Nontraumatic Chest Wall Pain MRI Chest Chest MRI is often complementary to CT in comprehensive tissue characterization of chest wall neoplasms, defining their extent, and for planning of therapeutic interventions [15,27-30,38]. The soft-tissue contrast afforded by MRI may allow for tissue characterization of lesions, including differentiation of neoplastic processes from nonneoplastic mimics (eg, infection) [27,30,39]. Chest MRI also has been utilized for determining neurovascular involvement [40]. Some studies have shown added value of respiratory dynamic chest MRI in determination of chest wall invasion, defined as restricted movement of a tumor by the chest wall during breathing maneuvers [41,42]. One study of 61 patients whose static CT or MRI were equivocal for invasion showed respiratory dynamic chest MRI to have 100% sensitivity, 82.9% specificity, and 88.5% accuracy for predicting chest wall invasion with positive and negative predictive values of 74.1% and 100%, respectively [41]. False-positives occurred in the setting of pleural adhesions that restricted movement, but in most cases, they could be differentiated from true invasion at surgery [41]. Radiography Rib Views For focal chest wall pain in patients with suspected malignancy, a radiographic rib series may be helpful to assess for a rib lesion [16]. However, as for chest radiography, further characterization with CT, MRI, or nuclear medicine studies may be beneficial to detect radiographically occult lesions. US Chest Generally, US serves a limited role in the primary evaluation of suspected primary chest wall neoplasms but may serve a role in determining secondary invasion of the chest wall by intrathoracic tumors.
Nontraumatic Chest Wall Pain. Nontraumatic Chest Wall Pain MRI Chest Chest MRI is often complementary to CT in comprehensive tissue characterization of chest wall neoplasms, defining their extent, and for planning of therapeutic interventions [15,27-30,38]. The soft-tissue contrast afforded by MRI may allow for tissue characterization of lesions, including differentiation of neoplastic processes from nonneoplastic mimics (eg, infection) [27,30,39]. Chest MRI also has been utilized for determining neurovascular involvement [40]. Some studies have shown added value of respiratory dynamic chest MRI in determination of chest wall invasion, defined as restricted movement of a tumor by the chest wall during breathing maneuvers [41,42]. One study of 61 patients whose static CT or MRI were equivocal for invasion showed respiratory dynamic chest MRI to have 100% sensitivity, 82.9% specificity, and 88.5% accuracy for predicting chest wall invasion with positive and negative predictive values of 74.1% and 100%, respectively [41]. False-positives occurred in the setting of pleural adhesions that restricted movement, but in most cases, they could be differentiated from true invasion at surgery [41]. Radiography Rib Views For focal chest wall pain in patients with suspected malignancy, a radiographic rib series may be helpful to assess for a rib lesion [16]. However, as for chest radiography, further characterization with CT, MRI, or nuclear medicine studies may be beneficial to detect radiographically occult lesions. US Chest Generally, US serves a limited role in the primary evaluation of suspected primary chest wall neoplasms but may serve a role in determining secondary invasion of the chest wall by intrathoracic tumors.