Hyperpolarized Xe-129 gas MRI allows for improved contrast of the lung parenchyma with techniques allowing for the evaluation of anatomical and functional data [48]. These techniques are still in their infancy and will likely require future studies to evaluate their role in imaging in chronic cough. In 2014, Ackman et al [44] surveyed thoracic radiologists from the Society of Thoracic Radiology regarding utilization of nonvascular thoracic MRI. Respondents offered an insight into the underutilization of thoracic MRI. Challenges in implementing MRI into clinical practice were described, including ordering health care provider awareness, lack of training, and technical, as well as administration hurdle. Variant 2: Chronic cough lasting more than 8 weeks. Increased risk for lung cancer. Initial imaging. Radiography Chest Chest radiography is often performed early in the investigation of chronic cough and is recommended by the ACCP [1]. There was no literature that addressed this modality in the setting of chronic cough with risk factors for lung cancer. In each of the available prospective case series evaluating standardized clinical protocols for chronic cough, there was a diagnosis of malignancy in 2 of 131 [7] and 2 of 122 [17] patients assessed, all of whom had initial chest radiography. Both studies reported that clinical and radiographic findings led to increased suspicion of malignancy. In a retrospective analysis of patients with chronic cough who had normal chest radiographs, 2 out of 266 diagnosis were determined to be malignant. Both patients had suspicious clinical findings, which prompted further evaluation with chest CT [16]. Cough has been shown to be a prevalent symptom in patients with lung cancer [49,50], with 57% consecutive patients with lung cancer reporting cough as a symptom (n = 223). The exact prevalence of malignancy in a population with chronic cough is not well documented and likely <1% to 2% from the small collection of case series Chronic Cough reviewed.
Chronic Cough. Hyperpolarized Xe-129 gas MRI allows for improved contrast of the lung parenchyma with techniques allowing for the evaluation of anatomical and functional data [48]. These techniques are still in their infancy and will likely require future studies to evaluate their role in imaging in chronic cough. In 2014, Ackman et al [44] surveyed thoracic radiologists from the Society of Thoracic Radiology regarding utilization of nonvascular thoracic MRI. Respondents offered an insight into the underutilization of thoracic MRI. Challenges in implementing MRI into clinical practice were described, including ordering health care provider awareness, lack of training, and technical, as well as administration hurdle. Variant 2: Chronic cough lasting more than 8 weeks. Increased risk for lung cancer. Initial imaging. Radiography Chest Chest radiography is often performed early in the investigation of chronic cough and is recommended by the ACCP [1]. There was no literature that addressed this modality in the setting of chronic cough with risk factors for lung cancer. In each of the available prospective case series evaluating standardized clinical protocols for chronic cough, there was a diagnosis of malignancy in 2 of 131 [7] and 2 of 122 [17] patients assessed, all of whom had initial chest radiography. Both studies reported that clinical and radiographic findings led to increased suspicion of malignancy. In a retrospective analysis of patients with chronic cough who had normal chest radiographs, 2 out of 266 diagnosis were determined to be malignant. Both patients had suspicious clinical findings, which prompted further evaluation with chest CT [16]. Cough has been shown to be a prevalent symptom in patients with lung cancer [49,50], with 57% consecutive patients with lung cancer reporting cough as a symptom (n = 223). The exact prevalence of malignancy in a population with chronic cough is not well documented and likely <1% to 2% from the small collection of case series Chronic Cough reviewed.