MR Imaging of Mediastinal Masses

The mediastinum contains vital vascular and nonvascular structures and organs, and a wide variety of abnormalities may arise from this region of the thorax. Although mediastinal masses may be initially detected on chest radiography, cross-sectional imaging plays an important role in the identification and evaluation of mediastinal lesions, enabling the formulation of focused differential diagnoses and ultimately guiding management. Computed tomography (CT) is considered the imaging modality of choice for evaluating most mediastinal masses; however, the role of magnetic resonance (MR) imaging continues to expand, as it is superior to CT in differentiating between cystic and solid masses, identifying cystic and solid components within complex lesions, and distinguishing thymic hyperplasia and normal thymus from thymic epithelial neoplasms and other neoplasms. In addition, it facilitates the staging and restaging of patients with thymic epithelial neoplasms and other tumors that cannot undergo contrast-enhanced CT imaging due to severe contrast allergy and/or impaired renal function. As division of the mediastinum into specific compartments is beneficial for diagnostic and treatment planning purposes and facilitates communication between clinicians in a multidisciplinary setting, a new classification model based on cross-sectional imaging has been developed by the International Thymic Malignancy Interest Group (ITMIG) and accepted as a new standard. In this article, we describe the role of MR imaging in the evaluation of mediastinal masses in conjunction with the new mediastinal compartment classification system introduced by ITMIG.