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4D-MRI analysis of lung tumor motion in patients with hemidiaphragmatic paralysis
Julien Dinkel1, Christian Hintze, Ralf Tetzlaff
1Department of Radiology, German Cancer Research Center, Heidelberg, Germany. j.dinkel@dkfz-heidelberg.de
Purpose:
To investigate the complex breathing patterns in patients with hemidiaphragmatic paralysis due to malignant infiltration using four-dimensional magnetic resonance imaging (4D-MRI).
Patients And Methods:
Seven patients with bronchial carcinoma infiltrating the phrenic nerve were examined using 1.5 T MRI. The motion of the tumor and of both hemi-diaphragms were measured on dynamic 2D TrueFISP and 4D FLASH MRI sequences.
Results:
For each patient, 3-6 breathing cycles were recorded. The respiratory-induced mean cranio-caudal displacement of the tumor was 6.6 mm (+/-2.8 SD). The mean displacement anterior-posterior was 7.4 mm (+/-2.6), while right-left movement was about 7.4 mm (+/-4.5). The mediastinum moved sidewards during inspiration, realizing a "mediastinal shift". The paralyzed hemidiaphragm and the tumor showed a paradox motion during respiration in five patients. In two patients, the affected hemidiaphragm had a regular, however minimal and asynchronous motion during respiration. Respiratory variability of both tumor and diaphragm motions was about 20% although patients were instructed to breath normally. The findings showed significant differences compared to breathing patterns of patients without diaphragm dysfunction.
Conclusion:
4D-MRI is a promising tool to analyze complex breathing patterns in patients with lung tumors. It should be considered for use in planning of radiotherapy to account for individual tumor motion.
