Chest MRI Recognition Pattern

Systematic approach to interpreting chest MRI with protocols, anatomical landmarks, and pathological patterns

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1. Essential Sequences

A. Standard Protocols

• • T1-weighted:
  - Anatomical detail
  - Mediastinal fat evaluation
  - With/without fat saturation
• • T2-weighted:
  - Pathological changes
  - Fluid-sensitive (STIR for edema)
  - TRUFI for motion resistance
• • DWI (b=50-1000):
  - Restricted diffusion in tumors/lymph nodes
  - ADC thresholds: <1.0 suspicious

B. Contrast-enhanced Imaging

• • Dynamic CE-MRI:
  - Arterial (20-30s)
  - Venous (60-90s)
  - Delayed (3-5min)
• • MR Angiography:
  - Time-resolved (4D)
  - ECG-gated for aortic root

2. Anatomical Landmarks

Structure

Key Features

Pathology Clues

Mediastinum

Fat planes, lymph node stations

LN >1cm short axis, necrosis

Pleura

<2mm thickness normally

Nodularity, enhancement

Chest Wall

Muscle/fat layers

T2 hyperintensity, enhancement

Diaphragm

Low T1/T2 signal

Eventration, rupture

3. Lung Parenchyma Patterns

A. Focal Lesions

Lesion

T1

T2

Enhancement

Solid nodule

Iso

Hyper

Homogeneous

GGN

Hypo

Hyper

Minimal

Cyst

Hypo

Very hyper

None

B. Diffuse Disease

• • Fibrosis:
  - Reticular T2 hyperintensity
  - Traction bronchiectasis
• • Pneumonia:
  - Consolidation + air bronchograms
  - T2 hyperintense

4. Vascular Assessment

A. Aortic Pathology

• • Dissection:
  - Intimal flap
  - Differential flow in true/false lumen
  - Delayed false lumen enhancement
• • Aneurysm:
  - Diameter >4cm ascending, >3cm descending
  - Thrombus evaluation

B. Pulmonary Vessels

• • PE:
  - Filling defects on MRA
  - Right heart strain signs
• • AVM:
  - Flow voids
  - Early venous drainage

5. Mediastinal Mass Evaluation

Compartment

Common Masses

MRI Features

Anterior

Thymoma, lymphoma, teratoma

T1/T2 heterogeneity, fat in teratomas

Middle

Lymph nodes, foregut cysts

Cysts: T2 hyperintense, no enhancement

Posterior

Neurogenic tumors

Dumbbell shape, neural foramina extension

6. Pediatric Applications

A. Common Indications

• • Airway compression:
  - Vascular rings
  - Tracheomalacia (cine MRI)
• • Congenital lesions:
  - CPAM
  - Bronchopulmonary sequestration

B. Protocol Adjustments

• • Free-breathing:
  - Radial sampling
  - Compressed sensing

7. Structured Report

• 1. Technique: Sequences, contrast use
• 2. Lungs:
  - Nodules/masses
  - Diffuse abnormalities
• 3. Mediastinum:
  - Lymph nodes
  - Mass characteristics
• 4. Vascular:
  - Aortic dimensions
  - Thrombus/emboli
• 5. Chest Wall/Pleura

Always correlate with available CT findings. For lung nodules, measure consistently and compare with prior imaging. Use DWI for lymph node characterization but confirm with size/morphology. In vascular cases, compare multiple phases. For pediatric patients, minimize sedation time with rapid protocols. Document incidental findings (adrenal nodules, bone lesions) with appropriate follow-up recommendations.

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