MRI for Lung Cancer Management: Any Closer to Clinical Application?

Management of lung cancer (LC) encompasses screening, diagnosis, staging, radiotherapy planning and guidance, therapy monitoring and surveillance. Across these domains, magnetic resonance imaging (MRI) offers a range of morphological and functional imaging capabilities-including diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) imaging, and whole-body MRI-to complement established imaging modalities. Recent technical advances have substantially improved the feasibility of lung MRI, enabling more reliable image acquisition and lesion assessment under controlled conditions. In LC screening, meta-analyses and prospective studies indicate that MRI can detect solid pulmonary nodules above clinically actionable size thresholds with moderate to high sensitivity and a low false-positive rate. However, the available evidence is largely derived from pilot studies, selected cohorts, and modeling-based analyses. MRI should therefore be regarded as technically feasible for screening but not yet a validated alternative to low-dose computed tomography in population-based programs. For staging, whole-body MRI incorporating DWI has demonstrated comparable diagnostic performance to standard multimodality pathways in prospective and randomized studies, with potential advantages including reduced radiation exposure and streamlined imaging workflows. In radiotherapy planning, DCE, DWI, and motion-resolved MRI techniques can improve target delineation and treatment adaptation, but their use remains largely confined to specialized centers. MRI shows promise for therapy response assessment and prognostication through quantitative DCE- and DWI-derived biomarkers, although reported parameters remain heterogeneous and insufficiently standardized for routine clinical decision-making. Overall, MRI has established clinical utility in selected aspects of LC management, while broader adoption is currently limited by availability, standardization, and validation gaps. Further technical refinement and large-scale prospective trials are required to define its role in routine clinical practice. LEVEL OF EVIDENCE: 5. TECHNICAL EFFICACY: Stage 2.