Multiphase ECG‐triggered 3D contrast‐enhanced MR angiography: Utility for evaluation of hilar and mediastinal invasion of bronchogenic carcinoma

The purpose of this study was to evaluate the usefulness of cardiac synchronized magnetic resonance angiography [electrocardiographically (ECG)‐triggered MRA] for improving image quality and detection of hilar and mediastinal invasion of bronchogenic carcinoma. Fifty patients, suspected of having hilar or mediastinal invasion of bronchogenic carcinoma, underwent contrast‐enhanced computed tomography and MR imaging including conventional and ECG‐triggered MRA. Twenty patients subsequently also underwent surgical resection. Vascular enhancement‐to‐background ratio (VBR), vascular enhancement‐to‐tumor ratio (VTR), signal‐to‐noise ratio (SNR), contrast‐to‐noise ratio (CNR) and image quality scores of thoracic vessels obtained with both MRA techniques were determined and compared. In addition, the diagnostic accuracy of tumor invasion of pulmonary vessels was compared. VBRs and VTRs of both MRA techniques were not significantly different. ECG‐triggered MRA significantly improved SNRs and CNRs (P < 0.05). Two readers judged that overall image quality of ECG‐triggered MRA was better than that of conventional MRA (κ ≥ 0.41). In conclusion, ECG‐triggered MRA improves the image quality and the detection of hilar and mediastinal invasion of bronchogenic carcinoma. J. Magn. Reson. Imaging 2001;13:215–224. © 2001 Wiley‐Liss, Inc.

[1]  M. Heller,et al.  Contrast‐enhanced, k‐space‐centered, breath‐hold MR angiography of the renal arteries and the abdominal aorta , 1997, Journal of magnetic resonance imaging : JMRI.

[2]  J. S. Orr,et al.  Tissue characterization by magnetic resonance spectroscopy and imaging: Results of a concerted research project of the European Economic Community. Introduction, objectives, and activities. , 1993, Magnetic resonance imaging.

[3]  M. Labeeuw,et al.  MR angiography of renal artery stenosis: value of the combination of three-dimensional time-of-flight and three-dimensional phase-contrast MR angiography sequences. , 1996, AJR. American journal of roentgenology.

[4]  M. Prince.  Gadolinium-enhanced MR aortography. , 1990, Radiology.

[5]  R. Levitt,et al.  Computed tomography in the preoperative evaluation of bronchogenic carcinoma. , 1982, Radiology.

[6]  R Frayne,et al.  Time‐resolved contrast‐enhanced 3D MR angiography , 1996, Magnetic resonance in medicine.

[7]  W. J. Matchett,et al.  Azotemia: gadopentetate dimeglumine as contrast agent at digital subtraction angiography. , 1996, Radiology.

[8]  S J Riederer,et al.  Fluoroscopically triggered contrast-enhanced three-dimensional MR angiography with elliptical centric view order: application to the renal arteries. , 1997, Radiology.

[9]  T K Foo,et al.  Contrast-enhanced abdominal MR angiography: optimization of imaging delay time by automating the detection of contrast material arrival in the aorta. , 1997, Radiology.

[10]  R R Edelman,et al.  Pulmonary perfusion: Qualitative assessment with dynamic contrast‐enhanced MRI using ultra‐short TE and inversion recovery turbo FLASH , 1996, Magnetic resonance in medicine.

[11]  H. Svanholm,et al.  Reproducibility of histomorphologic diagnoses with special reference to the kappa statistic , 1989, APMIS : acta pathologica, microbiologica, et immunologica Scandinavica.

[12]  S. Mentzer,et al.  Mediastinal invasion by bronchogenic carcinoma: CT signs. , 1994, Radiology.

[13]  G C McKinnon,et al.  Optimization of contrast timing for breath‐hold three‐dimensional MR angiography , 1997, Journal of magnetic resonance imaging : JMRI.

[14]  N. Nitta,et al.  Hilar and Mediastinal Invasion of Bronchogenic Carcinoma: Evaluation by Thin‐Section Electron‐Beam Computed Tomography , 1997, Journal of thoracic imaging.

[15]  W. Mali,et al.  Stent placement after iliac angioplasty: comparison of hemodynamic and angiographic criteria. Dutch Iliac Stent Trial Study Group. , 1996, Radiology.

[16]  Matthew S. Johnson,et al.  Three-dimensional gadolinium-enhanced MR angiography for aortoiliac inflow assessment plus renal artery screening in a single breath hold. , 1996, Radiology.

[17]  E. Rendina,et al.  Computed tomography for the evaluation of intrathoracic invasion by lung cancer. , 1987, The Journal of thoracic and cardiovascular surgery.

[18]  G C McKinnon,et al.  Breath-hold, contrast-enhanced, three-dimensional MR angiography. , 1996, Radiology.

[19]  W. Webb.  The role of magnetic resonance imaging in the assessment of patients with lung cancer: a comparison with computed tomography. , 1989, Journal of thoracic imaging.

[20]  T. Chenevert,et al.  Breath-hold gadolinium-enhanced MR angiography of the abdominal aorta and its major branches. , 1995, Radiology.

[21]  F. Venuta,et al.  Computed tomography for preoperative assessment of T3 and T4 bronchogenic carcinoma. , 1992, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[22]  J. Debatin,et al.  Contrast‐enhanced, ultrafast 3d pulmonary MR angiography in a single breath‐hold: Initial assessment of imaging performance , 1997, Journal of magnetic resonance imaging : JMRI.

[23]  P. McCormack,et al.  Comparative merits of conventional, computed tomographic, and magnetic resonance imaging in assessing mediastinal involvement in surgically confirmed lung carcinoma. , 1985, The Journal of thoracic and cardiovascular surgery.

[24]  L. Axel,et al.  Quality assurance methods and phantoms for magnetic resonance imaging: report of AAPM nuclear magnetic resonance Task Group No. 1. , 1990, Medical physics.

[25]  L. Quint,et al.  Central lung masses: prediction with CT of need for pneumonectomy versus lobectomy. , 1987, Radiology.

[26]  B. Tress,et al.  Standard dose Gd‐DTPA dynamic MR of renal arteries , 1998, Journal of magnetic resonance imaging : JMRI.

[27]  E. Butchart,et al.  Preoperative staging of carcinoma of the bronchus: can computed tomographic scanning reliably identify stage III tumours? , 1994, Thorax.

[28]  J. Debatin,et al.  Evaluation of the aortoiliac and renal arteries: comparison of breath-hold, contrast-enhanced, three-dimensional MR angiography with conventional catheter angiography. , 1997, Radiology.

[29]  R. Wahl,et al.  Preoperative staging of non-small-cell carcinoma of the lung: imaging methods. , 1995, AJR. American journal of roentgenology.

[30]  P. Molina,et al.  Indeterminate mediastinal invasion in bronchogenic carcinoma: CT evaluation. , 1989, Radiology.

[31]  Franca Podo,et al.  I. Introduction, objectives, and activities , 1988 .

[32]  P. M. Walker,et al.  V. Multi-center trial with protocols and prototype test objects for the assessment of MRI equipment , 1988 .

[33]  L R Schad,et al.  Clinical applications of MR angiography in intrathoracic masses. , 1991, Journal of computer assisted tomography.

[34]  T L Chenevert,et al.  Diagnosis of pulmonary embolism with magnetic resonance angiography. , 1997, The New England journal of medicine.

[35]  J. D. de Certaines,et al.  Performance assessment and quality control in MRI by Eurospin test objects and protocols. , 1993, Magnetic resonance imaging.

[36]  B J McNeil,et al.  CT and MR imaging in staging non-small cell bronchogenic carcinoma: report of the Radiologic Diagnostic Oncology Group. , 1991, Radiology.