Imaging thoracic malignancy

The radiological detection of a thoracic neoplasm is often a straightforward exercise. The differentiation of a benign from a malignant lesion is much more challenging and has met with limited success. Computed tomography (CT) may help to differentiate a benign nodule from a malignant lesion but magnetic resonance imaging (MRI) plays no part in the evaluation of a coin lesion. Recent studies indicate MRI to be superior in the staging of bronchogenic carcinoma with reference to chest wall infiltration, mediastinal invasion and vascular involvement. It is now known that in the staging of nodal metastasis, both CT and MRI are less sensitive and specific than previously believed. CT remains the method of choice in the detection of pulmonary metastatic disease. Biopsy under imaging control has contributed significantly in the management of patients with thoracic malignancy. Both CT and MRI are used in the monitoring of patients under treatment. The postlobectomy or pneumonectomy space is best evaluated by MRI. This paper reviews the current status of imaging in the detection, staging and follow-up of patients with thoracic malignancy.