Cine Magnetic Resonance Imaging for Assessing Chest Wall Invasion in Lung Cancer

PURPOSE: To conduct a meta-analysis assessing the effectiveness of cine MRI in evaluating tumor invasion of the chest wall, using surgical and histopathologic analysis as the reference standard. MATERIALS AND METHODS: This systematic review and meta-analysis was conducted following the recommendations of the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy and Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD420250654330. RESULTS: Five prospective studies comprising 190 patients with suspected chest wall invasion were included. The pooled sensitivity of cine MRI for detecting chest wall invasion was 99% (95% CI: 34%-100%), with a specificity of 74% (95% CI: 64%-82%), a negative predictive value of 100% (95% CI: 52%-100%), and a positive predictive value of 50% (95% CI: 39%-61%). No substantial heterogeneity was observed across studies. CONCLUSIONS: Cine MRI showed high sensitivity and excellent negative predictive value for ruling out chest wall invasion in lung cancer. These findings suggest cine MRI may be a useful noninvasive tool for preoperative assessment, particularly in cases with inconclusive CT or static MRI; however, CIs were wide due to the limited evidence base. Conversely, when cine MRI suggests invasion, the modest specificity and positive predictive value highlight the importance of invasive confirmation before definitive therapeutic decisions. Further prospective, multicenter studies using standardized protocols are warranted to validate and expand its clinical application.