# Role of Cine-Magnetic Resonance Imaging in the Assessment of Mediastinal Masses with Uncertain/Equivocal Findings from Pre-Operative Computed Tomography Scanning

## TL;DR

Cine-MRI is more accurate than CT scans in determining if mediastinal tumors invade nearby blood vessels, helping guide better surgical decisions.

## Contribution

This study demonstrates that cine-MRI outperforms CT in detecting cardiovascular infiltration by mediastinal tumors with uncertain findings.

## Key findings

- Cine-MRI had a significantly higher negative predictive value (93%) compared to CT (54%) for cardiovascular infiltration.
- Cine-MRI showed greater sensitivity (91%) and accuracy (66%) than CT (16% and 50%, respectively).
- Cine-MRI provided better inter- and intra-observer agreement for infiltration detection.

## Abstract

Background: Malignant neoplasms originating from or involving the mediastinum represent a diagnostic and therapeutic challenge when they are in contact with nearby cardiovascular structures. We aimed to test the diagnostic accuracy of cine-magnetic resonance imaging (cine-MRI) in detecting the infiltration of cardiovascular structures in cases with uncertain or equivocal findings from contrast-enhanced Computed Tomography (CT) scanning. Methods: Fifty patients affected by tumors with a suspected invasion of mediastinal cardiovascular structures at the pre-operative chest CT scan stage underwent cine-MRI before surgery at our Institution. Intraoperative findings and the histological post-surgical report were used as a reference standard to define infiltration. Inter- and intra-observer agreement for CT scans and cine-MRI were also computed over a homogenous sample of 14 patients. Results: Cine-MRI had a higher negative predictive value (93% vs. 54%, p < 0.001) than CT scans, higher sensitivity (91% vs. 16%, p < 0.001), as well as greater accuracy (66% vs. 50%, p < 0.001) in detecting cardiovascular invasion. Cine-MRI also showed better inter- and intra-observer agreement for infiltration detection. Conclusions: Cine-MRI outperforms conventional contrast-enhanced chest CT scans in the preoperative assessment of cardiovascular infiltration by mediastinal or pulmonary tumors, making it a useful imaging modality in the preoperative staging and evaluation of patients with equivocal findings at the chest CT scan stage.