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World J Radiol. Mar 28, 2019; 11(3): 27-45
Published online Mar 28, 2019. doi: 10.4329/wjr.v11.i3.27
Role of advanced magnetic resonance imaging in the assessment of malignancies of the mediastinum
Jordi Broncano, Ana María Alvarado-Benavides, Sanjeev Bhalla, Antonio Álvarez-Kindelan, Constantine A Raptis, Antonio Luna
Jordi Broncano, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, Health Time, Cordoba 14012, Spain
Ana María Alvarado-Benavides, Sanjeev Bhalla, Constantine A Raptis, Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
Antonio Álvarez-Kindelan, Thoracic Surgery Department, Hospital Reina Sofía, Cordoba 14004, Spain
Antonio Luna, MR imaging Unit, Clínica Las Nieves, Jaen 23007, Spain
Author contributions: All authors contributed to this article.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jordi Broncano, MD, Staff Physician, Cardiothoracic Imaging Unit, Hospital San Juan de Dios, Health Time, Avenida el Brillante, 106, Cordoba 14012, Spain. jordibroncano@gmail.com
Telephone: +34-957277000 Fax: +34-957277179
Received: November 21, 2018
Peer-review started: November 23, 2018
First decision: December 10, 2018
Revised: February 28, 2019
Accepted: March 12, 2019
Article in press: March 12, 2019
Published online: March 28, 2019
Abstract

In the new era of functional magnetic resonance imaging (MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high capability for lesion characterization and treatment monitoring. The application of several of these diagnostic weapons in a multiparametric fashion enables to better characterize thymic epithelial tumors and other mediastinal tumoral lesions, accurate assessment of the invasion of adjacent structures and detection of pathologic lymph nodes and metastasis. Also, “do not touch lesions” could be identified with the associated impact in the management of those patients. One of the hot-spots of the multiparametric chest MR is its ability to detect with acuity early response to treatment in patients with mediastinal malignant neoplasms. This has been related with higher rates of overall survival and progression free survival. Therefore, in this review we will analyze the current functional imaging techniques available (18F-Fluorodeoxiglucose positron emission tomography/computed tomography, diffusion-weighted imaging, dynamic contrast-enhanced MRI, diffusion tensor imaging and MR spectroscopy) for the evaluation of mediastinal lesions, with a focus in their correct acquisition and post-processing. Also, to review the clinical applications of these techniques in the diagnostic approach of benign and malignant conditions of the mediastinum.

Keywords: Mediastinum, Magnetic resonance, Diffusion, Perfusion, 18F-Fluorodeoxiglucose positron emission tomography/computed tomography, Advanced imaging

Core tip: With the past improvements on magnetic resonance hardware, gradients and advanced sequences, the interest of magnetic resonance application in the chest is exponentially growing. In this review, we show the evidence in the literature of its application in mediastinal malignancies. In addition, we explore the advantages of applying new imaging techniques for lesion characterization, helping to differentiate with acuity benign and malignant etiologies. The use of several advanced sequences together yields specificity in identifying false positives from 18F-Fluorodeoxiglucose positron emission tomography/computed tomography. Also, due to its precision in defining invasion and variation in tissue properties through the time, magnetic resonance enhances accurate staging and treatment monitoring.