pulmonary, and pleural disease. In fact, it would be easy to forget the developments in other modalities and lose sight of the position of MRI in the greater range ...
JOURNAL OF MAGNETIC RESONANCE IMAGING 32:1273–1274 (2010)
Introduction
Special Issue: Thoracic Imaging Pulmonary diseases in general are continuing to show an unabated upward trend in incidence, which is causing an increasing burden on society and significant economic costs including treatment, days in hospital, and those associated with morbidity and disability. Respiratory diseases affect people of all ages, from childhood to adulthood, while one in five people die from respiratory diseases alone. In recent years, lung cancer has become the number one killer among women, overtaking breast cancer. Magnetic resonance imaging (MRI) has increasingly been expanded for visualization of a range of thoracic organs, structures, and function, including cardiac, pulmonary, and pleural disease. In fact, it would be easy to forget the developments in other modalities and lose sight of the position of MRI in the greater range of imaging options open to both clinicians and researchers. The contributors of this special issue were carefully selected from a multidisciplinary and multimodality meeting, The Future of Quantitative and Functional Lung Imaging, held in Coralville, Iowa, in October 2008. We are grateful for their contributions, which put these developments into the greater context of multimodality approaches to lung function and pathology. In this Introduction we highlight some of the important new developments in lung imaging. Clearly, the issue is meant to set the scene for improving multimodality approaches, as some of the techniques are resulting in significant radiation burden, an area where MRI has a lot to offer. However, it is also equally important to recognize the importance of quantification for any technique to be clinically useful in the long term, as there is a need for refined assessment to provide a more robust overview of disease status and to be able to measure therapy response in individual patients. Lastly, the applications of contrast agents can offer highly useful measures of function, both through inhalation of contrast agents (eg, hyperpolarized noble gas MRI) or through ultrafast imaging of intravenously administered agents (eg, perfusion/blood flow imaging). The special issue is divided in two main parts. In the first part (clinical applications) we tried to address the main pathologies in the chest, including mediastinal disease, pleural disease, lung nodules, pulmonary vascular disease, and cystic fibrosis. In the second
DOI 10.1002/jmri.22409 View this article online at wileyonlinelibrary.com. C 2010 Wiley-Liss, Inc. V
part we tried to group some novel approaches to chest imaging incorporating molecular and functional imaging, modeling, and finally the interactions between genetic assessment and imaging of common pathologies like asthma and chronic obstructive pulmonary disease (COPD). It is particularly important to recognize that a significant amount of work is being done to reduce the radiation dose in chest computed tomography (CT) imaging. Thus, it is now feasible to perform CT scans of the chest with less than 10% of the dose compared to 5 years ago. In view of these protocol adaptations, the old-fashioned high-resolution CT scan of the chest is being left behind and volumetric as well as functional imaging are becoming feasible at radiation doses that are acceptable for use in patients. This in turn paves the way for much wider applications, and given the ease of access of most CT scanners (when compared to MRI), this modality is a real competitor to MRI in many respects. Molecular imaging with positron emission tomography (PET) has developed into a real workhorse for the staging of lung cancer. What is more, novel biomarkers are continuing to be developed, allowing probing of new structures and function within the chest and beyond. In addition, hardware improvements have reduced the required time to carry out PET scans by as much as 50%, while incorporation of dual modalities (including CT and MRI) now offers unprecedented combined functional/metabolic and anatomic imaging during a single investigation. MRI continues to have several major advantages, including absence of radiation and the ultrafast imaging potential which helps study moving organs as well as dynamic vascular phenomena. The use of MRI continues to expand, particularly when studying young patients or those where repeated imaging is contemplated, while studies of physiology in normal subjects clearly benefit from MRI methodologies. Finally, several large projects are ongoing which try to determine genetic factors in the development of some of the major lung diseases in adults (COPD) and the younger population (asthma). Imaging plays a pivotal role for the phenotyping of these populations, and is extensively used as a biomarker to detect subpopulations that are more or less affected. We hope that this special issue will help provide insight into the position of MRI within the field of thoracic imaging and that the enthusiasm continues unabated in bringing the best imaging methods to good use, thus
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increasing our understanding of chest diseases and helping us serve our patients better in the future. ACKNOWLEDGMENTS We thank Drs. W. Gefter, H. Hatabu, E. Hoffman, and R. Rizi of the organizing committee, the chairpersons of the scientific sessions (Drs. J. Barton, J. Gee, M. Graham, H. Jones, S. Ley, C-L. Lin, G. McLennan, W. Mitzner, A. Mehta, J. Newell, K. Prisk, B. Simon, M. Sonka, M. Tawhai, S. Verbanck, M. Welch, and J. Wild), and the speakers, participants, and sponsors of the aforementioned meeting. We thank Mrs. A. Thompson for assis-
Introduction
tance with the meeting organization. Last but not least, we thank the JMRI editorial office staff for their unwavering support to complete this project. Edwin J.R van Beek, MD, PhD, FRCR SINAPSE Chair of Clinical Radiology University of Edinburgh Edinburgh, Scotland, UK Hans-Ulrich Kauczor, MD Chair of Radiology University of Heidelberg Heidelberg, Germany
