1
|
Practical protocol for lung magnetic resonance imaging and common clinical indications. Pediatr Radiol 2022; 52:295-311. [PMID: 34037828 PMCID: PMC8150155 DOI: 10.1007/s00247-021-05090-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/23/2021] [Accepted: 04/20/2021] [Indexed: 12/22/2022]
Abstract
Imaging speed, spatial resolution and availability have made CT the favored cross-sectional imaging modality for evaluating various respiratory diseases of children - but only for the price of a radiation exposure. MRI is increasingly being appreciated as an alternative to CT, not only for offering three-dimensional (3-D) imaging without radiation exposure at only slightly inferior spatial resolution, but also for its superior soft-tissue contrast and exclusive morpho-functional imaging capacities beyond the scope of CT. Continuing technical improvements and experience with this so far under-utilized modality contribute to a growing acceptance of MRI for an increasing number of indications, in particular for pediatric patients. This review article provides the reader with practical easy-to-use protocols for common clinical indications in children. This is intended to encourage pediatric radiologists to appreciate the new horizons for applications of this rapidly evolving technique in the field of pediatric respiratory diseases.
Collapse
|
2
|
Gargani L, Bruni C, De Marchi D, Romei C, Guiducci S, Bellando-Randone S, Aquaro GD, Pepe A, Neri E, Colagrande S, Falaschi F, Moggi-Pignone A, Pingitore A, Matucci-Cerinic M. Lung magnetic resonance imaging in systemic sclerosis: a new promising approach to evaluate pulmonary involvement and progression. Clin Rheumatol 2020; 40:1903-1912. [PMID: 33161470 DOI: 10.1007/s10067-020-05491-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/24/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION/OBJECTIVES Interstitial lung disease (ILD) is frequent and highly disabling in systemic sclerosis (SSc). Magnetic resonance imaging (MRI) is not routinely used to evaluate the lung, due to poorer spatial resolution compared to high-resolution computed tomography (HRCT). We aimed to compare lung MRI signal with HRCT and evaluate the role of MRI in predicting ILD progression. METHODS Thirty SSc patients underwent lung MRI and HRCT. STIR and T1 mapping sequences were acquired before and after gadolinium injection. Patients were classified as normal (group 1 with normal HRCT and MRI), discordant (group 2 without ILD signs on HRCT but areas of hyperintensity on MRI), and abnormal (group 3 with ILD signs on HRCT and areas of hyperintensity on MRI). Patients were followed up for ILD progression. RESULTS Mean STIR and T1 values were different between the three groups (p < 0.0001). STIR values correlated with HRCT score (R = 0.79, p < 0.0001), lung ultrasound B-lines (R = 0.73, p < 0.0001), and %DLco (R = - 0.63, p = 0.0001). Nine events were recorded during a follow-up of 25 ± 20 months. Continuous STIR values were independently associated with events (HR 1.018; CI 1.005-1.031, p = 0.005). A STIR value >90 ms discriminated patients at a higher risk of worsening pulmonary involvement (HR 8.80; CI 1.81-42.74; p < 0.007). CONCLUSIONS Lung MRI can detect SSc-related ILD, with good correlations with other ILD markers. STIR values, independently of HRCT appearance, may predict worsening lung involvement. Lung MRI, although very preliminary, is a promising tool that in a near future could help selecting patients for an early treatment of SSc-related ILD and a more appropriate use of HRCT. Key points • Lung MRI has the potential to differentiate inflammation-predominant versus fibrosis-predominant lesions, but it is not currently used in routine clinical practice to assess SSc-related ILD. • Lung MRI STIR and T1 values are significantly different between patients with and without SSc-related ILD. STIR values, independently of HRCT appearance, are also able to predict worsening lung involvement over time. • These preliminary data suggest that, in a near future, MRI could support the choice for an early treatment of SSc-related ILD, as well as a more appropriate use of HRCT.
Collapse
Affiliation(s)
- Luna Gargani
- Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1, 56124, Pisa, Italy.
| | - Cosimo Bruni
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Daniele De Marchi
- Department of Magnetic Resonance, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Chiara Romei
- II Radiology Unit, University Hospital of Pisa, Pisa, Italy
| | - Serena Guiducci
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| | | | - Alessia Pepe
- Department of Magnetic Resonance, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Emanuele Neri
- Diagnostic and Interventional Radiology, Department of Translational Research, University of Pisa, Pisa, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Fabio Falaschi
- II Radiology Unit, University Hospital of Pisa, Pisa, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, Department of Emergency Medicine DEA, Division of Internal Medicine AOUC, University of Florence, Florence, Italy
| | - Alessandro Pingitore
- Institute of Clinical Physiology, National Research Council, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Department of Geriatric Medicine, Division of Rheumatology AOUC, University of Florence, Florence, Italy
| |
Collapse
|
3
|
Applicability of radiomics in interstitial lung disease associated with systemic sclerosis: proof of concept. Eur Radiol 2020; 31:1987-1998. [PMID: 33025174 PMCID: PMC7979612 DOI: 10.1007/s00330-020-07293-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 01/04/2023]
Abstract
Objective To retrospectively evaluate if texture-based radiomics features are able to detect interstitial lung disease (ILD) and to distinguish between the different disease stages in patients with systemic sclerosis (SSc) in comparison with mere visual analysis of high-resolution computed tomography (HRCT). Methods Sixty patients (46 females, median age 56 years) with SSc who underwent HRCT of the thorax were retrospectively analyzed. Visual analysis was performed by two radiologists for the presence of ILD features. Gender, age, and pulmonary function (GAP) stage was calculated from clinical data (gender, age, pulmonary function test). Data augmentation was performed and the balanced dataset was split into a training (70%) and a testing dataset (30%). For selecting variables that allow classification of the GAP stage, single and multiple logistic regression models were fitted and compared by using the Akaike information criterion (AIC). Diagnostic accuracy was evaluated from the area under the curve (AUC) from receiver operating characteristic (ROC) analyses, and diagnostic sensitivity and specificity were calculated. Results Values for some radiomics features were significantly lower (p < 0.05) and those of other radiomics features were significantly higher (p = 0.001) in patients with GAP2 compared with those in patients with GAP1. The combination of two specific radiomics features in a multivariable model resulted in the lowest AIC of 10.73 with an AUC of 0.96, 84% sensitivity, and 99% specificity. Visual assessment of fibrosis was inferior in predicting individual GAP stages (AUC 0.86; 83% sensitivity; 74% specificity). Conclusion The correlation of radiomics with GAP stage, but not with the visually defined features of ILD-HRCT, implies that radiomics might capture features indicating severity of SSc-ILD on HRCT, which are not recognized by visual analysis. Key Points • Radiomics features can predict GAP stage with a sensitivity of 84% and a specificity of almost 100%. • Extent of fibrosis on HRCT and a combined model of different visual HRCT-ILD features perform worse in predicting GAP stage. • The correlation of radiomics with GAP stage, but not with the visually defined features of ILD-HRCT, implies that radiomics might capture features on HRCT, which are not recognized by visual analysis. Electronic supplementary material The online version of this article (10.1007/s00330-020-07293-8) contains supplementary material, which is available to authorized users.
Collapse
|
4
|
Buzan MT, Wetscherek A, Rank CM, Kreuter M, Heussel CP, Kachelrieß M, Dinkel J. Delayed contrast dynamics as marker of regional impairment in pulmonary fibrosis using 5D MRI - a pilot study. Br J Radiol 2020; 93:20190121. [PMID: 32584606 DOI: 10.1259/bjr.20190121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyse delayed contrast dynamics of fibrotic lesions in interstitial lung disease (ILD) using five dimensional (5D) MRI and to correlate contrast dynamics with disease severity. METHODS 20 patients (mean age: 71 years; M:F, 13:7), with chronic fibrosing ILD: n = 12 idiopathic pulmonary fibrosis (IPF) and n = 8 non-IPF, underwent thin-section multislice CT as part of the standard diagnostic workup and additionally MRI of the lung. 2 min after contrast injection, a radial gradient echo sequence with golden-angle spacing was acquired during 5 min of free-breathing, followed by 5D image reconstruction. Disease was categorized as severe or non-severe according to CT morphological regional severity. For each patient, 10 lesions were analysed. RESULTS IPF lesions showed later peak enhancement compared to non-IPF (severe: p = 0.01, non-severe: p = 0.003). Severe lesions showed later peak enhancement compared to non-severe lesions, in non-IPF (p = 0.04), but not in IPF (p = 0.35). There was a tendency towards higher accumulation and washout rates in IPF compared to non-IPF in non-severe disease. Severe lesions had lower washout rate than non-severe ones in both IPF (p = 0.003) and non-IPF (p = 0.005). Continuous contrast agent accumulation, without washout, was found only in IPF lesions. CONCLUSIONS Contrast agent dynamics are influenced by type and severity of pulmonary fibrosis, which might enable a more thorough characterisation of disease burden. The regional impairment is of particular interest in the context of antifibrotic treatments and was characterised using a non-invasive, non-irradiating, free-breathing method. ADVANCES IN KNOWLEDGE Delayed contrast enhancement patterns allow the assessment of regional lung impairment which could represent different disease stages or phenotypes in ILD.
Collapse
Affiliation(s)
- Maria Ta Buzan
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Andreas Wetscherek
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Christopher M Rank
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Center for Rare and Interstitial Lung Diseases, Pneumology and respiratory critical care medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Center for Rare and Interstitial Lung Diseases, Pneumology and respiratory critical care medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julien Dinkel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| |
Collapse
|
5
|
Frenk NE, Montesi SB, Chen T, Liang LL, Zhou I, Seethamraju R, Caravan P, Digumarthy SR. Free-breathing dynamic contrast-enhanced magnetic resonance of interstitial lung fibrosis. Magn Reson Imaging 2020; 69:16-21. [PMID: 32126265 DOI: 10.1016/j.mri.2020.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/24/2020] [Accepted: 02/27/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE Computed tomography (CT) imaging is the standard to assess interstitial lung disease. Magnetic resonance (MR) is potentially advantageous due to superior tissue characterization and better assessment of blood flow dynamics. This study aimed to evaluate idiopathic pulmonary fibrosis (IPF) using prototype 4D Stack of Stars GRE (StarVIBE) MR and compare it to CT. METHOD This IRB-approved prospective study included 13 patients [5F:8M; average age 66 ± 8.1 years] with pulmonary fibrosis, and 12 healthy controls [3F:9M; average age 55 ± 3.6 years]. MR of the chest included noncontrast steady-state free precession imaging (SSFP) and free-breathing 4D StarVIBE sequence with intravenous contrast administration up to 160 s. The images were assessed for quality and artifacts. The image resolution was evaluated based on the visibility of the smallest bronchi, vessels, lymph nodes, and pleural fissures. Independent assessment of reticulation, ground-glass opacity, and traction bronchiectasis was performed and compared to CT. RESULTS The StarVIBE images had fewer artifacts and higher spatial resolution. The findings associated with IPF were significantly better seen with StarVIBE, with superior CT correlation. CONCLUSION Contrast-enhanced free-breathing StarVIBE MR can generate high quality images with good correlation to CT in patients with IPF, and with high spatial and temporal resolution to generate rapid sequential dynamic images.
Collapse
Affiliation(s)
- Nathan E Frenk
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Sydney B Montesi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Tianqi Chen
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, United States of America
| | - Lloyd L Liang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Iris Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ravi Seethamraju
- Siemens Healthcare, Boston, MA, United States of America; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America; Institute for Innovation in Imaging, Massachusetts General Hospital, Boston, MA, United States of America
| | - Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America.
| |
Collapse
|
6
|
Jacob J, Pienn M, Payer C, Urschler M, Kokosi M, Devaraj A, Wells AU, Olschewski H. Quantitative CT-derived vessel metrics in idiopathic pulmonary fibrosis: A structure-function study. Respirology 2019; 24:445-452. [PMID: 30786325 PMCID: PMC6519024 DOI: 10.1111/resp.13485] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/09/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE This study aimed to investigate whether quantitative lung vessel morphology determined by a new fully automated algorithm is associated with functional indices in idiopathic pulmonary fibrosis (IPF). METHODS A total of 152 IPF patients had vessel volume, density, tortuosity and heterogeneity quantified from computed tomography (CT) images by a fully automated algorithm. Separate quantitation of vessel metrics in pulmonary arteries and veins was performed in 106 patients. Results were evaluated against readouts from lung function tests. RESULTS Normalized vessel volume expressed as a percentage of total lung volume was moderately correlated with functional indices on univariable linear regression analysis: forced vital capacity (R2 = 0.27, P < 1 × 10-6 ), diffusion capacity for carbon monoxide (DLCO ; R2 = 0.12, P = 3 × 10-5 ), total lung capacity (TLC; R2 = 0.45, P < 1 × 10-6 ) and composite physiologic index (CPI; R2 = 0.28, P < 1 × 10-6 ). Normalized vessel volume was correlated with vessel density but not with vessel heterogeneity. Quantitatively derived vessel metrics (and artery and vein subdivision scores) were not significantly linked with the transfer factor for carbon monoxide (KCO ), and only weakly with DLCO . On multivariable linear regression analysis, normalized vessel volume and vessel heterogeneity were independently linked with DLCO , TLC and CPI indicating that they capture different aspects of lung damage. Artery-vein separation provided no additional information beyond that captured in the whole vasculature. CONCLUSION Our study confirms previous observations of links between vessel volume and functional measures of disease severity in IPF using a new vessel quantitation tool. Additionally, the new tool shows independent linkages of normalized vessel volume and vessel heterogeneity with functional indices. Quantitative vessel metrics do not appear to reflect vasculopathic damage in IPF.
Collapse
Affiliation(s)
- Joseph Jacob
- Department of Respiratory MedicineUniversity College LondonLondonUK
- Centre for Medical Image ComputingUniversity College LondonLondonUK
| | - Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular ResearchGrazAustria
| | - Christian Payer
- Institute of Computer Graphics and VisionGraz University of TechnologyGrazAustria
| | - Martin Urschler
- Institute of Computer Graphics and VisionGraz University of TechnologyGrazAustria
- Ludwig Boltzmann Institute for Clinical‐Forensic ImagingGrazAustria
| | - Maria Kokosi
- Interstitial Lung Disease UnitRoyal Brompton HospitalLondonUK
| | - Anand Devaraj
- Department of RadiologyRoyal Brompton HospitalLondonUK
| | - Athol U. Wells
- Interstitial Lung Disease UnitRoyal Brompton HospitalLondonUK
| | - Horst Olschewski
- Ludwig Boltzmann Institute for Lung Vascular ResearchGrazAustria
- Division of Pulmonology, Department of Internal MedicineMedical University of GrazGrazAustria
| |
Collapse
|
7
|
Montesi SB, Caravan P. Novel Imaging Approaches in Systemic Sclerosis-Associated Interstitial Lung Disease. Curr Rheumatol Rep 2019; 21:25. [PMID: 31025121 DOI: 10.1007/s11926-019-0826-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF THE REVIEW Novel imaging approaches, such as quantitative computed tomography (CT), magnetic resonance imaging (MRI), and molecular imaging, are being applied to interstitial lung diseases to provide prognostic, functional, and molecular information. Here, we review such imaging approaches and their applicability to systemic sclerosis-associated interstitial lung disease (SSc-ILD). RECENT FINDINGS Quantitative CT can be used to quantify the radiographic response to SSc-ILD therapy. Due to advances in MRI sequence development, MRI can detect the presence of SSc-ILD with high accuracy. MRI can also be utilized to provide functional information as to SSc-ILD and paired with molecular probes to provide non-invasive molecular information. MRI and ultrasound have promising test characteristics for diagnosing ILD in SSc without the use of ionizing radiation. Novel imaging approaches can detect SSc-ILD without the use of ionizing radiation, provide non-invasive functional and molecular information, and quantify treatment response in SSc-ILD. These techniques hold promise for translation into clinical care and clinical trials.
Collapse
Affiliation(s)
- Sydney B Montesi
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.
| | - Peter Caravan
- A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Institute for Innovation in Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
8
|
Weatherley ND, Eaden JA, Stewart NJ, Bartholmai BJ, Swift AJ, Bianchi SM, Wild JM. Experimental and quantitative imaging techniques in interstitial lung disease. Thorax 2019; 74:611-619. [PMID: 30886067 PMCID: PMC6585263 DOI: 10.1136/thoraxjnl-2018-211779] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 01/05/2019] [Accepted: 01/14/2019] [Indexed: 01/19/2023]
Abstract
Interstitial lung diseases (ILDs) are a heterogeneous group of conditions, with a wide and complex variety of imaging features. Difficulty in monitoring, treating and exploring novel therapies for these conditions is in part due to the lack of robust, readily available biomarkers. Radiological studies are vital in the assessment and follow-up of ILD, but currently CT analysis in clinical practice is qualitative and therefore somewhat subjective. In this article, we report on the role of novel and quantitative imaging techniques across a range of imaging modalities in ILD and consider how they may be applied in the assessment and understanding of ILD. We critically appraised evidence found from searches of Ovid online, PubMed and the TRIP database for novel and quantitative imaging studies in ILD. Recent studies have explored the capability of texture-based lung parenchymal analysis in accurately quantifying several ILD features. Newer techniques are helping to overcome the challenges inherent to such approaches, in particular distinguishing peripheral reticulation of lung parenchyma from pleura and accurately identifying the complex density patterns that accompany honeycombing. Robust and validated texture-based analysis may remove the subjectivity that is inherent to qualitative reporting and allow greater objective measurements of change over time. In addition to lung parenchymal feature quantification, pulmonary vessel volume analysis on CT has demonstrated prognostic value in two retrospective analyses and may be a sign of vascular changes in ILD which, to date, have been difficult to quantify in the absence of overt pulmonary hypertension. Novel applications of existing imaging techniques, such as hyperpolarised gas MRI and positron emission tomography (PET), show promise in combining structural and functional information. Although structural imaging of lung tissue is inherently challenging in terms of conventional proton MRI techniques, inroads are being made with ultrashort echo time, and dynamic contrast-enhanced MRI may be used for lung perfusion assessment. In addition, inhaled hyperpolarised 129Xenon gas MRI may provide multifunctional imaging metrics, including assessment of ventilation, intra-acinar gas diffusion and alveolar-capillary diffusion. PET has demonstrated high standard uptake values (SUVs) of 18F-fluorodeoxyglucose in fibrosed lung tissue, challenging the assumption that these are ‘burned out’ and metabolically inactive regions. Regions that appear structurally normal also appear to have higher SUV, warranting further exploration with future longitudinal studies to assess if this precedes future regions of macroscopic structural change. Given the subtleties involved in diagnosing, assessing and predicting future deterioration in many forms of ILD, multimodal quantitative lung structure-function imaging may provide the means of identifying novel, sensitive and clinically applicable imaging markers of disease. Such imaging metrics may provide mechanistic and phenotypic information that can help direct appropriate personalised therapy, can be used to predict outcomes and could potentially be more sensitive and specific than global pulmonary function testing. Quantitative assessment may objectively assess subtle change in character or extent of disease that can assist in efficacy of antifibrotic therapy or detecting early changes of potentially pneumotoxic drugs involved in early intervention studies.
Collapse
Affiliation(s)
| | - James A Eaden
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Neil J Stewart
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Brian J Bartholmai
- Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Andrew J Swift
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Stephen Mark Bianchi
- Department of Respiratory Medicine, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Jim M Wild
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| |
Collapse
|
9
|
Long T2 suppression in native lung 3-D imaging using k-space reordered inversion recovery dual-echo ultrashort echo time MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 30:387-395. [DOI: 10.1007/s10334-017-0613-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/24/2017] [Accepted: 02/27/2017] [Indexed: 12/21/2022]
|
10
|
Rea G. Magnetic resonance imaging in the evaluation of idiopathic pulmonary fibrosis: a real possibility, or an attractive challenge? Quant Imaging Med Surg 2016; 6:331-3. [PMID: 27429921 DOI: 10.21037/qims.2016.06.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gaetano Rea
- Department of Radiology, Monaldi Hospital, AO dei Colli, Naples, Italy
| |
Collapse
|