Contrast-enhanced 3D MRI of lung perfusion in children with cystic fibrosis—initial results

Abstract

This paper is a feasibility study of magnetic resonance imaging (MRI) of lung perfusion in children with cystic fibrosis (CF) using contrast-enhanced 3D MRI. Correlation assessment of perfusion changes with structural abnormalities. Eleven CF patients (9 f, 2 m; median age 16 years) were examined at 1.5 T. Morphology: HASTE coronal, transversal (TR/TE/alpha/ST: 600 ms/28 ms/180 degrees /6 mm), breath-hold 18 s. Perfusion: Time-resolved 3D GRE pulse sequence (FLASH, TE/TR/alpha: 0.8/1.9 ms/40 degrees ), parallel imaging (GRAPPA, PAT 2). Twenty-five data sets were acquired after intravenous injection of 0.1 mmol/kg body weight of gadodiamide, 3-5 ml/s. A total of 198 lung segments were analyzed by two radiologists in consensus and scored for morphological and perfusion changes. Statistical analysis was performed by Mantel-Haenszel chi-square test. Results showed that perfusion defects were observed in all patients and present in 80% of upper, and 39% of lower lobes. Normal lung parenchyma showed homogeneous perfusion (86%, P<0.0001). Severe morphological changes led to perfusion defects (97%, P<0.0001). Segments with moderate morphological changes showed normal (53%) or impaired perfusion (47%). In conclusion, pulmonary perfusion is easy to judge in segments with normal parenchyma or severe changes. In moderately damaged segments, MRI of lung perfusion may help to better assess actual functional impairment. Contrast-enhanced 3D MRI of lung perfusion has the potential for early vascular functional assessment and therapy control in CF patients.

MRI of the lung – state of the art

“…In children with CF, perfusion defects imaged with MRI (Fig. 5b) correlated with the degree of tissue destruction (34). It seems reasonable that the reversibility of perfusion defects after a therapeutic intervention might serve as an indicator for response to therapy as well as a means to differentiate between regions with reversible and irreversible disease.…”

A View on Imaging in Drug Research and Development for Respiratory Diseases

“…Threedimensional (3D) MRI has provided the required high spatial and temporal resolution to analyze the first passage through the lungs of a bolus of MRI contrast agent. MRI lung perfusion has been used to demonstrate perfusion abnormalities in patients with CF (Eichinger et al, 2006) and emphysema (Ley-Zaporozhan et al, 2007). Fourier decomposition MRI has been introduced, enabling lung perfusion and ventilation imaging without the administration of contrast agents (Bauman et al, 2009) (Fig.…”

Imaging of Cystic Fibrosis Lung Disease and Clinical Interpretation

“…Typical patchy or wedge-shaped perfusion defects occur on MRI and it was shown that these areas of hypoperfusion correlate with the degree of parenchymal changes in pediatric (age range: 0 -6 years, mean age: 3.1 years) and adolescent (age range: 11 -19 years, median age: 16 years) CF patients (• ▶ Fig. 4, 5) [11,47]. Abnormal perfusion on MRI was already detected in the first year of life, with an overall prevalence of 85 % in preschool children, comparable to the aforementioned prevalence of air trapping [11].…”