MRI evaluation of pulmonary lesions and lung tissue changes induced by tuberculosis

Abstract

Objective: To evaluate the utility of magnetic resonance imaging (MRI) with an advanced motion correction technique in characterizing lung tissue changes and lesions induced by pulmonary tuberculosis (TB). Methods: Sixty-three subjects with computed tomography (CT) features of pulmonary TB underwent lung MRI. All subjects with pulmonary TB were confirmed by acid-fast bacillus (AFB) testing or the detection of Mycobacterium tuberculosis. T2-weighted turbo spin echo (TSE) sequence MRI with the MultiVane motion correction technique was used to image the lungs. Routine lung CT images were obtained as reference. MRI and CT images were reviewed by multiple readers independently. The performance of MRI in depicting abnormalities induced by pulmonary TB and their morphological changes were evaluated and compared with the performance of CT. Results: Lung MRI found pulmonary abnormalities in all 63 TB subjects, with satisfactory quality. With the implementation of MultiVane for T2-weighted TSE sequences to reduce the motion correction effect, MRI showed excellent agreement with CT in detecting abnormal imaging features of pulmonary TB (k = 0.88, p < 0.001), such as tree-in-bud sign, ground-glass opacity, consolidation, mass, and cavitation. MRI was advantageous in identifying caseation and liquefactive necrosis based on inhomogeneous signal distribution within consolidations and also in identifying mild pleural effusion. The optimized lung MRI was comparable to CT in detecting non-calcified nodules (k = 0.90), with overall sensitivity of 50.0%, 91.1%, and 100% for nodules of size <5 mm, 5-10 mm, and >10 mm, respectively. However, MRI was less effective in identifying lesions with calcification. Conclusions: The clinical implementation of an optimized MRI protocol with the MultiVane motion correction technique for imaging pulmonary TB is feasible. Lung MRI without ionizing radiation is a promising alternative to the clinical standard CT, especially for pregnant women, children, adolescents, and patients requiring short-term and repeated follow-up observations.

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“…They have been used as phantoms for lung ultrasound surface wave elastography [55] and for lung MR imaging [56]. Different MRI pulse sequences, including FSE (fast spin echo) and PROPELLER (periodically rotated overlapping parallel lines with enhanced reconstruction), have been tested, during the last decade, for detection and identification of different pulmonary changes induced by tuberculosis [9][10][11]. These methods are not particularly effective for imaging of lung tissue, characterized by fast signal decay due to very short T 2 /T 2 * relaxation times.…”

“…When diagnosing pulmonary diseases, the MRI can be used to detect disease-induced changes in the lungs [9][10][11]. MRI is especially attractive when dealing with pediatric patients [12] and pregnant women [13].…”

Practical protocol for lung magnetic resonance imaging and common clinical indications

“…For the examination of pulmonary tuberculosis, Zeng et al [ 46 ] compared the utility of MRI and CT using a T2-W fast spin-echo sequence with rotating phase-encoding for motion compensation. In a series of 63 patients, the authors clearly identified diagnostically relevant pathology such as tree-in-bud sign, ground-glass opacity, consolidation, masses and cavitations [ 46 ]. The sensitivity for non-calcified nodular lesions was consistent with previous reports (50.0%, 91.1% and 100% for nodules sizes <5 mm, 5–10 mm and >10 mm, respectively).…”

The current status and further prospects for lung magnetic resonance imaging in pediatric radiology

“…Assuming an adequate examination technique, MRI diagnostics is on a par with CT for these diseases. This includes all lung diseases with alveolar exudation and infiltration by infections [24,25], tissue proliferation such as tumors or metastases [22], malformations such as sequesters [26] and of course cystic fibrosis, which is particularly important in pediatric pulmonology [27].…”

“…c Apparent diffusion coefficient (ADC) map from the axial diffusion-weighted imaging sequence: The low ADC values (arrow) prove the purulent content within the cave shows high MRI signal (Figs. 3 and 4) [24,25]. MRI is not commonly used in the examination of simple pulmonary inflammation, but it can be useful if complications, for example abscess formation, are suspected (Figs.…”