While substantial technical progress has been made in high-field-strength MR imaging systems, relatively little evidence has been published regarding their added clinical value.

In an article appearing in the April issue of Radiology (RSNA.org/radiology), Christiane K. Kuhl, M.D., of the University of Bonn, and colleagues detail the current use of body high-field-strength MR in clinical patient care, as well as published evidence regarding its difficulties or advantages. Interpreting data from the perspective of a clinical radiologist, the authors address applications of high-field-strength MR imaging in:

• Cardiac
• Breast
• Abdomen
• Pelvis
• Musculoskeletal
• Pediatric
• MR spectroscopy

MR of the knee in a 26-year-old male patient with vertical femoral cartilage tear and joint effusion. Value of parallel imaging and dedicated multielement extremity coils for fast, highspatial-resolution extremity imaging by using an 8-element phased-array coil at 3.0 T. (a) Sagittal intermediate-weighted turbo spin echo image. (b) Transverse intermediate-weighted driven equilibrium, or DRIVE, sequence with fat suppression.

(Radiology 2008;247:16–35) © RSNA, 2008. All rights reserved. Printed with permission.

"Good or bad, it appears that the new technology is embraced and used clinically," Dr. Kuhl and colleagues write. "This is certainly not the first time for this to happen in the history of diagnostic imaging—there is only a very limited number of studies comparing 1.5 T imaging with MR at a lower field strength, after all. It seems natural to use an improved tool once it is available. However … there is a clear and urgent need for scientific data to establish the advantage of high-field-strength MR in clinical patient care."

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Imaging of Non-Small Cell Lung Cancer of the Superior Sulcus—Part 1: Anatomy, Clinical Manifestations, and Management and Part 2: Initial Staging and Assessment of Resectability and Therapeutic Response

Imaging is critical in diagnosing and staging superior sulcus tumors, assessing their resectability, determining the optimal disease management approach and evaluating response to therapy. CT, MR and positron emission tomography (PET)/CT contribute important and complementary information.

In a pair of articles in the March-April issue of RadioGraphics (RSNA.org/radiographics), John F. Bruzzi, F.F.R.R.C.S.I., and colleagues at M.D. Anderson Cancer Center in Houston describe the optimal methods for diagnostic imaging and management of superior sulcus tumors. In particular, the authors emphasize:

• Knowing the superior sulcus anatomy and patient-specific clinical manifestations

• Delineating local-regional extension and detecting nodal metastases

• Understanding the applicability of therapeutic modalities including surgery, irradiation and chemotherapy

• Identifying the imaging features on radiography, thoracic CT and MR imaging

Coronal (a) and sagittal (b) CT images, obtained at the level of the left superior sulcus for planning of intensity-modulated radiation treatment (IMRT) of an unresectable superior sulcus tumor, show the curve that will result in the delivery of a radiation dose of 66 Gy to the planned target volume. The use of intensity-modulated radiation therapy allows the targeted delivery of a dose of as much as 70 Gy with minimal toxic effects on the surrounding anatomy. Knowledge of the radiation treatment plan is useful when interpreting follow-up images.

"Because of the close and complex relationships among the anatomic structures in the thoracic inlet, optimal imaging requires a multiplanar and multimodality approach in which information obtained from CT, alone or with PET, is combined with that obtained from MR imaging," Dr. Bruzzi and colleagues write. "The usefulness of the imaging findings is enhanced by the radiologist's knowledge of the patient's symptoms and thorough understanding of the therapeutic options available."

Part 1 of this series meets the criteria for 1.0 AMA PRA Category 1 Credit^TM.

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