Comparison Between Magnetic Resonance Imaging and Computed Tomography of the Lung in Patients With Cystic Fibrosis With Regard to Clinical, Laboratory, and Pulmonary Functional Parameters

Abstract

Objective: To evaluate whether magnetic resonance imaging (MRI) is effective as computed tomography (CT) in determining morphologic and functional pulmonary changes in patients with cystic fibrosis (CF) in association with multiple clinical parameters. Materials and Methods: Institutional review board approval and patient written informed consent were obtained. In this prospective study, 30 patients with CF (17 men and 13 women; mean (SD) age, 30.2 (9.2) years; range, 19-52 years) were included. Chest CT was acquired by unenhanced low-dose technique for clinical purposes. Lung MRI (1.5 T) comprised T2-and T1-weighted sequences before and after the application of 0.1-mmol·kg −1 gadobutrol, also considering lung perfusion imaging. All CT and MR images were visually evaluated by using 2 different scoring systems: the modified Helbich and the Eichinger scores. Signal intensity of the peribronchial walls and detected mucus on T2-weighted images as well as signal enhancement of the peribronchial walls on contrast-enhanced T1-weighted sequences were additionally assessed on MRI. For the clinical evaluation, the pulmonary exacerbation rate, laboratory, and pulmonary functional parameters were determined. .2) (range, 4-31); and median, 21.0 (IQR, 9.5) vs mean (SD), 19.5 (7.1) (range, 4-33); and median, 20.0 (IQR, 9.0). All differences between CT and MR examinations were not significant (Wilcoxon rank sum tests and Student t tests; P > 0.05). In general, the correlations of the CT scores (overall and different imaging parameters) to the clinical parameters were slightly higher compared to the MRI scores. However, if all additional MRI parameters were integrated into the scoring systems, the correlations reached the values of the CT scores. The overall image quality was significantly higher for the CT examinations compared to the MRI sequences. Conclusions:One major diagnostic benefit of lung MRI in CF is the possible acquisition of several different morphologic and functional imaging features without the use of any radiation exposure. Lung MRI shows reliable associations with CT and clinical parameters, which suggests its implementation in CF for routine diagnosis, which would be particularly important in follow-up imaging over the long term.

Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis: MR Imaging of Airway Mucus Contrasts as a Tool for Diagnosis

“…In the field of imaging, it has been shown that the presence of mucous plugging impaction with hyperattenuating mucus (HAM) at computed tomography (CT) is a 100% specific criterion of ABPA in THORACIC IMAGING: MR Imaging Diagnosis of Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis Dournes et al imaging evaluation, readers were asked to assess the presence of mucoid impaction at the lobar level by using a binary scale (present = 1). When a mucoid impaction was considered to be present, readers had to then evaluate whether its signal intensity was similar to that of the previously published "waterlike" MR imaging appearance (ie, hypointensity on T1-weighted images and hyperintensity on T2-weighted images [18,20]) or if it was defined by the novel IMIS sign, which is hyperintense on T1-weighted images and hypointense on T2-weighted images (10).…”

Organization of Patient Management and Fungal Epidemiology in Cystic Fibrosis

“…Annual radiologic diagnostics are performed with X-ray or computed tomography (CT) scan producing a significant amount of radiation exposure to the patient. Newer techniques such as magnetic resonance imaging (MRI) allow a comparable examination of the lung [9][10][11]. Additionally, the radiology and nuclear medicine service should still include CT scanning, liver ultrasound and dual-energy X-ray absorptiometry (DXA) bone scanning.…”

Early detection and sensitive monitoring of CF lung disease: Prospects of improved and safer imaging

“…) . Due to this characteristic “increased signal pathology,” these studies found a high concordance between MRI and CT supporting comparable sensitivity in detecting structural abnormalities across a broad spectrum of CF lung disease severity despite apparent differences in spatial resolution . However, a direct comparison of the sensitivity of two techniques to detect mild bronchiectasis in infants and young children with CF is pending.…”

“…Compared to CT imaging, this conventional MRI approach has the apparent limitation of lower spatial resolution. However, a series of studies in older children and adults with CF demonstrated that characteristic abnormalities in CF lung disease such as airway mucus plugging, bronchial wall thickening, and progressive bronchiectasis are reliably detected by MRI . In fact, it was found that the increase in fluid and tissue (and thus proton density) associated with these abnormalities enhances the sensitivity of MRI and facilitates detection of these pathologies in CF lung disease.…”

“…To date, the various emerging MRI techniques for morphological and functional assessment of lung disease were mainly evaluated in relatively small groups of older children and adults with CF, mostly in a research setting . A recent study determined the sensitivity of MRI to detect early lung disease in a larger cohort of clinically stable infants and preschool children with CF in the clinical setting and compared results to age‐matched children without CF and without evidence of lung disease .…”