Evolving Indications, Technical Quality, Diagnostic Outcomes, and Utilization Patterns of Chest Magnetic Resonance Imaging: A Quaternary Care Center Experience With 3730 Patients Over 25 Years.

PURPOSE: To characterize longitudinal trends in clinical indications, technical quality, diagnostic outcomes, and demographic patterns of chest magnetic resonance imaging (MRI) at a US quaternary care center over 25 years.

MATERIALS AND

METHODS

This institutional review board-approved retrospective cohort study analyzed 3730 consecutive chest MRI examinations performed between August 2001 and April 2026 at a US quaternary care academic medical center. Clinical indications and technical quality assessment were extracted from radiology report narratives, normalized, and classified into 7 major categories. Differences in indication and diagnosis distributions between cohorts were evaluated using the χ2 test; age was compared using the independent-samples t test.

RESULTS

A total of 3730 examinations were included (mean patient age 34.0 ± 23.4 y; 55.1% females). Annual volume peaked at 270 in 2012 with a resurgence to 172 in 2025. The share of vascular indications declined from 70.9% of early-era examinations (2001-2005) to 23.5% in the recent era (2020-2025), while oncologic indications increased from 10.9% to 36.8% (both P < 0.001). Confirmed aortic/vascular pathology fell from 17.3% to 2.1%; malignant diagnoses increased from 3.2% to 10.2% (P < 0.001). Documented motion artifact decreased from the early to recent era (5.3% vs. 3.3%; P = 0.046).

CONCLUSIONS

Chest MRI utilization has shifted significantly over 25 years from predominantly vascular to oncology-driven indications, with stable diagnostic yield. Technical examination quality limitations were significantly more frequent during off-hours.