Fast 1.5 T chest MRI for the assessment of interstitial lung disease extent secondary to systemic sclerosis

Abstract

This study aims to evaluate the utility of magnetic resonance imaging (MRI) to assess interstitial lung disease (ILD) extent in patients with systemic sclerosis (SSc). Patients with SSc and varying degrees of ILD with a high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), and a chest MRI containing an ultrafast SE sequence performed less than 1 year apart were included in the study. Wells global disease extent and Goh's staging algorithm were used to measure and categorize ILD both for MRI and HRCT. Correlation and diagnostic performance of MRI compared with HRCT and PFTs were calculated. Eighteen SSc patients were studied. MRI showed a good performance to detect ILD (AUC = 0.96) and was correlated with forced vital capacity (r = -0.60, p = 0.01), diffusing capacity of the lung for carbon monoxide (r = -0.79, p = 0.04), and also with HRCT (r = 0.85, p < 0.001), but MRI extent values were consistently lower than HRCT and, thus, not directly comparable. Goh's algorithm using HRCT and transformed to be used with MRI showed a good agreement (kappa = 0.73, p < 0.001) and MRI-measured ILD extent presented good intra-observer (ICC = 0.86) and inter-observer (ICC = 0.90) reliability. In SSc patients, MRI proved to be a good technique to detect and categorize ILD extent compared with HRCT, suggesting that it may be a valuable x-ray sparing technique for selected cases.

The use of chest magnetic resonance imaging in interstitial lung disease: a systematic review

“…This study demonstrated that HASTE MRI could detect patients with >0.5% ILD extent with a sensitivity of 93% and specificity of 100%. Furthermore, MRI showed the same diagnostic performance ( p=0.03) of thin-slices MDCT to detect ILD in systemic sclerosis patients [25]. RAJARAM et al [26] retrospectively analysed chest MRI of 224 patients, acquired using a two-dimensional balanced steady-state free-precession (bSSFP) sequence.…”

“…However, HASTE imaging did not show a high diagnostic quality because of respiratory and cardiac motion artefacts [24]. PINAL-FERNANDEZ et al [25] evaluated the utility of HASTE to assess the extent of ILD involvement in patients with systemic sclerosis. HASTE showed a good diagnostic performance to detect ILD with an area under the curve of 96% (95% CI 89-100%).…”

Interstitial lung disease in Systemic sclerosis: insights into pathogenesis and evolving therapies

“…Though still inferior to CT, current high-Tesla MRI machines can offer a radiation-free alternative for ILD detection. 23 A promising screening strategy for ILD can be the use of ultrasound (US). The number of B-lines ("comet" artifact) has shown correlation with CT scores 24 in SSc.…”

Is computed tomography the ideal method for the identification and management of lung disease in systemic sclerosis?

“…However, the frequent use of ionizing radiation is a matter of growing concern, especially in this population that already has an increased risk of tumors, as mentioned by Bastos et al (4) . Therefore, new imaging techniques, such as ultrasound of the thorax, the reduction in the number of HRCT slices, and the use of low-dose CT, have been proposed as options to resolve this problem (9) .…”

“…However, the use of MRI is still limited to certain cases in which there is a need to minimize the use of ionizing radiation (9,10) . Allied to this problem, the upcoming addition of new antifibrotic drugs, such as pirfenidone (11) , to the therapeutic arsenal against SSc will further increase the challenges facing radiologists in the search for an ideal method to monitor patients with the disease.…”