HIGH-RESOLUTION MAGNETIC-RESONANCE-IMAGIN G (HR-MRI) OF THE PLEURA CHEST-WALL - NORMAL FINDINGS AND PATHOLOGICAL-CHANGES

Aim: To determine the value of high-resolution MRI in pleural and ches t wall, diseases, the normal and pathologic costal pleura and adjacent chest wall between paravertebral and the axillar region were examined with contrast enhanced high-resolution T-1-weighted MRI images using a surface coil. Material and methods: Normal anatomy was evaluated in 5 healthy Volunteers and a normal specimen of the thoracic wall, and c orrelation was made with corresponding HR-CT and histologic sections. CT-proved focal and diffuse changes of the pleura and the chest wall i n 36 patients underwent HR-MRI, and visual comparison of MRI and CT wa s done retrospectively. Results: Especially sagittal T-1-weighted HR-M RI images allowed accurate delineation of the peripleural fat layer (P FL) and the innermost intercostal muscle (IIM), which served as landma rks of the intact inner chest wall. PFL and IIM were well, delineated in 3/4 patients with tuberculous pleuritis, and in all 7 patients with non-specific pleuritis, as opposed to impairment of the PFL and/or th e IIM, which was detected in 15/18 malignancies as a pattern of malign ant chest wall involvement. In one case of tuberculous pleural empyema with edema of the inner chest wall HR-MRI produced false positive dia gnosis of malignant disease. Conclusion: HR-MRI images improved non-in vasive evaluation of pleural and chest wall diseases, and allowed for differentiation of benign and malignant changes.