CHEST CT AND

MR
IMAGING
 CT IMAGING: uses radiation that
passes through a patient to generate
images

 MR IMAGING: uses radiowaves

passing through a powerful magnetic
field to generate images.
 CT OF THE CHEST
 mainstay in the work up for chest
diseases

 integral part of the chest radiologist’s

imaging armamentarium
NORMAL CHEST CT
 INDICATIONS OF CHEST
CT
LUNG:
-evaluation and staging of primary
pulmonary neoplasm
-detection of pulmonary metastases
-characterization of pulmonary nodules
-characterization of focal and diffuse
lung diseases
-guidance in needle biopsy
MEDIASTINUM
-causes of mediastinal widening
-staging of tumors that spread to
mediastinum
-characterization of mediastinal
masses
myasthenia gravis- thymic mass
hyperparathyroidism- ectopic
adenomas
PLEURA
- localization and determination of the
extent of:
plaques
masses
loculated fluid
occult calcification
CHEST WALL
- study of masses involving soft
tissues, bone, spinal canal and
adjacent lung

* CT helpful in patient with HISTORY

OF TRAUMA involving the pleura,
chest wall, mediastinum and lung.
 HIGH RESOLUTION CT
(HRCT)
 uses narrow-beam collimator (1 to
1.5 mm slice sections at 10 mm
intervals)
 uses high spatial-frequency, edge-
enhancing algorithm

* Improved spatial resolution of CT

images of the LUNG PARENCHYMA-
visualized the secondary pulmonary
lobule
NORMAL HRCT
NORMAL HRCT
 INDICATIONS OF HRCT
 interstitial lung disease
 bronchiectasis
 emphysema
 cystic lung disease
 NORMAL CHEST CT
9 BASIC LEVELS
1. thoracic inlet and sternoclavicular
junction
2. crossing left brachiocephalic vein
3. aortic arch
4. aortopulmonary window
5. left pulmonary artery
6. main and right pulmonary artery
7. left atrium
8. cardiac ventricles
9. retrocrural space
 THORACIC INLET &
STERNOCLAVICULAR JUNCTION
 CROSSING LEFT
BRACHIOCEPHALIC VEIN
AORTIC ARCH
AORTOPULMONARY
WINDOW
LEFT PULMONARY
ARTERY
 MAIN AND RIGHT
PULMONARY ARTERY
LEFT ATRIUM
CARDIAC VENTRICLES
RETROCRURAL SPACE
 PULMONARY HILA
 main bronchi, pulmmonary arteries,
sup and inf pulmonary veins, normal
hilar lymph nodes
 NOT SEEN: lymphatic vessels, nerve
plexi and areolar tissues
 FISSURES
 indistinct broad lucent band with
paucity of vascular markings
(tapering of pulmonary vessels)
 discrete line (if vertical axis is
perpendicular to the plane of CT
section)
 SOLITARY PULMONARY
NODULE
 intraparenchymal opacity
 3 cm or less in diameter
 completely surrounded by lung
 without mediastinal adenopathy or
atelectasis
 Initial evaluation of SOLITARY
PULMONARY NODULE – comparison
of previous chest radiographs

* ABSENCE of growth for 2 years is

indicative of a BENIGN lesion.
 BENIGN NODULE
 ground glass opacity
 preserved bronchovascular margins
 sharp margin
 central, diffuse or lamellar
calcifications
 enhances less than 15 HU
BENIGN NODULE
BENIGN NODULE
 MALIGNANT NODULE
 solid or mixed type
 obscured bronchovascular margins
 irregular or spiculated margin
 eccentric calcification
 enhances more than 25 HU
MALIGNANT NODULE
PULMONARY NODULES

EDGE ANALYSIS
benign - sharp, smooth, slightly lobulated
malignant - spiculated
PATTERNS OF CALCIFICATION
benign - central calcification
malignant - eccentric calcification
BRONCHOGENIC CA
BRONCHOGENIC CA
 BRONCHIECTASIS
 Irreversible dilatation of the bronchi

3 forms:
1. cylindrical (tubular) - “tram-
tracks” sign
2. varicose - beaded
dilatation
3. cystic (saccular) - “cluster of
grapes” sign
 BRONCHIECTASIS
 CARDINAL SIGNS
- dilated bronchi
- bronchial wall thickening
- signet ring (dilated bronchus with
smooth
mural thickening)
- branching V or Y shaped structures
or large
dots (filled with mucus plugs)
BRONCHIECTASIS
 PULMONARY
EMPHYSEMA
 abnormal permanent enlargement of
the air spaces distal to terminal
bronchioles, accompanied by
destruction of alveolar walls and
without obvious fibrosis
4 TYPES:
1. centrilobular
2. panlobular
3. paraseptal
4. paracicatricial
 PULMONARY
EMPHYSEMA
 CT FEATURES:
- areas of decreased attenuation
without visible
walls
- pruning of pulmonary vessels
- pulmonary vessel distortion
- decreased lung density gradient
PULMONARY
EMPHYSEMA
PTB
PTB
CONSOLIDATION
CONSOLIDATION
 EMPYEMA
 infected exudative pleural effusion
containing pus
 CT features:
- thickened adjacent visceral and
parietal
pleura
- edema/inflammation of
extrapleural tissues
- “split pleural” sign ( marked
contrast
EMPYEMA
 PULMONARY
METASTASES
 HEMATOGENOUS : multiple nodules
of varying sizes or solitary nodule
PUMONARY METASTASES
WITH PLEURAL EFUSION
 PULMONARY
METASTASES
 LYMPHANGITIC: irregular
thickening of bronchovascular
bundles and interlobar septum,
beaded septum sign
 MRI OF THE CHEST
 limited applications in the lungs

 more accurate for detection of chest

wall and mediastinal invasion or
cardiac/vascular involvement
DISADVANTAGES OF MRI
 poor imaging of lung parenchyma
(low proton density of lung, air-
tissue interfaces)
 motion artifacts (respiration, cardiac
pulsation, blood flow)
 low signal of calcium
 claustrophobic patients , metallic
implants, life- support devices, etc.
 longer duration of scanning
 higher cost
BRONCHOGENIC CA WITH
SUBCARINAL
ADENOPATHIES
INDICATIONS OF CHEST MRI
 suspected aortic disease
 superior sulcus tumor
 brachial plexus mass
 paramediastinal/mediastinal masses
 juxtadiaphragmatic masses
 chest wall lesions
 central pulmonary artery disorders
GANGLIONEUROMA
LYMPHOMA
BRONCHOGENIC CA


THANK
 YOU
 THYROID CA WITH
BILATERAL PLEURAL
EFFUSION
CHONDROSARCOMA
LIPOMA