Investig Magn Reson Imaging.  2018 Dec;22(4):254-259. 10.13104/imri.2018.22.4.254.

Utility of Magnetic Resonance Imaging in the Diagnosis of Lung Adenocarcinoma with Extensive Necrosis: a Case Report

• Choi SL
• Cha MJ
• Choi HW
• Park BJ
• Kim MK
• Kim JY

• KMID: 2431111
• DOI: http://doi.org/10.13104/imri.2018.22.4.254

Abstract

Application of magnetic resonance imaging (MRI) for assessment of pulmonary disease has been limited, due to susceptibility to cardiac pulsation, respiratory motion, and inhomogeneity of the magnetic field of the lung. With technical advances of MRI and unmet clinical needs for more accurate diagnosis and assessment of the disease, however, the use of MRI for evaluation of the lung has broadened. Herein, we present a case of pneumonic-type lung adenocarcinoma in a patient with history of anaphylactic shock to iodinated contrast medium, in which MRI played a critical role for targeted lung biopsy and cancer staging. Through this paper, we would like to report potential value of MRI in assessment of lung cancer.

Keyword

Mucinous adenocarcinoma; Pneumonia; Anaphylaxis; Magnetic resonance imaging

MeSH Terms

Adenocarcinoma*
Adenocarcinoma, Mucinous
Anaphylaxis
Biopsy
Diagnosis*
Humans
Lung Diseases
Lung Neoplasms
Lung*
Magnetic Fields
Magnetic Resonance Imaging*
Necrosis*
Neoplasm Staging
Pneumonia

Figure

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  Fig. 1 Sequential chest radiographs obtained at 4 months (a), 2 months (b) prior to visit, and at the time point of the visit (c) demonstrate increasing extent of poorly-defined consolidation in the left upper lobe. High resolution axial CT (d) shows an area of dense consolidation and ground-glass opacity in the left upper lobe.

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  Fig. 2 (a) Axial half-Fourier acquisition single shot turbo spin-echo (HASTE) MRI shows high signal intensity consolidation in the left upper lobe. Consolidation has signal intensity comparable to cerebrospinal fluid within the thoracic spinal canal (arrow). (b, c) Pre- and post-contrast volumetric interpolated 3D gradient-echo (VIBE) images show an area of heterogeneous enhancement, at the anterior apical portion of consolidation (arrow). The fat plane between the mass and adjacent vessels were relatively well-preserved, whereas the boundary between the mass and anterior pleura was not well-delineated (arrowheads). (d, e) Axial diffusion-weighted image obtained with a b factor of 800 s/mm2 shows an area of high signal intensity, with low apparent diffusion coefficient value at the corresponding area (arrows).

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  Fig. 3 CT-guided percutaneous core biopsy of the lung was performed targeting the area showing diffusion restriction.

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  Fig. 4 (a) Resected lung tumor specimen showing ill-defined whitish solid lesion (arrows) on the cut surface. (b, c) Hematoxylin-eosin stained specimen demonstrates invasive adenocarcinoma with gland formation and extensive necrosis (magnification of × 40 and × 400, respectively).

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