Evolving Indications, Technical Quality, Diagnostic Outcomes, and Utilization Patterns of Chest Magnetic Resonance...

To characterize longitudinal trends in clinical indications, technical quality, diagnostic outcomes, and demographic patterns of chest magnetic resonance imaging (MRI) at a US quaternary care center over 25 years.

This institutional review board-approved retrospective cohort study analyzed 3730 consecutive chest MRI examinations performed between August 2001 and April 2026 at a US quaternary care academic medical center. Clinical indications and technical quality assessment were extracted from radiology report narratives, normalized, and classified into 7 major categories. Differences in indication and diagnosis distributions between cohorts were evaluated using the χ2 test; age was compared using the independent-samples t test.

A total of 3730 examinations were included (mean patient age 34.0 ± 23.4 y; 55.1% females). Annual volume peaked at 270 in 2012 with a resurgence to 172 in 2025. The share of vascular indications declined from 70.9% of early-era examinations (2001-2005) to 23.5% in the recent era (2020-2025), while oncologic indications increased from 10.9% to 36.8% (both P < 0.001). Confirmed aortic/vascular pathology fell from 17.3% to 2.1%; malignant diagnoses increased from 3.2% to 10.2% (P < 0.001). Documented motion artifact decreased from the early to recent era (5.3% vs. 3.3%; P = 0.046).

Chest MRI utilization has shifted significantly over 25 years from predominantly vascular to oncology-driven indications, with stable diagnostic yield. Technical examination quality limitations were significantly more frequent during off-hours.