEDIATE
DARK, HYPOINTENSE
BRIGHT, HYPERINTENSE
GRAY, ISOINTENSE
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MR images depend on the movement of hydrogen protons in response to the applied radiofrequency
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Cortical bone
Mature fibrous tissue
Calcifications
Non mobile hydrogen
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AIR
Lung &
Sinuses
Minimal hydrogen
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H
Amount
Motion Minimal hydrogen [air] → no signal
Non mobile hydrogen [cortical bone] → no signal Fast hydrogen [flowing blood] → no signal
The image will depend on
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T2 T1
Air
Cortical bone
Fibrous tissue
Calcifications
Flowing blood
Each structure [lesion] in the human body has a characteristic signal
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T2 T1 Subacute blood
Each structure [lesion] in the human body has a characteristic signal
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T2 T1 Subacute blood
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Each structure [lesion] in the human body has a characteristic signal
T2 T1
T2 T1
Fluid
Fat
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T1
T1
T2
T2
Fat
Blood
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T1 T2
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Small cell lung cancer
CT versus MRI
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MR imaging has dramatically changed the practice of medicine
Neurology and orthopedics
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Thoracic Imaging
Chest X – ray
Screening,
Emergency medicine,
Intensive care units
CT Scan
MR imaging
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Assessment of vascular abnormalities [aorta,
pulmonary arteries, veins, SVC,…]
Evaluation of mediastinal masses
Staging of bronchogenic carcinoma
Diagnosis of chest wall pathology
MAJOR CLINICAL APPLICATIONS
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Aortic dissection
Vessels appear usually black due to the signal void of flowing blood
Flow sensitive techniques
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Saccular aortic aneurysm
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Pulmonary embolism
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Bronchogenic carcinoma
chest wall invasion + nodes
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Bronchogenic Carcinoma with mediastinal invasion
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Bronchogenic Carcinoma , SVC invasion
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Superior mediastinal lipoma
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Pericardial cyst
T1 T2
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Bronchiectasis
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سبحانك اللهم و بحمدك نشهد ان ال اله اال انت نستغفرك و نتوب اليك
Thank you
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Contrast injection
Modality Item
-
+
CT
MR > CT
Diffuse lung diseases
Focal lung diseases
Staging of bronchogenic carcinoma
Lung parenchyma
• Nodules, miliary shadows CT - • Masses, cysts CT = MR
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Contrast injection
Modality Item
-
+
+
-
+ + +
CT
MR > CT
CT = MR
MR ≥ CT
CT = MR
CT≥ MR
MR≥ CT
CT = MR
Diffuse lung diseases
Focal lung diseases
Staging of bronchogenic carcinoma
Masses/ cysts
Lymph nodes
vessels
Hernia and diaphragmatic lesions
Primary lesions
Invasion by lung or mediastinal lesions
Pleural masses and effusion
Lung parenchyma
• Nodules, miliary shadows CT - • Masses, cysts CT = MR +
Mediastinum
• Aorta MR ± • Pulmonary arteries CT = MR ± • Pulmonary veins MR ≥ CT ± • peripheral vessels - (X ray) -
Pleural and chest wall
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Contrast injection
Modality Item
-
+
+
-
+ + +
CT
MR > CT
CT = MR
MR ≥ CT
CT = MR
CT≥ MR
MR≥ CT
CT = MR
Diffuse lung diseases
Focal lung diseases
Staging of bronchogenic carcinoma
Masses/ cysts
Lymph nodes
vessels
Hernia and diaphragmatic lesions
Primary lesions
Invasion by lung or mediastinal lesions
Pleural masses and effusion
Lung parenchyma
• Nodules, miliary shadows CT - • Masses, cysts CT = MR +
Mediastinum
• Aorta MR ± • Pulmonary arteries CT = MR ± • Pulmonary veins MR ≥ CT ± • peripheral vessels - (X ray) -
Pleural and chest wall
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Intramural hematoma in the descending aorta
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MR pulse sequences
T1 weighted images
T2 weighted images
Gradient images
Spin echo images
Fast spin echo images
T1 weighted images with fat suppression
T1 weighted images with contrast [Gd- DTPA]
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Molecular O2 enhanced MR imaging
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?
THE END
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Current applications
Lung cancer
Superior structure tumor
Invasion of vessels [No contrast material]
Mediastinum Pericardium Chest wall [90% sensitivity] Spine
Lymph node deposits
Adrenal metastases
Differentiation of tumors from obstructive atelectasis
Evaluation after surgery or radiotherapy
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Aortic dissection
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Tumour
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Empyema
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Bronchogenic carcinoma
invading the pulmonary artery
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Bronchogenic carcinoma
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Chondrosarcoma of the chest wall
Assessment of chest wall lesions