Magnetic resonance tomography of the lungs with paramagnetic contrast enhancement in dynamic follow-up control of treatment of lung cancer in radiophobic patient: a case report

Abstract

Till now the facilities of MRI with paramagnetic contrast enhancement (CE-MRI) in detection of lung tumors remain underused and almost ignored. A clinical case of primary detection and prospective follow-up of lung cancer in a patient whose MRI of the chest revealed a tumor lesion — a central cancer of the left lung, in particular a lesion of the bronchus of the lower lobe of the left lung. MRI of the chest with paramagnetic contrast enhancement was carried out as part of the whole body CE-MRI study after the complex therapy of breast cancer, and both the primary lung tumor and metastatic lesion of mediastinal — subbifurcation lymph nodes were revealed. With a transbronchial biopsy, the diagnosis of lung cancer was verified. Chemotherapy (ChT) was started using the vinorelbin/ carboplatin regimen. After this, the CE-MRI has been carried out during the whole period of followup of anti-cancer chemotherapy. At the CE-MRI during the first course of ChT visually the complete regression of the disease, also with clinical remission was achieved. However, the ChT scheme was not fully completed due to the patient’s departure for urgent private reasons. Two months later, the patient was examined again according to the same CE-MRI protocol, while a relapse of the disease was detected with a more pronounced lesion of the mediastinal lymph nodes than during the initial treatment. ChT with vinorelbine/carboplatin was again carried out under the control CE-MRI, this time completely. According to the chest CE-MRI, visual remission was achieved, with the disappearance of nodular tumor at the site of the previously identified primary tumor of lung cancer and metastatic lesions of lymph nodes. Thus, it was the CE-MRI which provided the early diagnosis and adequate control of treatment of the lung cancer with extensive local lymph nodes spread. After this CE-MRI, the whole body PET with 18F-fluorodeoxyglucose (FDG) was also performed and no signs of relapse or continued tumor growth were revealed. Five months after this stage, the patient did persist to stay completely preserved clinically, at work and socially active. Thus, the chest CE-MRI can be employed for the follow-up of the tumor process in lung cancer, as necessary, without radiation exposure, without limiting the number and frequency of studies.