W460 AJR:197, September 2011 PET/CT FDG activity provides information re- garding the metabolic status of chest wall masses but only limited additional diagnos- tic information regarding the primary lesion. It is most useful in providing data on region- al and distant metastases and in choosing the most metabolically active area for biopsy. Imaging-Guided Biopsy Chest wall lesions are usually amenable to imaging-guided percutaneous biopsy with CT or ultrasound. Review of CT, MRI, and PET/CT findings allows the percutaneous ap- proach to be formulated. Directing biopsy to- ward areas of enhancing or metabolically ac- tive soft tissue within the lesion will avoid an inadequate specimen resulting from tumor necrosis. PET/CT can be particularly helpful in confirming areas of viable tumor with FDG uptake in a large chest wall lesion or nodal metastases, which may be easier to access. Scenario 1 Clinical History A 76-year-old man with a remote history of aortic and mitral valve replacement presented with acute left chest wall pain. There was no his- tory of significant trauma. ECG showed no evi- dence of an acute myocardial event. On clinical examination, the patient had pain, tenderness, and swelling in the left anterolateral chest wall. There were no systemic symptoms or history of fever, and serum WBC count was normal. A chest radiograph and MRI were obtained. Radiology of Chest Wall Masses Charles P. Mullan 1 Rachna Madan 2 Beatrice Trotman-Dickenson 2 Xiaohua Qian 3 Francine L. Jacobson 2 Andetta Hunsaker 2 Mullan CP, Madan R, Trotman-Dickenson B, Qian X, Jacobson FL, Hunsaker A 1 Department of Radiology, Altnagelvin Hospital, Londonderry BT46 5QR, Northern Ireland. Address correspondence to C. P. Mullan (cpmullan@hotmail.com). 2 Department of Radiology, Brigham & Women’s Hospital, Boston, MA. 3 Department of Pathology, Brigham & Women’s Hospital, Boston, MA. Cardiopulmonary฀Imaging฀•฀Review CME This article is available for CME credit. See www.arrs.org for more information. WEB This is a Web exclusive article. AJR 2011; 197:W460–W470 0361–803X/11/1973–W460 © American Roentgen Ray Society Choosing an Imaging Technique Radiography Chest radiographs and dedicated views of the ribs and sternoclavicular joints provide basic information regarding the site of the lesion and reveal osseous changes. Radio- graphs are especially useful in the setting of trauma, infection, and osseous tumors. Ultrasound Superficial chest wall lesions can be char- acterized with ultrasound imaging, and these lesions are amenable to biopsy with ultra- sound guidance. CT CT is the workhorse of diagnostic imag- ing for chest wall lesions and provides good spatial resolution, including depiction of os- seous and soft-tissue structures. MDCT en- ables imaging of a large tissue volume in a short acquisition time, reducing the effect of respiratory motion in the thorax. CT reveals mineralization and bony involvement and helps in narrowing the differential diagnosis. MRI MRI has superior soft-tissue resolution and is invaluable for local assessment of pri- mary tumors. It enables accurate tissue char- acterization and assessment of enhancement patterns. It plays a key role in preoperative staging to assess for multispatial and multi- compartment involvement and involvement of neurovascular structures. Keywords: biopsy, cardiopulmonary imaging, CT, MRI, PET/CT, thorax DOI:10.2214/AJR.10.7259 Received July 6, 2010; accepted after revision October 4, 2010. OBJECTIVE. The purpose of this article is to highlight the role of radiography, CT, PET/ CT, and MRI in the diagnosis and management of chest wall lesions. Chest wall masses are caused by a spectrum of clinical entities. The lesions highlighted in this selection of case sce- narios include neoplastic, inflammatory, and vascular lesions. CONCLUSION. Imaging evaluation with radiography, CT, MRI, and PET/CT plays an important role in the accurate diagnosis of chest wall lesions. It can also facilitate percutane- ous biopsy, when it is indicated. Imaging enables accurate staging and is a key component of treatment planning for chest wall masses. Mullan et al. Imaging of Chest Wall Masses Cardiopulmonary Imaging Review Downloaded from www.ajronline.org by 41.35.75.140 on 06/01/13 from IP address 41.35.75.140. Copyright ARRS. For personal use only; all rights reserved