Department of Radiology, Fujita Health University School of Medicine.
Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine.
Magn Reson Med Sci. 2022 Mar 1;21(1):212-234. doi: 10.2463/mrms.rev.2020-0184. Epub 2021 Apr 29.
Since thoracic MR imaging was first used in a clinical setting, it has been suggested that MR imaging has limited clinical utility for thoracic diseases, especially lung diseases, in comparison with x-ray CT and positron emission tomography (PET)/CT. However, in many countries and states and for specific indications, MR imaging has recently become practicable. In addition, recently developed pulmonary MR imaging with ultra-short TE (UTE) and zero TE (ZTE) has enhanced the utility of MR imaging for thoracic diseases in routine clinical practice. Furthermore, MR imaging has been introduced as being capable of assessing pulmonary function. It should be borne in mind, however, that these applications have so far been academically and clinically used only for healthy volunteers, but not for patients with various pulmonary diseases in Japan or other countries. In 2020, the Fleischner Society published a new report, which provides consensus expert opinions regarding appropriate clinical indications of pulmonary MR imaging for not only oncologic but also pulmonary diseases. This review article presents a brief history of MR imaging for thoracic diseases regarding its technical aspects and major clinical indications in Japan 1) in terms of what is currently available, 2) promising but requiring further validation or evaluation, and 3) developments warranting research investigations in preclinical or patient studies. State-of-the-art MR imaging can non-invasively visualize lung structural and functional abnormalities without ionizing radiation and thus provide an alternative to CT. MR imaging is considered as a tool for providing unique information. Moreover, prospective, randomized, and multi-center trials should be conducted to directly compare MR imaging with conventional methods to determine whether the former has equal or superior clinical relevance. The results of these trials together with continued improvements are expected to update or modify recommendations for the use of MRI in near future.
自胸部磁共振成像首次应用于临床以来，与 X 射线 CT 和正电子发射断层扫描（PET）/CT 相比，人们一直认为磁共振成像在胸部疾病，特别是肺部疾病的临床应用中具有有限的作用。然而，在许多国家和州，出于特定的适应证，磁共振成像最近已经变得可行。此外，最近开发的具有超短回波时间（UTE）和零回波时间（ZTE）的肺部磁共振成像增强了磁共振成像在常规临床实践中对胸部疾病的应用。此外，磁共振成像已被引入用于评估肺功能。然而，需要注意的是，这些应用迄今为止仅在学术和临床层面上用于健康志愿者，而不适用于日本或其他国家的各种肺部疾病患者。2020 年，Fleischner 学会发表了一份新报告，就肺部磁共振成像的临床适应证提供了共识专家意见，不仅涉及肿瘤学，还涉及肺部疾病。这篇综述文章简要介绍了日本在胸部疾病磁共振成像的技术方面及其主要临床适应证方面的历史，1）目前可应用的，2）有前途但需要进一步验证或评估的，3）值得在临床前或患者研究中进行研究的。最先进的磁共振成像可以非侵入性地可视化肺部结构和功能异常，而不会产生电离辐射，因此提供了 CT 的替代方法。磁共振成像被认为是提供独特信息的工具。此外，应该进行前瞻性、随机和多中心试验，以直接比较磁共振成像与常规方法，以确定前者是否具有同等或更高的临床相关性。这些试验的结果以及持续的改进有望在不久的将来更新或修改磁共振成像的使用建议。
