A chest MRI uses powerful magnets and radio waves to create pictures of the body.

Conventional radiography and computed tomographic (CT) imaging use potentially harmful radiation (x-rays) that passes through a patient to generate images. Magnetic resonance imaging (MRI) is based on the magnetic properties of atoms, and there is no exposure to the same type of radiation used in x-rays and CT scans.

A powerful magnet generates a magnetic field roughly 10,000 times stronger than the Earth's. A very small percentage of hydrogen atoms within the body will align with this field. Radio wave pulses are broadcast towards the aligned hydrogen atoms in tissues of interest, returning a signal of their own. The slight differences of those signals from different tissues enables MRI to tell the difference between various organs, and potentially, provide contrast between benign and malignant tissue.

Any imaging angle, or "slice", can be projected, and then stored in a computer or printed on film. MRI can easily be performed through clothing and bones. However, certain types of metal in or around the area of interest can cause significant errors in the reconstructed images.

Since MRI makes use of radio waves very close in frequency to those of ordinary FM radio stations, the scanner must be located within a specially shielded room to avoid outside interference. The patient will be asked to lie on a narrow table that slides into a large, tunnel-like tube within the scanner.

If contrast dye is used, it will be injected into a small vein of the hand or forearm. A technologist will operate the machine and observe you during the entire study from an adjacent room.

Several sets of images are usually required, each taking from 2 to 15 minutes. Depending on the sequences performed and the possibility of the need for a contrast dye, a complete scan may take up to a hour or more. Newer scanners with more powerful magnets, updated software, and advanced sequences may complete the process in less time.

No special tests, diets, or medications are usually needed. An MRI may be performed immediately after other imaging studies.

Because of the strong magnets, certain metallic objects are not allowed into the room. Items such as jewelry, watches, credit cards, and hearing aids can be damaged. Pins, hairpins, metal zippers, and similar metallic items can distort the images. Removable dental work should be taken out just prior to the scan. Pens, pocketknives, and eyeglasses can become dangerous projectiles when magnet is activated and should not accompany the patient into the scanner area.

Because the strong magnetic fields can displace or disrupt the action of implanted metallic objects, people with cardiac pacemakers cannot be scanned and should not enter the MRI area. MRI also should not be used for people with metallic objects in their bodies such as inner ear (cochlear) implants, brain aneurysm clips, some artificial heart valves, older vascular stents, and recently placed artificial joints. The technologist will usually provide you with a questionnaire which lists the potentially dangerous items.

Sheet metal workers, or persons with similar potential exposure to small metal fragments, will first be screened for metal shards within the eyes with x-rays of the skull. The patient will be asked to sign a consent form confirming that none of the above issues apply before the study will be performed.

A hospital gown may be recommended, or the patient may be allowed to wear a sweatsuit or similar clothing without metal fasteners.

There is no pain. The magnetic field and radio waves are not felt. Some people experience a claustrophobic feeling from being inside the scanner. The table may be hard or cold, but you can request a blanket or pillow.

The machine produces loud thumping and humming noises during normal operation. Ear plugs are usually given to the patient to reduce the noise. A technologist observes the patient during the entire procedure and may be spoken to through an intercom in the scanner. Some MRI scanners are equipped with televisions and special headphones to help the examination time pass.

Excessive movement can blur MRI images and cause errors in the image. If the patient has difficulty lying still or is very anxious, they may be given medicine to relax them (a sedative), by mouth or through a vein. There is no recovery, unless sedation was necessary. After an MRI scan, you can resume normal diet, activity, and medications.

A chest MRI provides detailed pictures of tissues within the chest cavity, without image blocking by overlying bone. It may be used to:

• Clarify findings from previous x-rays or CT scans
• Show the structures of the chest from multiple angles
• Help diagnose abnormal growths and provide information for the staging (such as the size, extent, and spread) of tumors in the chest cavity; MRI can distinguish tumors or other lesions from normal tissues
• Show lymph nodes and blood vessels
• Evaluate blood flow
• Avoid the dangers of angiography, or of repeated exposure to radiation.

A normal MRI would not show any abnormalities in the size or position of organs in the chest cavity, as viewed from any angle. The MRI would not reveal any new growths or lesions. Organs would appear to be functioning normally (for those organs where MRI can show function).

The sensitivity of MRI depends, in part, on the experience of the radiologist.

A chest MRI may reveal disorders including:

• Thymus tumor
• Lung masses
• Esophageal mass (clumping together of cells in the esophagus)
• Other masses or tumors of the chest
• Abnormal lymph nodes
• Swollen glands and enlarged lymph nodes in any location of the chest
• Chronic Obstructive Pulmonary Disease (COPD)
• Bronchial abnormalities
• Bronchiectasis
• Cystic lung lesions
• Pleural abnormalities, including thickening or pleural effusion
• Abnormal pulmonary vessels
• Coarctation of the aorta
• Aortic stenosis
• Aortic dissection
• Pericardial effusion
• Thoracic aortic aneurysm

• Atrial myxoma
• Atrial septal defect
• Cardiac tamponade
• Ischemic cardiomyopathy
• Mitral regurgitation - acute
• Mitral regurgitation - chronic
• Staging of tumors including invasion of blood vessels
• Mitral valve prolapse
• Bacterial pericarditis
• Constrictive pericarditis
• Pericarditis after heart attack
• Pulmonary edema
• Restrictive cardiomyopathy
• Skin lesion of histoplasmosis
• SVC obstruction

There is no ionizing radiation involved in MRI. To date, there have been no documented significant side effects of the magnetic fields and radio waves used on the human body during an MRI scan.

The most common MR intravenous contrast agent, gadolinium, is very safe, and although there have been documented allergic reactions to it, it is an extremely rare occurrence. However, gadolinium should not be given if you are pregnant because of potential harm to the fetus.

If sedation is used, there are associated risks of over-sedation. The technologist monitors the patient's vital signs, including heart rate and breathing as needed.

People have been harmed in MRI machines when they did not remove metal objects from their clothes or when metal objects were left in the room by others.

MRI is more accurate than CT scan or other tests for certain conditions, but less accurate for others. The disadvantages include the high cost, long duration of the scan, and sensitivity to movement. People with claustrophobia (fear of enclosed spaces), or people who are confused or anxious, may have difficulty lying still for the relatively long scan times.

MRI is not portable and is incompatible with some metallic implants, life support-devices, traction apparatus, and similar equipment.

MRI is a superior technique in most cases where telling differences in soft tissues is necessary. It can show organs without blockage by bone and foreign bodies. It can show the tissues from multiple viewpoints and is a noninvasive way to evaluate blood flow. Currently, MRI is not valuable in the evaluation of slight changes of the lung tissue, since the lungs contain mostly air and are difficult to image.