MRI Chest Chest MRI is valuable in the evaluation of patients after treatment of chest wall neoplasms and is superior to chest CT for detection of sites of residual or recurrent tumor after chest radiation or resection, especially using T1- weighted fat-suppressed sequences after administration of gadolinium-based contrast material [27]. MRI may also be used to determine the etiology of rib fractures in patients with known malignancy [63]. MRI has been also used in follow-up and response evaluation of patients with chest wall and breast desmoid tumors that developed after mastectomy and silicone implant augmentation [79]. Chest MRI may be a valuable tool in the early detection of sternal wound infections, given its high spatial resolution and soft-tissue contrast, but is limited by susceptibility artifacts related to sternotomy wires and other cardiac implants [69]. Radiography Rib Views There is no relevant literature to support the use of radiography rib views beyond chest radiography in the primary evaluation of chest wall pain in patients with prior chest wall intervention. US Chest Apart from targeted evaluation of the chest wall soft tissues for hematoma or abscess evaluation or treatment after chest wall surgery, US has a limited role. One study utilized sternal US to assess for sternal nonunion with dynamic compression and cortical sliding as a cause for poststernotomy chest pain [70]. WBC Scan Chest There is sparse literature to support the use of WBC scans in the primary evaluation of patients who present with chest wall pain after previous intervention. Quirce et al [80,81] compared the diagnostic performance of planar and SPECT WBC scans among 41 patients with suspected sternal infections after sternotomy, showing superior performance of SPECT over planar imaging for detection of infections at both 4 and 20 hours after injection and for differentiating superficial from deeper infections.
Nontraumatic Chest Wall Pain. MRI Chest Chest MRI is valuable in the evaluation of patients after treatment of chest wall neoplasms and is superior to chest CT for detection of sites of residual or recurrent tumor after chest radiation or resection, especially using T1- weighted fat-suppressed sequences after administration of gadolinium-based contrast material [27]. MRI may also be used to determine the etiology of rib fractures in patients with known malignancy [63]. MRI has been also used in follow-up and response evaluation of patients with chest wall and breast desmoid tumors that developed after mastectomy and silicone implant augmentation [79]. Chest MRI may be a valuable tool in the early detection of sternal wound infections, given its high spatial resolution and soft-tissue contrast, but is limited by susceptibility artifacts related to sternotomy wires and other cardiac implants [69]. Radiography Rib Views There is no relevant literature to support the use of radiography rib views beyond chest radiography in the primary evaluation of chest wall pain in patients with prior chest wall intervention. US Chest Apart from targeted evaluation of the chest wall soft tissues for hematoma or abscess evaluation or treatment after chest wall surgery, US has a limited role. One study utilized sternal US to assess for sternal nonunion with dynamic compression and cortical sliding as a cause for poststernotomy chest pain [70]. WBC Scan Chest There is sparse literature to support the use of WBC scans in the primary evaluation of patients who present with chest wall pain after previous intervention. Quirce et al [80,81] compared the diagnostic performance of planar and SPECT WBC scans among 41 patients with suspected sternal infections after sternotomy, showing superior performance of SPECT over planar imaging for detection of infections at both 4 and 20 hours after injection and for differentiating superficial from deeper infections.