Limits...
Lung magnetic resonance imaging with diffusion weighted imaging provides regional structural as well as functional information without radiation exposure in primary antibody deficiencies.

Milito C, Pulvirenti F, Serra G, Valente M, Pesce AM, Granata G, Catalano C, Fraioli F, Quinti I - J. Clin. Immunol. (2015)

Bottom Line: Magnetic Resonance Imaging was non-inferior to High Resolution Computerized Tomography in the capacity to identify bronchial and parenchymal abnormalities.HRCT had a higher capacity to identify peripheral airways abnormalities, defined as an involvement of bronchial generation up to the fifth and distal (scores 2-3).Bronchial scores negatively related to pulmonary function tests.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome, Italy.

ABSTRACT

Purpose: Primary antibody deficiency patients suffer from infectious and non-infectious pulmonary complications leading over time to chronic lung disease. The complexity of this pulmonary involvement poses significant challenge in differential diagnosis in patients with long life disease and increased radio sensitivity. We planned to verify the utility of chest Magnetic Resolution Imaging with Diffusion-Weighted Imaging as a radiation free technique.

Methods: Prospective evaluation of 18 patients with Common Variable Immunodeficiency and X-linked Agammaglobulinemia. On the same day, patients underwent Magnetic Resonance Imaging with Diffusion Weighted Imaging sequences, High Resolution Computerized Tomography and Pulmonary Function Tests, including diffusing capacity factor for carbon monoxide. Images were scored using a modified version of the Bhalla scoring system.

Results: Magnetic Resonance Imaging was non-inferior to High Resolution Computerized Tomography in the capacity to identify bronchial and parenchymal abnormalities. HRCT had a higher capacity to identify peripheral airways abnormalities, defined as an involvement of bronchial generation up to the fifth and distal (scores 2-3). Bronchial scores negatively related to pulmonary function tests. One third of consolidations and nodules had Diffusion Weighted Imaging restrictions associated with systemic granulomatous disease and systemic lymphadenopathy. Lung Magnetic Resolution Imaging detected an improvement of bronchial and parenchymal abnormalities, in recently diagnosed patients soon after starting Ig replacement.

Conclusions: Magnetic Resonance Imaging with Diffusion Weighted Imaging was a reliable technique to detect lung alterations in patients with Primary Antibody Deficiencies.

No MeSH data available.


Related in: MedlinePlus

Representative MRI with DWI sequences: nodules Nodules detected by MRI with DWI. MRI BLADE sequence detecting a nodule (white arrow) at the right lower lobe (a) without a DWI corresponding hotspot (b). MRI BLADE sequence detecting multiple and bilateral small nodules of the lower lobes (c) and their corresponding hotspots at DWI assessment (white arrow) (d)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4502290&req=5

Fig5: Representative MRI with DWI sequences: nodules Nodules detected by MRI with DWI. MRI BLADE sequence detecting a nodule (white arrow) at the right lower lobe (a) without a DWI corresponding hotspot (b). MRI BLADE sequence detecting multiple and bilateral small nodules of the lower lobes (c) and their corresponding hotspots at DWI assessment (white arrow) (d)

Mentions: Six out of nine patients with consolidations recorded by MRI had DWI hotspots. Overall, 14 out of 41 consolidations recorded (34.1 %) were DWI restricted (Fig. 3a). DWI hotspots were related to consolidations with a MRI score <1 (segmental or lobar extension). All consolidations with a MRI score of 1 (sub-segmental extension) were DWI negative. Four out of ten patients with nodules had DWI hotspots. Overall, 13 out of 40 nodules recorded by MRI (32.5 %) were DWI-restricted (Fig. 3b). Nodules had a maximum transversal diameter ranging between 3 and 14 mm. There was no difference in the mean diameter between nodules with or without DWI hotspots (7 mm, IQR 6–8, vs 5.5 mm, IQR 4.75–7). In Fig. 4 and Fig. 5, we show representative MRIs with DWI-restricted and DWI-non restricted areas. Patients with DWI hotspots had higher total MRI Bhalla score and higher total MRI parenchymal scores in comparison to patients who did not have DWI-restricted parenchymal areas (total score 10 (IQR 7.5–16) vs 6 (IQR 2.5–8.5) (p = 0.05); total parenchymal score 5 (IQR 3.5–6) vs 0 (IQR 0–0.75), respectively). Patients with DWI-restricted consolidations had also a lower predicted FEV1% in comparison to patients without DWI hotspots (45 %, IQR 34–71 % vs 81 %, IQR 60.8–85 %). DWI restricted abnormalities (nodules and/or consolidations) were only detected in patients with systemic granulomatous diseases. Isolated DWI restricted consolidations were mainly present in patients with systemic lymphadenopathy (85 % vs 36 %, p = 0.04). The presence of DWI-restricted areas was not associated with splenomegaly and autoimmune manifestations. Moreover, patients with DWI-restricted abnormalities had an increased percentage of CD21low B cells in comparison to patients without DWI hot spots (33 %, IQR 23.5–47, vs 16 %, IQR 14–21, p = 0.05). The analysis of other B and T cell subsets did not show any differences between patients with DWI restricted and not restricted areas.Fig. 3


Lung magnetic resonance imaging with diffusion weighted imaging provides regional structural as well as functional information without radiation exposure in primary antibody deficiencies.

Milito C, Pulvirenti F, Serra G, Valente M, Pesce AM, Granata G, Catalano C, Fraioli F, Quinti I - J. Clin. Immunol. (2015)

Representative MRI with DWI sequences: nodules Nodules detected by MRI with DWI. MRI BLADE sequence detecting a nodule (white arrow) at the right lower lobe (a) without a DWI corresponding hotspot (b). MRI BLADE sequence detecting multiple and bilateral small nodules of the lower lobes (c) and their corresponding hotspots at DWI assessment (white arrow) (d)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502290&req=5

Fig5: Representative MRI with DWI sequences: nodules Nodules detected by MRI with DWI. MRI BLADE sequence detecting a nodule (white arrow) at the right lower lobe (a) without a DWI corresponding hotspot (b). MRI BLADE sequence detecting multiple and bilateral small nodules of the lower lobes (c) and their corresponding hotspots at DWI assessment (white arrow) (d)
Mentions: Six out of nine patients with consolidations recorded by MRI had DWI hotspots. Overall, 14 out of 41 consolidations recorded (34.1 %) were DWI restricted (Fig. 3a). DWI hotspots were related to consolidations with a MRI score <1 (segmental or lobar extension). All consolidations with a MRI score of 1 (sub-segmental extension) were DWI negative. Four out of ten patients with nodules had DWI hotspots. Overall, 13 out of 40 nodules recorded by MRI (32.5 %) were DWI-restricted (Fig. 3b). Nodules had a maximum transversal diameter ranging between 3 and 14 mm. There was no difference in the mean diameter between nodules with or without DWI hotspots (7 mm, IQR 6–8, vs 5.5 mm, IQR 4.75–7). In Fig. 4 and Fig. 5, we show representative MRIs with DWI-restricted and DWI-non restricted areas. Patients with DWI hotspots had higher total MRI Bhalla score and higher total MRI parenchymal scores in comparison to patients who did not have DWI-restricted parenchymal areas (total score 10 (IQR 7.5–16) vs 6 (IQR 2.5–8.5) (p = 0.05); total parenchymal score 5 (IQR 3.5–6) vs 0 (IQR 0–0.75), respectively). Patients with DWI-restricted consolidations had also a lower predicted FEV1% in comparison to patients without DWI hotspots (45 %, IQR 34–71 % vs 81 %, IQR 60.8–85 %). DWI restricted abnormalities (nodules and/or consolidations) were only detected in patients with systemic granulomatous diseases. Isolated DWI restricted consolidations were mainly present in patients with systemic lymphadenopathy (85 % vs 36 %, p = 0.04). The presence of DWI-restricted areas was not associated with splenomegaly and autoimmune manifestations. Moreover, patients with DWI-restricted abnormalities had an increased percentage of CD21low B cells in comparison to patients without DWI hot spots (33 %, IQR 23.5–47, vs 16 %, IQR 14–21, p = 0.05). The analysis of other B and T cell subsets did not show any differences between patients with DWI restricted and not restricted areas.Fig. 3

Bottom Line: Magnetic Resonance Imaging was non-inferior to High Resolution Computerized Tomography in the capacity to identify bronchial and parenchymal abnormalities.HRCT had a higher capacity to identify peripheral airways abnormalities, defined as an involvement of bronchial generation up to the fifth and distal (scores 2-3).Bronchial scores negatively related to pulmonary function tests.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular Medicine, Sapienza University of Rome, Viale dell'Università 37, Rome, Italy.

ABSTRACT

Purpose: Primary antibody deficiency patients suffer from infectious and non-infectious pulmonary complications leading over time to chronic lung disease. The complexity of this pulmonary involvement poses significant challenge in differential diagnosis in patients with long life disease and increased radio sensitivity. We planned to verify the utility of chest Magnetic Resolution Imaging with Diffusion-Weighted Imaging as a radiation free technique.

Methods: Prospective evaluation of 18 patients with Common Variable Immunodeficiency and X-linked Agammaglobulinemia. On the same day, patients underwent Magnetic Resonance Imaging with Diffusion Weighted Imaging sequences, High Resolution Computerized Tomography and Pulmonary Function Tests, including diffusing capacity factor for carbon monoxide. Images were scored using a modified version of the Bhalla scoring system.

Results: Magnetic Resonance Imaging was non-inferior to High Resolution Computerized Tomography in the capacity to identify bronchial and parenchymal abnormalities. HRCT had a higher capacity to identify peripheral airways abnormalities, defined as an involvement of bronchial generation up to the fifth and distal (scores 2-3). Bronchial scores negatively related to pulmonary function tests. One third of consolidations and nodules had Diffusion Weighted Imaging restrictions associated with systemic granulomatous disease and systemic lymphadenopathy. Lung Magnetic Resolution Imaging detected an improvement of bronchial and parenchymal abnormalities, in recently diagnosed patients soon after starting Ig replacement.

Conclusions: Magnetic Resonance Imaging with Diffusion Weighted Imaging was a reliable technique to detect lung alterations in patients with Primary Antibody Deficiencies.

No MeSH data available.


Related in: MedlinePlus