Monitoring of Lung Motion in Patients With Malignant Pleural Mesothelioma Using Two-Dimensional and Three-Dimensional Dynamic Magnetic Resonance Imaging: Comparison With Spirometry

Purpose:To monitor lung motion in patients with malignant pleural mesothelioma (MPM) before and after chemotherapy (CHT) using 2-dimensional (2D) and 3-dimensional (3D) dynamic MRI (dMRI) in comparison with spirometry. Methods and Materials:Twenty-two patients with MPM were examined before CHT, as well as after 3 and 6 CHT cycles (3 months and 6 months) using 2D dMRI (trueFISP; 3 images/s) and 3D dMRI (FLASH 3D, 1 slab (52 slices)/s) using parallel imaging in combination with view-sharing technique. Maximum craniocaudal lung dimensions (2D) and lung volumes (3D) were monitored, separated into the tumor-bearing and nontumor-bearing hemithorax. Vital capacity (VC) was measured for comparison using spirometry. Results:Using 2D technique, there was a significant difference between the tumor-bearing and the nontumor-bearing hemithorax before CHT (P < 0.01) and after 3 CHT cycles (P < 0.05), whereas difference was not significant in the second control. In the tumor-bearing hemithorax, mobility increased significantly from the status before versus after 3 CHT cycles (4.1 ± 1.1 cm vs. 4.8 ± 1.4 cm, P < 0.05). Using 3D technique, at maximum inspiration, the volume of the tumor-bearing hemithorax was 0.6 ± 0.4 L and of the nontumor-bearing hemithorax 1.25 ± 0.4 L before CHT. In the follow-up exams, these volumes changed to 1.05 ± 0.4 L (P < 0.05) and 1.4 ± 0.5 L, respectively. Using spirometry, there was no significant change in VC (1.9 ± 0.4 L vs. 2.2 ± 0.7 L vs. 2.2 ± 0.9 L). Conclusion:dMRI is capable of monitoring changes in lung motion and volumetry in patients with MPM not detected by global spirometry. Thus, dMRI is proposed for use as a further measure of therapy response.