MRI of the Lung

314 Pages·2009·10.958 MB·English

by  Jürgen Biederer (auth.), Hans-Ulrich Kauczor (eds.)

MEDICAL RADIOLOGY
Diagnostic Imaging
Editors:
A. L. Baert, Leuven
M. Knauth, Göttingen
K. Sartor, Heidelberg
H.-U. Kauczor (Ed.)
MRI
of the Lung
With Contributions by
T. A. Altes ∙ J. Biederer ∙ J. P. Butler ∙ O. Dietrich ∙ J. Dinkel ∙ R. Eibel ∙ M. Eichinger
S. B. Fain ∙ C. Fink ∙ A. F. Halaweish ∙ H. Hatabu ∙ C. P. Heussel ∙ F. W. Hersman
C. Hintze ∙ J. H. Holmes ∙ M. I. Hrovat ∙ H. Koyama ∙ K.-F. Kreitner ∙ S. Ley
J. Ley-Zaporozhan ∙ K. Marten ∙ F. Molinari ∙ I. Muradian ∙ Y. Ohno ∙ S. Patz
C. Plathow ∙ M. Puderbach ∙ F. Risse ∙ W. G. Schreiber ∙ R. L. Sorkness ∙ K. Takahashi
R. Tetzlaff ∙ E. J. R. van Beek ∙ J. M. Wild
Foreword by
A. L. Baert
123
Hans-Ulrich Kauczor, MD
Chairman, Medical Director
Diagnostic and Interventional Radiology
University Clinic Heidelberg
Im Neuenheimer Feld 110
69120 Heidelberg
Germany
MEDical RaDioloGY ∙ Diagnostic Imaging and Radiation Oncology
Series Editors:
A.L. Baert ∙ L.W. Brady ∙ H.-P. Heilmann ∙ M. Knauth ∙ M. Molls ∙ C. Nieder ∙ K. Sartor
Continuation of Handbuch der medizinischen Radiologie
Encyclopedia of Medical Radiology
ISBN 978-3-540-34618-0 e-ISBN 978-3-540-34619-7
DOI 10.1007/978-3-540-34619-7
Library of Congress Control Number: 2008925886
© 2009 Springer-Verlag Berlin Heidelberg
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Foreword
One of the aims of the book series “Medical Radiology – Diagnostic Imaging” is to publish novel
work that explores new frontiers in the field of radiological imaging. The investigation of the po-
tential application of MRI to the study of lung diseases is a challenging and exciting field of clini-
cal research driven by the rapid development of new techniques and sequences for cardiac MRI
as well as by the use of noble hyperpolarised gases as novel contrast agents. The specific ability of
MRI to visualise simultaneously morphological changes and modifications in perfusion, ventila-
tion and gas exchange has opened up totally new perspectives in lung imaging. MRI of the lung
thus eminently illustrates the mutation of the discipline of radiology from pure morphology to
combined morphological-functional imaging.
The editor, H-U. Kauczor, is known internationally for his original research in various fields,
and particularly into new applications of CT and MRI in oncology and lung pathology. For many
years he has been the inspiration and principal investigator of a leading and innovative radio-
logical research group in Heidelberg. Their original ideas and dynamic work organisation have
resulted in an impressive list of scientific publications on various applications of MR imaging of
the lung.
I am very much indebted to the editor and the contributing authors, all outstanding experts
in their fields, for preparing this fine volume on a highly active topic for our series. It is indeed
one of the first handbooks to provide a comprehensive overview of our actual knowledge on the
clinical role of MRI of the lung. In addition it outlines future perspectives for potential new ap-
plications of this imaging modality. I would like to congratulate them on this outstanding work at
the cutting edge of radiology.
I highly recommend this volume to certified radiologists, particularly those with a special
interest in chest imaging, and to radiologists in training. However, pneumologists, cardiologists
and chest surgeons will also find it a very useful source of information for better diagnostic and
therapeutic management of their patients.
I have no doubt that this volume will meet the appropriate interest and well deserved success
with our readership.
Leuven AlbErt L. BaErt
Preface
For a long time the lung has been regarded as the black hole in MRI. In the 1980s courageous
physicists and radiologists have tried to investigate different lung diseases using MRI, but they
could neither produce convincing image quality within a reasonable examination time nor gen-
erate a substantial clinical impact. MRI was accepted for some minor clinical indications, such as
mediastinal tumors and chest wall invasion or Pancoast situation in lung cancer. With the advent
of spiral and high resolution CT, structural imaging and characterization of lung disease based on
patterns and compartments was of utmost interest. Also CT angiography of the pulmonary arter-
ies and the diagnosis of pulmonary embolism were major developments with significantly supe-
rior results when compared to some half-hearted attempts to introduce MRA of the pulmonary
arteries using 2D time-of-flight techniques. At this stage the scientific and clinical community as
well as the scanner manufacturers lost interest in MRI of the lung. Over time, however, two dif-
ferent groups tackled MRI of the lung again. The first of these, radiologists working on cardiac
MRI, realized that there are important cardiorespiratory interactions. They started to investigate
MRI and contrast-enhanced MRA of pulmonary arteries and veins as well as analyze the func-
tion of the right ventricle. The second group, basic and laser physicists, came up with the idea
that their hyperpolarized noble gases might be an attractive novel contrast mechanism for MRI
of the lung. Thus, iatrogenic signal-enhancing compounds started to shed light into the black
hole of MRI. Suddenly, more and more groups made basic research and development efforts to
discover the unknown in MRI of the lung. It soon became very obvious that MRI will always be
second to CT when it comes to the visualization of pulmonary structure, disease and patterns
with high spatial resolution. Till now, the ability to provide different soft tissue contrasts (T1, T2,
contrast-enhancement, fat suppression) has not really proven advantageous for MRI. However,
the most appealing development was the introduction of functional imaging of the lung by MRI.
More and more contrast mechanisms for functional studies were described. The MR hardware
development – which was driven by cardiac MRI striving for higher and higher temporal resolu-
tion – allowed for a variety of techniques which cope with the challenges related to respiratory
motion, as well as cardiac contraction and vascular pulsation. The diagnostic benefits stem from
the ability of MRI to visualize changes in lung structure while simultaneously imaging different
aspects of lung function, such as perfusion, respiratory motion, ventilation and gas exchange. On
this basis, novel imaging findings, endpoints and quantitative surrogates for lung function can be
obtained.
As all these techniques become more and more available they are being applied to a wide
variety of different lung diseases. Most of these early clinical applications have been very suc-
cessful and impressive, and important indications have emerged for MRI of the lung: pulmonary
hypertension, congenital vascular anomalies, and cystic fibrosis. Other strongholds for MRI of
the lung are staging lung cancer and malignant pleural mesothelioma as well as characterization
of mediastinal and pleural tumors or even the diagnosis and follow-up of pulmonary embolism.
This means that MRI can already substantially contribute to clinical diagnostic imaging in lung
disease but at the same time it is heavily underused for two reasons: first the clinical indications
and the potential advantages of MRI over CT or nuclear medicine are not widely known, and sec-
ond the knowledge of how to carry out MRI of the lung and obtain high image quality providing
a confident diagnosis is not widespread. However, standard protocols can now be implemented
on up-to-date scanners, allowing MRI to be used as a first-line imaging modality for various lung
diseases.
VIII Preface
For me, as the editor of this book, it was an enormously invigorating experience bringing to-
gether renowned experts and the support from Professor Albert Baert and the publisher, Springer,
to provide the first well illustrated and comprehensive textbook of “MRI of the Lung”. It provides
an extensive overview of how to use MRI for imaging of different types of lung disease. Standard
and easy-to-use protocols are presented and the MR strategies used in different clinical situations
are explained. Special emphasis is placed on benign diseases requiring regular monitoring, given
that it is patients with these diseases who derive the greatest benefit from the avoidance of ion-
izing radiation. I hope the book will be of great assistance to all who are establishing MRI of the
lung in their daily clinical and research activities.
Heidelberg Hans-Ulrich Kauczor
Contents
Technical
1 General Requirements of MRI of the Lung and Suggested Standard
Protocol .............................................................. 3
JürGEn BiEDErEr
2 MR Angiography of the Pulmonary Vasculature ...................... 17
Christian Fink
3 MR Perfusion in the Lung ............................................ 25
Frank RissE
4 MRI of Pulmonary Ventilation ....................................... 35
4.1 Hyperpolarised 3He MRI: Physical Methods for Imaging Human
Lung Function .................................................... 35
Jim M. WilD
4.2 Hyperpolarized 129Xenon MRI of the Lung ......................... 57
SamuEl Patz, IGa MuraDian, Mirko I. Hrovat,
F. William HErsman, Hiroto Hatabu and JamEs P. ButlEr
4.3 19Fluorine MRI .................................................... 69
WolfGanG G. SchrEibEr
4.4 Proton MRI: Oxygen-enhanced Lung MRI and Alternative
Approaches ....................................................... 75
Olaf DiEtrich
5 Respiratory Mechanics and Pulmonary Motion ....................... 91
Ralf TEtzlaff
Clinical
6 Pulmonary Hypertension and Thromboembolic Disease ............. 107
SEbastian LEY and Karl-FriEDrich KrEitnEr
X Contents
7 Vascular Anomalies and Diseases ..................................... 121
SEbastian LEY and Julia LEY-Zaporozhan
8 Asthma ............................................................... 139
SEan B. Fain, JamEs H. HolmEs, and RonalD L. SorknEss
9 Chronic Obstructive Pulmonary Diseases ............................ 155
Julia LEY-Zaporozhan, AhmED F. HalawEish
and EDwin J. R. van BEEk
10 Cystic Fibrosis ........................................................ 169
MichaEl PuDErbach, Monika EichinGEr and Talissa A. AltEs
11 Lung Cancer .......................................................... 179
Yoshiharu Ohno, Hisanobu KoYama, JuliEn DinkEl,
and Christian HintzE
12 Mediastinal Disease .................................................. 217
Koji Takahashi
13 Pulmonary Infections – Pneumonia .................................. 255
RoGEr EibEl
14 Interstitial Lung Disease ............................................. 277
Katharina MartEn and FrancEsco Molinari
15 Diseases of the Pleura and the Chest Wall ............................ 291
Claus PEtEr HEussEl and Christian Plathow
Subject Index .............................................................. 307
List of Contributors ....................................................... 311
Technical
1
General Requirements of MRI of the Lung

and suggested standard Protocol
JürGEn BiEDErEr
Contents
KE Y PO InT s
1.1 Introduction 3
MRI of the lung has been shown to be highly sensi-
1.2 Proton-MRI of the Lung:
tive to infiltrative and solid pathology. It offers par-
the Challenge 4
ticular advantages beyond the scope of CT such as
1.3 strategies for Motion dynamic studies of respiratory mechanics and first
Compensation 4
pass perfusion imaging. However, challenges such
1.4 strategies for Imaging as motion artifacts and low signal have delayed the
Lung Parenchyma Disease 5 introduction into clinical routine. This chapter dis-
1.5 suggestions for a Lean cusses the strategies to overcome these obstacles
standard Protocol 6 and suggests a comprehensive protocol for a spec-
trum of indications. This comprises a basic selec-
1.6 specific Variations
of the Protocol 10 tion of non-contrast enhanced sequences and can
1.6.1 Paramagnetic Contrast Agents 10 be extended by contrast enhanced series. Breath
1.6.2 Lung Perfusion and Angiography: hold T1- and T2-weighted imaging are applied for
Temporal vs Spatial Resolution 10
the detection of small solid lesions and infiltrates.
1.6.3 Mediastinum 12
Inversion recovery series visualize enlarged lymph
1.6.4 Chest Wall and Apex 13
1.6.5 Paediatric Applications 13 nodes and skeletal lesions. Steady-state gradient
echo series in free breathing contribute to the de-
1.7 Protocols for Ultra High
and Low Field scanners 13 tection of pulmonary embolism, cardiac dysfunc-
tion and impairment of respiratory mechanics.
References 14
Tumors, suspicious pleural effusions and inflam-
matory diseases warrant additional contrast-en-
hanced sequences. Perfusion studies contribute to
imaging of thromboembolic vascular and obstruc-
tive airway diseases.
1.1
Introduction
Evolving from a research tool, MRI of the lung is be-
coming increasingly important for specific clinical ap-
plications. The advantages over CT are not only limited
J. BiEDErEr, MD
University Hospital Schleswig-Holstein, Campus Kiel, Depart- to the lack of ionizing radiation, which is of particular
ment of Diagnostic Radiology, Arnold-Heller-Strasse 9, 24105 interest for the assessment of lung disease in children
Kiel, Germany (e.g. pneumonia, cystic fibrosis) or in patients who re-