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West ME, Spielberg DR, Roach DJ, Willmering MM, Bdaiwi AS, Cleveland ZI, Woods JC. Short-term structural and functional changes after airway clearance therapy in cystic fibrosis. J Cyst Fibros 2023; 22:926-932. [PMID: 36740542 DOI: 10.1016/j.jcf.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/10/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Airway clearance therapy (ACT) with a high-frequency chest wall oscillation (HFCWO) vest is a common but time-consuming treatment. Its benefit to quality of life for cystic fibrosis (CF) patients is well established but has been questioned recently as new highly-effective modulator therapies begin to change the treatment landscape. 129Xe ventilation MRI has been shown to be very sensitive to lung obstruction in mild CF disease, making it an ideal tool to identify and quantify subtle, regional changes. METHODS 20 CF patients (ages 20.7 ± 5.1 years) refrained from performing ACT before arriving for a single-day visit. Multiple-breath washout (MBW), spirometry, Xe MRI, and ultrashort echo-time (UTE) MRI were obtained twice-before and after patients performed ACT using their prescribed HFCWO vests (average 4.7 ± 0.5 h). UTE MRIs were scored for structural abnormalities, and standard functional metrics were obtained from MBW, spirometry, and Xe MRI-FEV1,pp, LCI2.5, and VDPN4, respectively. RESULTS Spirometry and Xe MRI detected significant improvements in lung function post-ACT. 15/20 patients showed improvements from a baseline median of 92% FEV1,pp. Similarly, 16/20 patients showed improvements in Xe MRI from a baseline median of 15.2% VDPN4. Average individual changes were +2.6% in FEV1,pp and -1.3% in VDPN4, but without spatial correlations to easily-identifiable causative structural defects (e.g. mucus plugs or bronchiectasis) on UTE MRI. CONCLUSIONS Lung function improved after a single instance of HFCWO-vest ACT and was detectable by spirometry and Xe MRI. The only common structural abnormalities were mucus plugs, which corresponded to ventilation defects, but ventilation defects were often present without visible abnormalities.
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Affiliation(s)
- Michael E West
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States
| | - David R Spielberg
- Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, Illinois, 60611, United States
| | - David J Roach
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States
| | - Matthew M Willmering
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States
| | - Abdullah S Bdaiwi
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, 45229, United States
| | - Zackary I Cleveland
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, 45229, United States; Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, 45229, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, 45229, United States; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, United States; Department of Physics, University of Cincinnati, Cincinnati, OH, 45229, United States.
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Gräfe D, Prenzel F, Hirsch FW. Chest magnetic resonance imaging in cystic fibrosis: technique and clinical benefits. Pediatr Radiol 2023; 53:640-648. [PMID: 36372855 PMCID: PMC10027634 DOI: 10.1007/s00247-022-05539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 10/14/2022] [Indexed: 11/15/2022]
Abstract
Cystic fibrosis (CF) is one of the most common inherited and life-shortening pulmonary diseases in the Caucasian population. With the widespread introduction of newborn screening and the development of modulator therapy, tremendous advances have been made in recent years both in diagnosis and therapy. Since paediatric CF patients tend to be younger and have lower morbidity, the type of imaging modality that should be used to monitor the disease is often debated. Computed tomography (CT) is sensitive to many pulmonary pathologies, but radiation exposure limits its use, especially in children and adolescents. Conventional pulmonary magnetic resonance imaging (MRI) is a valid alternative to CT and, in most cases, provides sufficient information to guide treatment. Given the expected widespread availability of sequences with ultra-short echo times, there will be even fewer reasons to perform CT for follow-up of patients with CF. This review aims to provide an overview of the process and results of monitoring CF with MRI, particularly for centres not specialising in the disease.
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Affiliation(s)
- Daniel Gräfe
- Department of Pediatric Radiology, Leipzig University Hospital, Liebigstraße 20a, 04103, Leipzig, Germany.
| | - Freerk Prenzel
- Department of Pediatrics, Leipzig University Hospital, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Franz Wolfgang Hirsch
- Department of Pediatric Radiology, Leipzig University Hospital, Liebigstraße 20a, 04103, Leipzig, Germany
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Duan H, Iagaru A. Neuroendocrine Tumor Diagnosis: PET/MR Imaging. PET Clin 2023; 18:259-266. [PMID: 36707370 DOI: 10.1016/j.cpet.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Imaging plays a critical role in the diagnosis and management of neuroendocrine tumors (NETs). The initial workup of the primary tumor, including its characterization, local and distant staging, defines subsequent treatment decisions. Functional imaging using hybrid systems, such as PET combined with computed tomography, has become the gold standard. As NETs majorly arise from the gastrointestinal system and metastasize primarily to the liver, simultaneous PET and MR imaging with its high soft tissue contrast might be a valuable clinical one-stop-shop whole-body imaging tool. This review presents the current status and challenges of PET/MR imaging for diagnosis of NETs.
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Affiliation(s)
- Heying Duan
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Stanford University, 300 Pasteur Drive, H2200, Stanford, CA 94305, USA.
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Abstract
The need for airway imaging is defined by the limited sensitivity of common clinical tests like spirometry, lung diffusion (DLCO) and blood gas analysis to early changes of peripheral airways and to inhomogeneous regional distribution of lung function deficits. Therefore, X-ray and computed tomography (CT) are frequently used to complement the standard tests.As an alternative, magnetic resonance imaging (MRI) offers radiation-free lung imaging, but at lower spatial resolution. Non-contrast enhanced MRI shows healthy airways down to the first subsegmental level/4th order (CT: eighth). Bronchiectasis can be identified by wall thickening and fluid accumulation. Smaller airways become visible, when altered by peribronchiolar inflammation or mucus retention (tree-in-bud sign).The strength of MRI is functional imaging. Dynamic, time-resolved MRI directly visualizes expiratory airway collapse down to the lobar level (CT: segmental level). Obstruction of even smaller airways becomes visible as air trapping on the expiratory scans. MRI with hyperpolarized noble gases (3He, 129Xe) directly shows the large airways and peripheral lung ventilation. Dynamic contrast-enhanced MRI (DCE MRI) indirectly shows airway dysfunction as perfusion deficits resulting from hypoxic vasoconstriction of the dependent lung volumes. Further promising scientific approaches such as non-contrast enhanced, ventilation-/perfusion-weighted MRI from periodic signal changes of respiration and blood flow are in development.In summary, MRI of the lungs and airways excels with its unique combination of morphologic and functional imaging capacities for research (e.g., in chronic obstructive lung disease or asthma) as well as for clinical imaging (e.g., in cystic fibrosis).
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Affiliation(s)
- Juergen Biederer
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany.,University of Latvia, Faculty of Medicine, Raina bulvaris, Riga, Latvia.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Im Neuenheimer Feld, Heidelberg, Germany.,Department of Diagnostic and interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
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5
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Feng H, Shi G, Liu H, Xu Q, Wang L, Zhang N. The Application and Value of 3T Magnetic Resonance Imaging in the Display of Pulmonary Nodules. Front Oncol 2022; 12:844514. [PMID: 35664742 PMCID: PMC9157594 DOI: 10.3389/fonc.2022.844514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study was to evaluate the sensitivity and accuracy of multi-sequence 3T magnetic resonance imaging (MRI) in the detection of different types of pulmonary nodules. Methods A total of 68 patients with pulmonary nodules identified using computed tomography (CT) subsequently underwent MRI. Using CT images with a slice thickness of 1 mm as the gold standard, the sensitivity of three MRI sequences in detecting different types of pulmonary nodules was calculated, and the image quality was also evaluated. Nodule types included solid nodules, ground glass nodules (GGN), and part-solid nodules (PSN). Statistical analyses of data were conducted using the software SPSS 21.0. The intra-class correlation coefficient was calculated in order to compare the consistency of nodule size in both MRI and CT. Results CT detected 188 pulmonary nodules in 68 patients, including 87 solid nodules and 101 sub-solid nodules, the latter comprising 46 PSNs and 55 GGNs. The average nodule diameter was approximately 7.7 mm. The sensitivity of MRI in detecting nodules ≥ 6 mm in diameter and those of > 8 mm in diameter was 92% and 100%, respectively, and the sequence with the highest detection rate was T2-BLADE. In relation to solid nodules, the sequence with the highest detection rate was T1 Star-VIBE, while the T2-BLADE sequence demonstrated the highest detection rate of sub-solid nodules. The image quality of the T1 Star-VIBE sequence was better than that of both the T2-HASTE and the T2-BLADE sequences. The consistency of CT and MRI sequences for nodule size was high with a consistency coefficient of 0.94–0.98. Conclusion The detection rate of MRI for nodules with a diameter of > 8 mm was 100%. The T2-BLADE sequence had the highest detection sensitivity. The sequence with the best image quality was the T1 Star-VIBE.
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Affiliation(s)
- Hui Feng
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gaofeng Shi
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Liu
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Xu
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lijia Wang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Zhang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Bhattacharya I, Ramasawmy R, Javed A, Lowery M, Henry J, Mancini C, Machado T, Jones A, Julien-Williams P, Lederman RJ, Balaban RS, Chen MY, Moss J, Campbell-Washburn AE. Assessment of Lung Structure and Regional Function Using 0.55 T MRI in Patients With Lymphangioleiomyomatosis. Invest Radiol 2022; 57:178-186. [PMID: 34652290 PMCID: PMC9926400 DOI: 10.1097/rli.0000000000000832] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Contemporary lower-field magnetic resonance imaging (MRI) may offer advantages for lung imaging by virtue of the improved field homogeneity. The aim of this study was to evaluate the utility of lower-field MRI for combined morphologic imaging and regional lung function assessment. We evaluate low-field MRI in patients with lymphangioleiomyomatosis (LAM), a rare lung disease associated with parenchymal cysts and respiratory failure. MATERIALS AND METHODS We performed lung imaging on a prototype low-field (0.55 T) MRI system in 65 patients with LAM. T2-weighted imaging was used for assessment of lung morphology and to derive cyst scores, the percent of lung parenchyma occupied by cysts. Regional lung function was assessed using oxygen-enhanced MRI with breath-held ultrashort echo time imaging and inhaled 100% oxygen as a T1-shortening MR contrast agent. Measurements of percent signal enhancement from oxygen inhalation and percentage of lung with low oxygen enhancement, indicating functional deficits, were correlated with global pulmonary function test measurements taken within 2 days. RESULTS We were able to image cystic abnormalities using T2-weighted MRI in this patient population and calculate cyst score with strong correlation to computed tomography measurements (R = 0.86, P < 0.0001). Oxygen-enhancement maps demonstrated regional deficits in lung function of patients with LAM. Heterogeneity of oxygen enhancement between cysts was observed within individual patients. The percent low-enhancement regions showed modest, but significant, correlation with FEV1 (R = -0.37, P = 0.007), FEV1/FVC (R = -0.33, P = 0.02), and cyst score (R = 0.40, P = 0.02). The measured arterial blood ΔT1 between normoxia and hyperoxia, used as a surrogate for dissolved oxygen in blood, correlated with DLCO (R = -0.28, P = 0.03). CONCLUSIONS Using high-performance 0.55 T MRI, we were able to perform simultaneous imaging of pulmonary structure and regional function in patients with LAM.
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Affiliation(s)
- Ipshita Bhattacharya
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Ahsan Javed
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Margaret Lowery
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Jennifer Henry
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Christine Mancini
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Tania Machado
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Amanda Jones
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Patricia Julien-Williams
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Robert S Balaban
- Systems Biology Center, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Joel Moss
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
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Hamamoto K, Chiba E, Oyama-Manabe N, Yuzawa H, Shinmoto H. Assessment of pulmonary arteriovenous malformation with ultra-short echo time magnetic resonance imaging. Eur J Radiol 2022; 147:110144. [PMID: 34999474 DOI: 10.1016/j.ejrad.2021.110144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/15/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic performance of ultra-short echo time magnetic resonance imaging (UTE MRI) in the assessment of pulmonary arteriovenous malformation (PAVM). METHODS Eighteen consecutive patients (mean [± standard deviation] age, 48.6 ± 16.8 years) with 46 untreated PAVMs who underwent and thin-section computed tomography (CT) and UTE MRI with a 1.5-Tesla and 3-Tesla unit were retrospectively assessed. Two radiologists evaluated the diagnostic capabilities of UTE MRI for the detection and classification of PAVMs with reference to CT. Sensitivity, specificity, and kappa statistics were calculated with reference to CT. We also compared the differences in PAVM measurements between CT and MRI. RESULTS The sensitivity and specificity of UTE-MRI for the detection of PAVMs were 89.1% and 100%, respectively, for reader 1 and 87.0% and 100%, respectively, for reader 2. In the classification of PAVMs, inter-modality agreement in reader 1 and 2 were both substantial (κ = 0.78 and 0.69, respectively). The measurements of the PAVM feeding artery and sac on CT and MRI were strongly correlated in both readers 1 and 2 (R2 = 0.981 and 0.983, respectively). Both readers 1 and 2 slightly underestimated the diameter of the PAVM feeding artery and sac on UTE MRI (p < 0.001). CONCLUSION This study indicates that UTE MRI is a feasible and promising modality for noninvasive assessment of PAVMs.
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Affiliation(s)
- Kohei Hamamoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan; Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama 330-8503, Japan.
| | - Emiko Chiba
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8551, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama 330-8503, Japan
| | - Hironao Yuzawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama 330-8503, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
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Gräfe D, Anders R, Prenzel F, Sorge I, Roth C, Benkert T, Hirsch FW. Pediatric MR lung imaging with 3D ultrashort-TE in free breathing: Are we past the conventional T2 sequence? Pediatr Pulmonol 2021; 56:3899-3907. [PMID: 34491627 DOI: 10.1002/ppul.25664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Magnetic resonance imaging (MRI) of the lungs is challenging for several reasons, mainly due to the respiratory motion, low proton density, and rapid T2* decay. Recent MR sequences with ultrashort TE (UTE) coupled with respiratory compensation promise to overcome these obstacles. So far, there are very few studies on the relevance of these sequences in children. The aim of the study was to compare the diagnostic value of a respiratory-self-gated three-dimensional UTE sequence versus a conventional respiratory-triggered T2-weighted turbo spin echo (T2-TSE) sequence in a pediatric collective. STUDY DESIGN Seventy-one patients between 0 and 18 years of age, who were scheduled for a thoracic MRI based on diverse clinical indications, were examined on a 3T MRI system. The UTE and T2-TSE sequences were evaluated by two readers regarding quality features and visualization of eight common pathology patterns. RESULTS The image quality of both sequences was equally high, with UTE depicting pleural and central bronchi more clearly. In pathologies, UTE was superior to T2-TSE for so-called "MR-negative pathologies", significant for air trapping, and in tendency for bullae and cysts. In all remaining pathologies, T2-TSE proved to be at least equivalent to UTE. CONCLUSIONS At present, UTE cannot serve as a universal replacement for conventional T2-TSE for all pathologies. It yields, however, a substantial benefit in the context of hyperinflation, emphysema, cysts, or pathologies of the bronchial system.
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Affiliation(s)
- Daniel Gräfe
- Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany
| | - Rebecca Anders
- Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany
| | - Freerk Prenzel
- Department of Pediatrics, University of Leipzig, Leipzig, Germany
| | - Ina Sorge
- Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany
| | - Christian Roth
- Department of Pediatric Radiology, University of Leipzig, Leipzig, Germany
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
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Olthof SC, Reinert C, Nikolaou K, Pfannenberg C, Gatidis S, Benkert T, Küstner T, Krumm P. Detection of lung lesions in breath-hold VIBE and free-breathing Spiral VIBE MRI compared to CT. Insights Imaging 2021; 12:175. [PMID: 34817715 PMCID: PMC8613318 DOI: 10.1186/s13244-021-01124-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detection of pulmonary nodules in MRI requires fast imaging strategies without respiratory motion impairment, such as single-breath-hold Cartesian VIBE. As patients with pulmonary diseases have limited breath-hold capacities, this study investigates the clinical feasibility of non-Cartesian Spiral VIBE under free-breathing compared to CT as the gold standard. METHODS Prospective analysis of 27 oncological patients examined in PET/CT and PET/MR. A novel motion-robust 3D ultrashort-echo-time (UTE) MR sequence was evaluated in comparison with CT and conventional breath-hold MR. CT scans were performed under breath-hold in end-expiratory and end-inspiratory position (CT ex, CT in). MR data was acquired with non-contrast-enhanced breath-hold Cartesian VIBE followed by a free-breathing 3D UTE Spiral VIBE. Impact of respiratory motion on pulmonary evaluation was investigated by two readers in Cartesian VIBE, followed by UTE Spiral VIBE and CT ex and the reference standard of CT in. Diagnostic accuracy was calculated, and visual image quality assessed. RESULTS Higher detection rate and sensitivity of pulmonary nodules in free-breathing UTE Spiral VIBE in comparison with breath-hold Cartesian VIBE were found for lesions > 10 mm (UTE Spiral VIBE/VIBE/CT ex): 93%/54%/100%; Lesions 5-10 mm: 67%/25%/ 92%; Lesions < 5 mm: 11%/11%/78%. Lobe-based analysis revealed sensitivities and specificities of 64%/96%/41% and 96%/93%/100% for UTE Spiral VIBE/VIBE/CT ex. CONCLUSION Free-breathing UTE Spiral VIBE indicates higher sensitivity for detection of pulmonary nodules than breath-hold Cartesian VIBE and is a promising but time-consuming approach. However, sensitivity and specificity of inspiratory CT remain superior in comparison and should be preferred for detection of pulmonary lesions.
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Affiliation(s)
- Susann-Cathrin Olthof
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straβe 3, 72076, Tuebingen, Germany
| | - Christian Reinert
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straβe 3, 72076, Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straβe 3, 72076, Tuebingen, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straβe 3, 72076, Tuebingen, Germany
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straβe 3, 72076, Tuebingen, Germany
| | - Thomas Benkert
- MR Applications Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Thomas Küstner
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straβe 3, 72076, Tuebingen, Germany.
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straβe 3, 72076, Tuebingen, Germany
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Radbruch A, Paech D, Gassenmaier S, Luetkens J, Isaak A, Herrmann J, Othman A, Schäfer J, Nikolaou K. 1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 2. Invest Radiol 2021; 56:692-704. [PMID: 34417406 DOI: 10.1097/rli.0000000000000818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT The second part of this review deals with experiences in neuroradiological and pediatric examinations using modern magnetic resonance imaging systems with 1.5 T and 3 T, with special attention paid to experiences in pediatric cardiac imaging. In addition, whole-body examinations, which are widely used for diagnostic purposes in systemic diseases, are compared with respect to the image quality obtained in different body parts at both field strengths. A systematic overview of the technical differences at 1.5 T and 3 T has been presented in part 1 of this review, as well as several organ-based magnetic resonance imaging applications including musculoskeletal imaging, abdominal imaging, and prostate diagnostics.
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Affiliation(s)
- Alexander Radbruch
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Daniel Paech
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Sebastian Gassenmaier
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Julian Luetkens
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Alexander Isaak
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Judith Herrmann
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | | | - Jürgen Schäfer
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
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11
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Garg M, Prabhakar N, Dhooria S, Lamichhane S. Magnetic resonance imaging (MRI) chest in post-COVID-19 pneumonia. Lung India 2021; 38:498-499. [PMID: 34472535 PMCID: PMC8509173 DOI: 10.4103/lungindia.lungindia_206_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mandeep Garg
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saurav Lamichhane
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Bhattacharya I, Ramasawmy R, Javed A, Chen MY, Benkert T, Majeed W, Lederman RJ, Moss J, Balaban RS, Campbell-Washburn AE. Oxygen-enhanced functional lung imaging using a contemporary 0.55 T MRI system. NMR IN BIOMEDICINE 2021; 34:e4562. [PMID: 34080253 PMCID: PMC8377594 DOI: 10.1002/nbm.4562] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 05/14/2023]
Abstract
The purpose of this study was to evaluate oxygen-enhanced pulmonary imaging at 0.55 T with 3D stack-of-spirals ultrashort-TE (UTE) acquisition. Oxygen-enhanced pulmonary MRI offers the measurement of regional lung ventilation and perfusion using inhaled oxygen as a contrast agent. Low-field MRI systems equipped with contemporary hardware can provide high-quality structural lung imaging by virtue of the prolonged T2 *. Fortuitously, the T1 relaxivity of oxygen increases at lower field strengths, which is expected to improve the sensitivity of oxygen-enhanced lung MRI. We implemented a breath-held T1 -weighted 3D stack-of-spirals UTE acquisition with a 7 ms spiral-out readout. Measurement repeatability was assessed using five repetitions of oxygen-enhanced lung imaging in healthy volunteers (n = 7). The signal intensity at both normoxia and hyperoxia was strongly dependent on lung tissue density modulated by breath-hold volume during the five repetitions. A voxel-wise correction for lung tissue density improved the repeatability of percent signal enhancement maps (coefficient of variation = 34 ± 16%). Percent signal enhancement maps were compared in 15 healthy volunteers and 10 patients with lymphangioleiomyomatosis (LAM), a rare cystic disease known to reduce pulmonary function. We measured a mean percent signal enhancement of 9.0 ± 3.5% at 0.55 T in healthy volunteers, and reduced signal enhancement in patients with LAM (5.4 ± 4.8%, p = 0.02). The heterogeneity, estimated by the percent of lung volume exhibiting low enhancement, was significantly increased in patients with LAM compared with healthy volunteers (11.1 ± 6.0% versus 30.5 ± 13.1%, p = 0.01), illustrating the capability to measure regional functional deficits.
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Affiliation(s)
- Ipshita Bhattacharya
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Rajiv Ramasawmy
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Ahsan Javed
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Marcus Y Chen
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Thomas Benkert
- Siemens Healthcare GmbH, Henkestraße 127, 91052 Erlangen, Germany
| | - Waqas Majeed
- Siemens Medical Solutions USA Inc., 40 Liberty Boulevard, Malvern PA, 1935 USA
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Joel Moss
- Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
| | - Robert S Balaban
- Systems Biology Center, Division of Intramural Research, National Heart, Lung, and Blood I nstitute, National Institutes of Health, Bethesda MD, USA 20892
| | - Adrienne E Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda MD, USA 20892
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13
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Abstract
A decade of PET/MRI clinical imaging has passed and many of the pitfalls are similar to those on earlier studies. However, techniques to overcome them have emerged and continue to develop. Although clinically significant lung nodules are demonstrable, smaller nodules may be detected using ultrashort/zero echo-time (TE) lung MRI. Fast reconstruction ultrashort TE sequences have also been used to achieve high-resolution lung MRI even with free-breathing. The introduction and improvement of time-of-flight scanners and increasing the axial length of the PET detector arrays have more than doubled the sensitivity of the PET part of the system. MRI for attenuation correction has provided many potential pitfalls, including misclassification of tissue classes based on MRI information for attenuation correction. Although the use of short echo times have helped to address these pitfalls, one of the most exciting developments has been the use of deep learning algorithms and computational neural networks to rapidly provide soft tissue, fat, bone and air information for the attenuation correction as a supplement to the attenuation correction information from fat-water imaging. Challenges with motion correction, particularly respiratory and cardiac remain but are being addressed with respiratory monitors and using PET data. In order to address truncation artefacts, the system manufacturers have developed methods to extend the MR field-of-view for the purpose of the attenuation and scatter corrections. General pitfalls like stitching of body sections for individual studies, optimum delivery of images for viewing and reporting, and resource implications for the sheer volume of data generated remain Methods to overcome these pitfalls serve as a strong foundation for the future of PET/MRI. Advances in the underlying technology with significant evolution in hard-ware and software and the exiting developments in use of deep learning algorithms and computational neural networks will drive the next decade of PET/MRI imaging.
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Affiliation(s)
- Asim Afaq
- University of Iowa Carver College of Medicine, Iowa City; Institute of Nuclear Medicine, UCL/ UCLH London, UK
| | | | | | - Simon Wan
- Institute of Nuclear Medicine, UCL/ UCLH London, UK
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Patrick Veit Haibach
- Toronto Joint Dept. Medical Imaging, University Health Network, Sinai Health System, Women's College University of Toronto, Canada
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14
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Abstract
Magnetic resonance imaging (MRI) of the lungs is one of the most underutilized imaging modality when it comes to imaging of thoracic diseases in children. This is largely due to less-than-optimal image quality and multiple technical challenges involved with MRI of the lungs. Advances in MRI technology along with increased awareness about optimization of MR protocol have led to it being viewed as a feasible option for evaluation of various chest diseases in children. This short review article takes the reader to the road less travelled to explore newer horizons for applications of this rapidly evolving magnetic resonance technique in the field of thoracic diseases in children.
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Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radio-diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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15
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Smith M, Bambach S, Selvaraj B, Ho ML. Zero-TE MRI: Potential Applications in the Oral Cavity and Oropharynx. Top Magn Reson Imaging 2021; 30:105-115. [PMID: 33828062 DOI: 10.1097/rmr.0000000000000279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Zero-echo time (ZTE) magnetic resonance imaging (MRI) is the newest in a family of MRI pulse sequences that involve ultrafast sequence readouts, permitting visualization of short-T2 tissues such as cortical bone. Inherent sequence properties enable rapid, high-resolution, quiet, and artifact-resistant imaging. ZTE can be performed as part of a "one-stop-shop" MRI examination for comprehensive evaluation of head and neck pathology. As a potential alternative to computed tomography for bone imaging, this approach could help reduce patient exposure to ionizing radiation and improve radiology resource utilization. Because ZTE is not yet widely used clinically, it is important to understand the technical limitations and pitfalls for diagnosis. Imaging cases are presented to demonstrate potential applications of ZTE for imaging of oral cavity, oropharynx, and jaw anatomy and pathology in adult and pediatric patients. Emerging studies indicate promise for future clinical implementation based on synthetic computed tomography image generation, 3D printing, and interventional applications.
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Affiliation(s)
- Mark Smith
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH
| | - Sven Bambach
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Bhavani Selvaraj
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, Columbus, OH
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16
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Vasilev YA, Sergunova KA, Bazhin AV, Masri AG, Vasileva YN, Semenov DS, Kudryavtsev ND, Panina OY, Khoruzhaya AN, Zinchenko VV, Akhmad ES, Petraikin AV, Vladzymyrskyy AV, Midaev AV, Morozov SP. Chest MRI of patients with COVID-19. Magn Reson Imaging 2021; 79:13-19. [PMID: 33727149 PMCID: PMC7955570 DOI: 10.1016/j.mri.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022]
Abstract
During the pandemic of novel coronavirus infection (COVID-19), computed tomography (CT) showed its effectiveness in diagnosis of coronavirus infection. However, ionizing radiation during CT studies causes concern for patients who require dynamic observation, as well as for examination of children and young people. For this retrospective study, we included 15 suspected for COVID-19 patients who were hospitalized in April 2020, Russia. There were 4 adults with positive polymerase chain reaction (PCR) test for COVID-19. All patients underwent magnetic resonance imaging (MRI) examinations using MR-LUND PROTOCOL: Single-shot Fast Spin Echo (SSFSE), LAVA 3D and IDEAL 3D, Echo-planar imaging (EPI) diffusion-weighted imaging (DWI) and Fast Spin Echo (FSE) T2 weighted imaging (T2WI). On T2WI changes were identified in 9 (60,0%) patients, on DWI - in 5 (33,3%) patients. In 5 (33,3%) patients lesions of the parenchyma were visualized on T2WI and DWI simultaneously. At the same time, 4 (26.7%) patients had changes in lung tissue only on T2WI. (P(McNemar) = 0,125; OR = 0,00 (95%); kappa = 0,500). In those patients who had CT scan, the changes were comparable to MRI. The results showed that in case of CT is not available, it is advisable to conduct a chest MRI for patients with suspected or confirmed COVID-19. Considering that T2WI is a fluid-sensitive sequence, if imaging for the lung infiltration is required, we can recommend the abbreviated MRI protocol consisting of T2 and T1 WI. These data may be applicable for interpreting other studies, such as thoracic spine MRI, detecting signs of viral pneumonia of asymptomatic patients. MRI can detect features of viral pneumonia.
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Affiliation(s)
- Yu A Vasilev
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia
| | - K A Sergunova
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A V Bazhin
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A G Masri
- Imed Clinic, Grozny, Chechen Republic, Russia.
| | - Yu N Vasileva
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
| | - D S Semenov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - N D Kudryavtsev
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - O Yu Panina
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A N Khoruzhaya
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - V V Zinchenko
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - E S Akhmad
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A V Petraikin
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A V Vladzymyrskyy
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A V Midaev
- Imed Clinic, Grozny, Chechen Republic, Russia.
| | - S P Morozov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
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17
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Lung MRI assessment with high-frequency noninvasive ventilation at 3 T. Magn Reson Imaging 2020; 74:64-73. [DOI: 10.1016/j.mri.2020.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/12/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
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Yang S, Zhang Y, Shen J, Dai Y, Ling Y, Lu H, Zhang R, Ding X, Qi H, Shi Y, Zhang Z, Shan F. Clinical Potential of UTE-MRI for Assessing COVID-19: Patient- and Lesion-Based Comparative Analysis. J Magn Reson Imaging 2020; 52:397-406. [PMID: 32491257 PMCID: PMC7300684 DOI: 10.1002/jmri.27208] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chest computed tomography (CT) has shown tremendous clinical potential for screening, diagnosis, and surveillance of COVID-19. However, safety concerns are warranted due to repeated exposure of X-rays over a short period of time. Recent advances in MRI suggested that ultrashort echo time MRI (UTE-MRI) was valuable for pulmonary applications. PURPOSE To evaluate the effectiveness of UTE-MRI for assessing COVID-19. STUDY TYPE Prospective. POPULATION In all, 23 patients with COVID-19 and with an average interval of 2.81 days between hospital admission and image examination. FIELD STRENGTH/SEQUENCE 3T; Respiratory-gated three-dimensional radial UTE pulse sequence. ASSESSMENT Image quality score. Patient- and lesion-based interobserver and intermethod agreement for identifying the representative image findings of COVID-19. STATISTICAL TESTS Wilcoxon-rank sum test, Kendall's coefficient of concordance (Kendall's W), intraclass coefficients (ICCs), and weighted kappa statistics. RESULTS There was no significant difference between the image quality of CT and UTE-MRI (CT vs. UTE-MRI: 4.3 ± 0.4 vs. 4.0 ± 0.5, P = 0.09). Moreover, both patient- and lesion-based interobserver agreement of CT and UTE-MRI for evaluating the image signs of COVID-19 were determined as excellent (ICC: 0.939-1.000, P < 0.05; Kendall's W: 0.894-1.000, P < 0.05.). In addition, the intermethod agreement of two image modalities for assessing the representative findings of COVID-19 including affected lobes, total severity score, ground glass opacities (GGO), consolidation, GGO with consolidation, the number of crazy paving pattern, and linear opacities, as well as pseudocavity were all determined as substantial or excellent (kappa: 0.649-1.000, P < 0.05; ICC: 0.913-1.000, P < 0.05). DATA CONCLUSION Pulmonary MRI with UTE is valuable for assessing the representative image findings of COVID-19 with a high concordance to CT. EVIDENCE LEVEL 2 TECHNICAL EFFICACY STAGE: 3 J. Magn. Reson. Imaging 2020;52:397-406.
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Affiliation(s)
- Shuyi Yang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yunfei Zhang
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Jie Shen
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Yun Ling
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Rengyin Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xueting Ding
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Huali Qi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuxin Shi
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhiyong Zhang
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.,Department of the Principal's Ofce, Fudan University, Shanghai, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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19
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Heidenreich JF, Weng AM, Metz C, Benkert T, Pfeuffer J, Hebestreit H, Bley TA, Köstler H, Veldhoen S. Three-dimensional Ultrashort Echo Time MRI for Functional Lung Imaging in Cystic Fibrosis. Radiology 2020; 296:191-199. [PMID: 32343212 DOI: 10.1148/radiol.2020192251] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In cystic fibrosis (CF), recurrent imaging and pulmonary function tests (PFTs) are needed for the assessment of lung function during disease management. Purpose To assess the clinical feasibility of pulmonary three-dimensional ultrashort echo time (UTE) MRI at breath holding for quantitative image analysis of ventilation inhomogeneity and hyperinflation in CF compared with PFT. Materials and Methods In this prospective study from May 2018 to June 2019, participants with CF and healthy control participants underwent PFTs and functional lung MRI by using a prototypical single breath-hold three-dimensional UTE sequence. Fractional ventilation (FV) was calculated from acquired data in normal inspiration and normal expiration. FV of each voxel was normalized to the whole lung mean (FVN), and interquartile range of normalized ventilation (IQRN; as a measure of ventilation heterogeneity) was calculated. UTE signal intensity (SI) was assessed in full expiration (SIN, normalized to aortic blood). Obtained metrics were compared between participants with CF and control participants. For participants with CF, MRI metrics were correlated with the standard lung clearance index (LCI) and PFT. Mann-Whitney U tests and Spearman correlation were used for statistical analysis. Results Twenty participants with CF (mean age, 17 years ± 9 [standard deviation]; 12 men) and 10 healthy control participants (24 years ± 8; five men) were included. IQRN was higher for participants with CF than for control participants (mean, 0.66 ± 0.16 vs 0.50 ± 0.04, respectively; P = .007). In the 20 participants with CF, IQRN correlated with obstruction markers forced expiratory volume in 1 second-to-forced vital capacity ratio (r = -0.70; 95% confidence interval [CI]: -0.92, -0.28; P < .001), mean expiratory flow 25% (r = 0.78; 95% CI: -0.95, -0.39; P < .001), and with the ventilation inhomogeneity parameter LCI (r = 0.90; 95% CI: 0.69, 0.96; P < .001). Mean SIN in full expiration was lower in participants with CF than in control participants (0.34 ± 0.08 vs 0.39 ± 0.03, respectively; P = .03). Conclusion Three-dimensional ultrashort echo time MRI in the lungs allowed for functional imaging of ventilation inhomogeneity within a few breath holds in patients with cystic fibrosis. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Wielpütz in this issue.
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Affiliation(s)
- Julius F Heidenreich
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
| | - Andreas M Weng
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
| | - Corona Metz
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
| | - Thomas Benkert
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
| | - Josef Pfeuffer
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
| | - Helge Hebestreit
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
| | - Thorsten A Bley
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
| | - Herbert Köstler
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
| | - Simon Veldhoen
- From the Department of Diagnostic and Interventional Radiology (J.F.H., A.M.W., C.M., T.A.B., H.K., S.V.) and Department of Pediatrics (H.H.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Department of Application Development, Siemens Healthcare GmbH, Erlangen, Germany (T.B., J.P.)
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20
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Yan Q, Yang S, Shen J, Lu S, Shan F, Shi Y. 3T magnetic resonance for evaluation of adult pulmonary tuberculosis. Int J Infect Dis 2020; 93:287-294. [PMID: 32062060 DOI: 10.1016/j.ijid.2020.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/17/2020] [Accepted: 02/09/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To evaluate image quality and detection rate of four 3T magnetic resonance imaging (MRI) sequences and MRI performances in pulmonary tuberculosis (TB) when compared to computed tomography (CT). METHODS Forty patients with pulmonary tuberculosis separately underwent CT and 3T-MRI with T1-weighted free-breathing star-volumetric interpolated breath-hold examination (Star-VIBE) and standard VIBE, T2-weighted two-dimensional fast BLADE turbo spin-echo (2D-fBLADE TSE) and three-dimensional isotropic turbo spin-echo (3D-SPACE). Four MRI sequences were compared in terms of detection rate and image quality, which consisted of signal to noise ratio (SNR), contrast to noise ratio (CNR) and 5-point scoring scale. The total sensitivity was also compared between CT and MRI. Inter-observer agreement on 5-point scoring scale was calculated by Cohen's kappa (k). SNR, CNR and 5-point scoring scale were compared using two-tailed pared t-test. Using CT as a reference, the MRI detection rate of pulmonary abnormality was evaluated by Pearson's Chi-square test. Furthermore, the sizes of the nodules (≥5 mm) were compared using intraclass correlation coefficient. RESULTS In this study, Free-breathing Star-VIBE had significantly better SNR and identical CNR compared with standard VIBE. 2D-fBLADE TSE had statistically higher SNR but uniform or inferior CNR compared with 3D-SPACE. Inter-observers showed excellent agreement on 5-point scoring scale. The average score of Star-VIBE and VIBE had no difference. The average score of 2D-fBLADE TSE was higher than 3D-SPACE. There were no statistical differences in the detection rates of non-calcified parenchymal lesions between Star-VIBE and standard VIBE, 2D-fBALDE TSE and 3D-SPACE. MRI is comparable to CT in detecting consolidation, cavity, non-calcified nodules of ≥5 mm and tree-in-bud signs compared to CT. MRI detected non-calcified nodules of <5 mm, 5-10 mm, ≥10 mm and calcified nodules with sensitivity of 69.6%, 90.6%, 100% and 89.5% respectively. In addition, the sizes of the nodules (≥5 mm) had statistical consistency. MRI is more sensitive in detecting caseous necrosis, liquefaction, active cavity, abnormalities of lymph nodes and pleura. CONCLUSIONS T1-weighted free-breathing Star-VIBE and T2-weighted 2D-fBLADE TSE, both with satisfactory image quality, are suitable for patients with pulmonary TB who need long-term follow-ups in clinical routine, especially for children, young women and pregnant women.
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Affiliation(s)
- Qinqin Yan
- Shanghai Institute of Medical Imaging, Shanghai, Fudan university, Shanghai, China; Department of Radiology, Shanghai public health clinical center, Shanghai, China
| | - Shuyi Yang
- Department of Radiology, Shanghai public health clinical center, Shanghai, China
| | - Jie Shen
- Department of Radiology, Shanghai public health clinical center, Shanghai, China
| | - Shuihua Lu
- Department of Tuberculosis, Shanghai public health clinical center, Shanghai, China
| | - Fei Shan
- Department of Radiology, Shanghai public health clinical center, Shanghai, China.
| | - Yuxin Shi
- Department of Radiology, Shanghai public health clinical center, Shanghai, China.
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