Perfusion abnormalities in congenital and neoplastic pulmonary disease: comparison of MR perfusion and multislice CT imaging

Abstract

The aim of this work was to assess magnetic resonance (MR) perfusion patterns of chronic, non-embolic pulmonary diseases of congenital and neoplastic origin and to compare the findings with results obtained with pulmonary, contrast-enhanced multislice computed tomography (CT) imaging to prove that congenital and neoplastic pulmonary conditions require MR imaging over the pulmonary perfusion cycle to successfully and directly detect changes in lung perfusion patterns. Twenty-five patients underwent concurrent CT and MR evaluation of chronic pulmonary diseases of congenital (n=15) or neoplastic (n=10) origin. Analysis of MR perfusion and contrast-enhanced CT datasets was realized by defining pulmonary and vascular regions of interest in corresponding positions. MR perfusion calculated time-to-peak enhancement, maximal enhancement and the area under the perfusion curve. CT datasets provided pulmonary signal-to-noise ratio measurements. Vessel center-lines of bronchial arteries were determined. Underlying perfusion type, such as pulmonary arterial or systemic arterial supply, as well as regions with significant variations in perfusion were determined statistically. Analysis of the pulmonary perfusion pattern detected pulmonary arterial supply in 19 patients; six patients showed systemic arterial supply. In pulmonary arterial perfusion, MR and multislice CT imaging consistently detected the perfusion type and regions with altered perfusion patterns. In bronchial arterial supply, MR perfusion and CT imaging showed significant perfusion differences. Patients with bronchial arterial supply had bronchial arteries ranging from 2.0 to 3.6 mm compared with submillimeter diameters in pulmonary arterial perfusion. Dynamic MR imaging of congenital and neoplastic pulmonary conditions allowed characterization of the pulmonary perfusion type. CT imaging suggested the presence of systemic arterial perfusion by visualizing hypertrophied bronchial arteries.

Quantitative contrast-enhanced computed tomography: is there a need for system calibration?

“…This technique has attracted interest as a means to evaluate pulmonary nodules detected during CT screening for lung cancer [2] and has been evaluated as a potential method for characterising and assessing treatment response in advanced bronchial cancers [3,4]. Quantification of contrast enhancement has also been used to assess perfusion abnormalities associated with congenital pulmonary diseases [5]. Within the abdomen, quantification of hepatic enhancement during dual-phase spiral CT of the liver has been reported as a means of identifying patients at risk of subsequently developing hepatic metastases [6,7].…”

Detection of small pulmonary nodules in high-field MR at 3 T: evaluation of different pulse sequences using porcine lung explants

“…It provides the opportunity to control disease progression in children without the use of ionizing radiation and may even be discussed for lung cancer screening [11][12][13] for example as part of wholebody imaging. Several approaches have been made to differentiate benignant from malignant pulmonary lesions using dynamic contrast enhanced MRI of the lung [14][15][16][17]. The feasibility of lung MRI for depicting alveolar infiltrates and diffuse lung disease has recently been evaluated [18,19].…”

Integrated Cardiothoracic Imaging with MDCT

“…The current temporal limitations of dual-energy CT may lead to masking pulmonary perfusion alterations as increased systemic arterial supply may mimic regular pulmonary arterial blood supply on monophasic, contrast-enhanced pulmonary CT imaging (Boll et al 2005). First, as previously pointed out, it is neither a true perfusion imaging nor a blood fl ow imaging.…”