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Morpho-Functional 1H-MRI of the Lung in COPD: Short-Term Test-Retest Reliability.

Jobst BJ, Wielpütz MO, Triphan SM, Anjorin A, Ley-Zaporozhan J, Kauczor HU, Biederer J, Ley S, Sedlaczek O - PLoS ONE (2015)

Bottom Line: Median global scores [10(Q1:8.00;Q3:16.00) vs.11(Q1:6.00;Q3:15.00)] as well as category subscores were similar between both timepoints, and kappa statistics indicated "almost perfect" global agreement (ĸ = 0.86, 95%CI = 0.81-0.91).Most MRI acquisitions showed at least diagnostic quality at MRI1 (276 of 278) and MRI2 (259 of 264).Morpho-functional 1H-MRI can be obtained with reproducible image quality and high short-term test-retest reliability for COPD-related morphological and functional changes of the lung.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.

ABSTRACT

Purpose: Non-invasive end-points for interventional trials and tailored treatment regimes in chronic obstructive pulmonary disease (COPD) for monitoring regionally different manifestations of lung disease instead of global assessment of lung function with spirometry would be valuable. Proton nuclear magnetic resonance imaging (1H-MRI) allows for a radiation-free assessment of regional structure and function. The aim of this study was to evaluate the short-term reproducibility of a comprehensive morpho-functional lung MRI protocol in COPD.

Materials and methods: 20 prospectively enrolled COPD patients (GOLD I-IV) underwent 1H-MRI of the lung at 1.5T on two consecutive days, including sequences for morphology, 4D contrast-enhanced perfusion, and respiratory mechanics. Image quality and COPD-related morphological and functional changes were evaluated in consensus by three chest radiologists using a dedicated MRI-based visual scoring system. Test-retest reliability was calculated per each individual lung lobe for the extent of large airway (bronchiectasis, wall thickening, mucus plugging) and small airway abnormalities (tree in bud, peripheral bronchiectasis, mucus plugging), consolidations, nodules, parenchymal defects and perfusion defects. The presence of tracheal narrowing, dystelectasis, pleural effusion, pulmonary trunk ectasia, right ventricular enlargement and, finally, motion patterns of diaphragma and chest wall were addressed.

Results: Median global scores [10(Q1:8.00;Q3:16.00) vs.11(Q1:6.00;Q3:15.00)] as well as category subscores were similar between both timepoints, and kappa statistics indicated "almost perfect" global agreement (ĸ = 0.86, 95%CI = 0.81-0.91). Most subscores showed at least "substantial" agreement of MRI1 and MRI2 (ĸ = 0.64-1.00), whereas the agreement for the diagnosis of dystelectasis/effusion (ĸ = 0.42, 95%CI = 0.00-0.93) was "moderate" and of tracheal abnormalities (ĸ = 0.21, 95%CI = 0.00-0.75) "fair". Most MRI acquisitions showed at least diagnostic quality at MRI1 (276 of 278) and MRI2 (259 of 264).

Conclusion: Morpho-functional 1H-MRI can be obtained with reproducible image quality and high short-term test-retest reliability for COPD-related morphological and functional changes of the lung. This underlines its potential value for the monitoring of regional lung characteristics in COPD trials.

No MeSH data available.


Related in: MedlinePlus

Pulmonary emphysema with concomitant perfusion deficit.Grossly circumscribed structural defect (arrowheads) located in the periphery of the right upper lobe of a 50 year old male patient with GOLD stage I, as displayed on VIBE (A), post-contrast VIBE (B), and HASTE (C). A corresponding, but slightly larger defect (arrowheads) is visible on subtraction images of MR perfusion datasets (D). With regard to the category subscore “parenchymal defects”, the lobe was rated with a score of 1, and with regard to the perfusion score, it was rated with a 2. Additionally, one recognizes a small pleural effusion in the right oblique fissure which is also visible in Fig 4B.
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pone.0137282.g003: Pulmonary emphysema with concomitant perfusion deficit.Grossly circumscribed structural defect (arrowheads) located in the periphery of the right upper lobe of a 50 year old male patient with GOLD stage I, as displayed on VIBE (A), post-contrast VIBE (B), and HASTE (C). A corresponding, but slightly larger defect (arrowheads) is visible on subtraction images of MR perfusion datasets (D). With regard to the category subscore “parenchymal defects”, the lobe was rated with a score of 1, and with regard to the perfusion score, it was rated with a 2. Additionally, one recognizes a small pleural effusion in the right oblique fissure which is also visible in Fig 4B.

Mentions: At single patient level, airway abnormalities (Fig 1), pulmonary consolidations, COPD related-perfusion defects (Fig 2, Fig 3), and impairments of respiratory mechanics (collateral findings) were detected in the same number of patients at MRI1 and MRI2 (Table 4). The prevalence of pulmonary nodules was reported slightly higher at MRI1 (37%) than in MRI2 (26%), just as well as the prevalence of special findings (42% vs. 32%). Other categories differed by 1 subject at most between MRI1 and MRI2 (Table 4).


Morpho-Functional 1H-MRI of the Lung in COPD: Short-Term Test-Retest Reliability.

Jobst BJ, Wielpütz MO, Triphan SM, Anjorin A, Ley-Zaporozhan J, Kauczor HU, Biederer J, Ley S, Sedlaczek O - PLoS ONE (2015)

Pulmonary emphysema with concomitant perfusion deficit.Grossly circumscribed structural defect (arrowheads) located in the periphery of the right upper lobe of a 50 year old male patient with GOLD stage I, as displayed on VIBE (A), post-contrast VIBE (B), and HASTE (C). A corresponding, but slightly larger defect (arrowheads) is visible on subtraction images of MR perfusion datasets (D). With regard to the category subscore “parenchymal defects”, the lobe was rated with a score of 1, and with regard to the perfusion score, it was rated with a 2. Additionally, one recognizes a small pleural effusion in the right oblique fissure which is also visible in Fig 4B.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556659&req=5

pone.0137282.g003: Pulmonary emphysema with concomitant perfusion deficit.Grossly circumscribed structural defect (arrowheads) located in the periphery of the right upper lobe of a 50 year old male patient with GOLD stage I, as displayed on VIBE (A), post-contrast VIBE (B), and HASTE (C). A corresponding, but slightly larger defect (arrowheads) is visible on subtraction images of MR perfusion datasets (D). With regard to the category subscore “parenchymal defects”, the lobe was rated with a score of 1, and with regard to the perfusion score, it was rated with a 2. Additionally, one recognizes a small pleural effusion in the right oblique fissure which is also visible in Fig 4B.
Mentions: At single patient level, airway abnormalities (Fig 1), pulmonary consolidations, COPD related-perfusion defects (Fig 2, Fig 3), and impairments of respiratory mechanics (collateral findings) were detected in the same number of patients at MRI1 and MRI2 (Table 4). The prevalence of pulmonary nodules was reported slightly higher at MRI1 (37%) than in MRI2 (26%), just as well as the prevalence of special findings (42% vs. 32%). Other categories differed by 1 subject at most between MRI1 and MRI2 (Table 4).

Bottom Line: Median global scores [10(Q1:8.00;Q3:16.00) vs.11(Q1:6.00;Q3:15.00)] as well as category subscores were similar between both timepoints, and kappa statistics indicated "almost perfect" global agreement (ĸ = 0.86, 95%CI = 0.81-0.91).Most MRI acquisitions showed at least diagnostic quality at MRI1 (276 of 278) and MRI2 (259 of 264).Morpho-functional 1H-MRI can be obtained with reproducible image quality and high short-term test-retest reliability for COPD-related morphological and functional changes of the lung.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.

ABSTRACT

Purpose: Non-invasive end-points for interventional trials and tailored treatment regimes in chronic obstructive pulmonary disease (COPD) for monitoring regionally different manifestations of lung disease instead of global assessment of lung function with spirometry would be valuable. Proton nuclear magnetic resonance imaging (1H-MRI) allows for a radiation-free assessment of regional structure and function. The aim of this study was to evaluate the short-term reproducibility of a comprehensive morpho-functional lung MRI protocol in COPD.

Materials and methods: 20 prospectively enrolled COPD patients (GOLD I-IV) underwent 1H-MRI of the lung at 1.5T on two consecutive days, including sequences for morphology, 4D contrast-enhanced perfusion, and respiratory mechanics. Image quality and COPD-related morphological and functional changes were evaluated in consensus by three chest radiologists using a dedicated MRI-based visual scoring system. Test-retest reliability was calculated per each individual lung lobe for the extent of large airway (bronchiectasis, wall thickening, mucus plugging) and small airway abnormalities (tree in bud, peripheral bronchiectasis, mucus plugging), consolidations, nodules, parenchymal defects and perfusion defects. The presence of tracheal narrowing, dystelectasis, pleural effusion, pulmonary trunk ectasia, right ventricular enlargement and, finally, motion patterns of diaphragma and chest wall were addressed.

Results: Median global scores [10(Q1:8.00;Q3:16.00) vs.11(Q1:6.00;Q3:15.00)] as well as category subscores were similar between both timepoints, and kappa statistics indicated "almost perfect" global agreement (ĸ = 0.86, 95%CI = 0.81-0.91). Most subscores showed at least "substantial" agreement of MRI1 and MRI2 (ĸ = 0.64-1.00), whereas the agreement for the diagnosis of dystelectasis/effusion (ĸ = 0.42, 95%CI = 0.00-0.93) was "moderate" and of tracheal abnormalities (ĸ = 0.21, 95%CI = 0.00-0.75) "fair". Most MRI acquisitions showed at least diagnostic quality at MRI1 (276 of 278) and MRI2 (259 of 264).

Conclusion: Morpho-functional 1H-MRI can be obtained with reproducible image quality and high short-term test-retest reliability for COPD-related morphological and functional changes of the lung. This underlines its potential value for the monitoring of regional lung characteristics in COPD trials.

No MeSH data available.


Related in: MedlinePlus