Diffuse panbronchiolitis is a disease of obscure aetiology that is traditionally associated with Asian ethnicity. We propose that this disease also occurs in Caucasians and the incidence in this population is greater than currently recognised. We further propose that high resolution computed tomography (HRCT) and response to macrolide therapy should be relied upon to make this diagnosis without verification by lung biopsy. In most circumstances, obtaining a biopsy for histopathology is not practical, and the disease may then be mistaken for other more common airway diseases. Accuracy of diagnosis is important as untreated disease is associated with a poor prognosis, and effective treatment is available. We report four out of a series of cases as evidence that DPB is in fact more common in the Western population than is currently understood.

Introduction Intervertebral disk degeneration (IVD) on magnetic resonance imaging (MRI) is an etiological factor associated with low back pain. The (IVD) has been well acknowledged to degenerate as characterized by biochemical and morphological changes. T2 relaxation time has been suggested to be sensitive to changes in collagen and water content in cartilage and in the IVD. In the disk, the investigators have quantified chemical exchange saturation transfer (CEST) and its specificity as well as its correlation capacity for glycosaminoglycan (GAG) content (gagCEST). However, the correlation between conventional qualitative MRI assessment (T2-weighted) and quantitative MRI measurement, such as T2 and CEST, remains unknown. In this study, we aimed to investigate the association between CEST, T2 and degenerative grades in IVD using T2-weighted MRI in human subjects. Materials and Methods Total 21 subjects (8 females, 13 males; median age 34; age range: 24 to 58 years) with no prior spine surgery were recruited. Sagittal T2-weighted, CEST, and T2 MRI of the lumbar spine were obtained. All images of the lumbar spine were acquired using a 3T Achieva scanner. High-resolution T2-weighted disks were qualitatively graded according to Schneiderman's classification (score range: 0 to 3). CEST and T2 maps were quantitatively assessed based on a voxel-by-voxel basis. Results A decreasing trend of CEST and T2 values with increasing grade of degeneration was noted. The mean CEST values in L3/4, L4/5 and L5/S1 discs with Schneiderman grades 0 (n = 41), 1 (n = 10), 2 (n = 7) and 3 (n = 5) were 7.17 ± 1.10%, 6.00 ± 0.83%, 2.85 ± 0.39%, and 1.84 ± 0.27%, respectively. The mean T2 values in discs with Schneiderman grades 0 (n = 41), 1 (n = 10), 2 (n = 7) and 3 (n = 5) were 109.74 ± 12.40 ms, 83.84 ± 6.19 ms, 71.70 ± 3.44 ms, and 65.16 ± 2.97 ms, respectively. Schneiderman grade was correlated with both CEST (r = -0.67, p < 0.001) and T2 (r = -0.71, p) Conclusion Our results showed that CEST and T2 decreases with increasing grade of disk degeneration and that CEST values significantly correlated with T2. Our findings propose useful quantitative imaging tools with discriminatory capacity to assess early and end-stage IVD degeneration. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared

Introduction Magnetic resonance imaging (MRI) has been shown to improve the diagnosis and management of patients with intervertebral disk (IVD) related disorders. Multiparametric MRI offers the possibility of noninvasively assessing multiple aspects of pathophysiological processes that exist simultaneously, thereby further assisting in patient treatment management. The purpose of this study is to determine the correlation between relaxation parameters (T1-rho and T2), diffusion properties including fractional anisotropy (FA) and mean diffusivity (MD) measured by diffusion tensor imaging (DTI), and degenerative grades in human IVD based on T2-weighted MRI. Materials and Methods Total 21 subjects (mean age 41.3 years; age range: 24 to 61 years; gender: 10 females, 11 males) with no prior spine surgery were recruited. Sagittal T2-weighted, T1-rho, T2, FA and MD MRI of the lumbar spine were obtained. All images of the lumbar spine were acquired using a 3T Achieva scanner. High-resolution T2-weighted discs were qualitatively graded by two spine specialists in consensus according to Schneiderman's classification (score range: 0 to 3). T1-rho, T2, FA, and MD maps were quantitatively assessed based on a voxel-by-voxel basis. Results By visual inspection, the nucleus pulposus (NP) and annulus fibrosus (AF) in IVDs were distinctively separable on all quantitative maps while some of the discs on T2-weighted images did not show a clear difference between the NP and the AF. The Schneiderman grades and subjects' age significantly correlated with all parameters (p < 0.001). Univariate analysis demonstrated that T1-rho correlated significantly with MD and FA (r = 0.729 and −0.715, respectively; p < 0.001 for both). Quantitative T2 also correlated significantly with MD and FA (r = 0.805 and −0.811, respectively; p < 0.001 for both). In addition, T1-rho showed significant correlation with quantitative T2 (r = 0.824; p < 0.001). Conclusion In this study, we performed quantitative multiparametric MRI to investigate its sensitivity to changes in tissue microstructure of in vivo human lumbar IVDs. Our results suggest that each imaging parameter may attribute different sensitivity to tissue properties. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared