MR imaging to detect chest wall and pleural involvement in patients with lymphoma: effect on radiation therapy planning.

OBJECTIVE: The purpose of this study was to determine the influence that accurate MR detection of chest wall and pleural disease has on the type and extent of radiation therapy subsequently performed in patients with thoracic lymphoma.

MATERIALS AND METHODS: MR images and CT scans of the chests of 57 patients who had biopsy-proved lymphoma were retrospectively examined for evidence of involvement of the chest wall and pleura. For patients with thoracic lymphoma, we compared radiation portals and dosage designed by using information from MR images with portals and dosage designed by using information from chest radiographs and CT scans.

RESULTS: Chest wall or pleural disease was detected in 22 of the 57 patients examined. Chest wall disease was identified on MR images in 20 patients (29 sites) and pleural disease in 14 patients (16 sites). Chest wall and pleural disease were identified on CT scans in seven and five patients, respectively. Of the 15 patients who received radiation therapy, three (20%) had treatment planning altered, either by increasing the area exposed to radiation or by increasing the radiation dose, because of findings noted only on MR images.

CONCLUSION: Chest wall and pleural sites of disease that may be detected only on MR images can be important in designing appropriate radiation portals and dosage for patients who have chest lymphoma.