Magnetic resonance imaging features of coronavirus disease 2019 (COVID-19) pneumonia: The first preliminary case series

Abstract

Rationale and objectives: There is a rising onus on understanding the common features of COVID-19 pneumonia on different imaging modalities. In this study, we aimed to review and depict the common MRI features of COVID-19 pneumonia in our laboratory confirmed case series, the first comprehensive reported cohort in the literature. Materials and methods: Upon IRB approval, eight laboratory confirmed COVID-19 patients who presented to our outpatient imaging clinic underwent chest CT and, once various features of COVID-19 pneumonia were identified, a dedicated multisequence chest MRI was performed on the same day with an institutional protocol. Demographic data and the morphology, laterality and location of the lesions were recorded for each case. Results: Five males and three females with the mean age of 40.63 ± 12.64 years old were present in this case series. Five cases had typical CT features with ground glass opacities and consolidations, readily visible on different MRI sequences. Three cases had indeterminate or atypical features which were also easily seen on MRI. The comprehensive review of MRI features for each case and representative images have been illustrated. Conclusion: Becoming familiar with typical findings of COVID-19 pneumonia in MRI is crucial for every radiologist. Although MRI is not the modality of choice for evaluation of pulmonary opacities, it has similar capabilities in detection of COVID-19 pneumonia when compared to chest CT.

Imaging of COVID-19: CT, MRI, and PET

“…In a preliminary case series of eight patients, Torkian et al demonstrated visualization of GGOs, consolidation, reticulation, and a reverse halo sign on multiple MRI sequences. 34 T2-weighted turbo spin-echo turbo inversion recovery magnitude (T2W TSE-TIRM) was found to resolve lesions more brightly than the other sequences studied, likely highlighting areas of edema secondary to parenchymal inflammatory changes. Similarly, Ates et al showed no significant differences in MRI detection of GGOs or consolidative lesions versus conventional CT. 33 In their study, MRI had 91.7% sensitivity, 100% specificity, 100% positive predictive value, and 95.2% negative predictive value when using CT as the reference.…”

“… 5 , 15 , 18 , 25 Bilateral lung involvement most often predominates, usually in a peripheral, subpleural, and posterior distribution. 6 , 7 , 11 , 12 , 14 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 Ground-glass opacities (GGOs) – defined as hazy opacities with preservation of the underlying vascular and bronchial architecture 35 – have been most commonly observed, with occurrence rates ranging from 50% to 98% in the adult population 2 , 12 , 14 , 28 , 29 , 30 , 31 , 32 , 33 , 36 , 37 ( Figs. 1 and 2 ).…”

“…58 , 59 Concerns with regard to infectious transmission notwithstanding, pulmonary MRI has historically been limited by cardiac and respiratory motion artifact, low proton density of the parenchymal tissues, and susceptibility artifacts resulting from multiple soft-tissue-air interfaces. 34 , 54 , 55 , 56 , 57 , 60 Yet, these intrinsic properties of the lung parenchyma are in fact advantages when imaging pathology of the alveolar spaces, as GGOs and consolidation appear hyperintense relative to the surrounding tissues secondary to exudative fluid accumulation and increased proton density. 33 , 34 , 55 , 56 , 60 Though not considered routine for evaluating suspected lower respiratory tract infections, pulmonary MRI may provide a viable alternative for imaging high-risk patient groups – such as pregnant women and children – in whom exposure to ionizing radiation should be avoided.…”

“… 34 , 54 , 55 , 56 , 57 , 60 Yet, these intrinsic properties of the lung parenchyma are in fact advantages when imaging pathology of the alveolar spaces, as GGOs and consolidation appear hyperintense relative to the surrounding tissues secondary to exudative fluid accumulation and increased proton density. 33 , 34 , 55 , 56 , 60 Though not considered routine for evaluating suspected lower respiratory tract infections, pulmonary MRI may provide a viable alternative for imaging high-risk patient groups – such as pregnant women and children – in whom exposure to ionizing radiation should be avoided. 33 , 34 , 54 , 57 , 60 …”

“… 33 , 34 , 55 , 56 , 60 Though not considered routine for evaluating suspected lower respiratory tract infections, pulmonary MRI may provide a viable alternative for imaging high-risk patient groups – such as pregnant women and children – in whom exposure to ionizing radiation should be avoided. 33 , 34 , 54 , 57 , 60 …”