Reproducibility of pulmonary magnetic resonance angiography in adults with muco-obstructive pulmonary disease

Abstract

Background Recent studies support magnetic resonance angiography (MRA) as a diagnostic tool for pulmonary arterial disease. Purpose To determine MRA image quality and reproducibility, and the dependence of MRA image quality and reproducibility on disease severity in patients with chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF). Material and Methods Twenty patients with COPD (mean age 66.5 ± 8.9 years; FEV1% = 42.0 ± 13.3%) and 15 with CF (mean age 29.3 ± 9.3 years; FEV1% = 66.6 ± 15.8%) underwent morpho-functional chest magnetic resonance imaging (MRI) including time-resolved MRA twice one month apart (MRI1, MRI2), and COPD patients underwent non-contrast computed tomography (CT). Image quality was assessed visually using standardized subjective 5-point scales. Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were measured by regions of interest. Disease severity was determined by spirometry, a well-evaluated chest MRI score, and by computational CT emphysema index (EI) for COPD. Results Subjective image quality was diagnostic for all MRA at MRI1 and MRI2 (mean score = 4.7 ± 0.6). CNR and SNR were 4 43.8 ± 8.7 and 50.5 ± 8.7, respectively. Neither image quality score nor CNR or SNR correlated with FEV1% or chest MRI score for COPD and CF (r = 0.239–0.248). CNR and SNR did not change from MRI1 to MRI2 ( P = 0.434–0.995). Further, insignificant differences in CNR and SNR between MRA at MRI1 and MRI2 did not correlate with FEV1% nor chest MRI score in COPD and CF (r = −0.238–0.183), nor with EI in COPD (r = 0.100–0.111). Conclusion MRA achieved diagnostic quality in COPD and CF patients and was highly reproducible irrespective of disease severity. This supports MRA as a robust alternative to CT in patients with underlying muco-obstructive lung disease.

Magnetic resonance imaging detects onset and association with lung disease severity of bronchial artery dilatation in cystic fibrosis

“…Recent studies investigating the effects of highly effective CFTR modulator therapy with elexacaftor/tezacaftor/ivacaftor in adolescent and adult patients with at least one F508del mutation demonstrated improvements in the MRI morphology score, but did not detect improvements in the MRI perfusion score despite a significant reduction in mucus plugging [13,14]. These findings contrast previous results from MRI studies in paediatric patients showing that antibiotic therapy for pulmonary exacerbation results in improved pulmonary perfusion [6,8].…”

“…First, we acknowledge that the perfusion MRI technique used in our study to detect BAD in preschool- and school-age children has limited resolution when compared with conventional invasive fluoroscopic or CT angiography. However, we sought to detect pathologically enlarged vessels, which usually have a diameter of ≥2 mm, which is clearly within the range of spatial resolution of 4D perfusion MRI [ 6 , 27 , 33 ]. This highly temporally resolved sequence is able to separate lung from systemic vessels due to the different time-course of enhancement after intravenous contrast material injection, which is not the case for CT angiography, but which facilitates detection of the systemic supply to the lungs in our present study [ 6 – 8 ].…”

“…Specifically for detection of BAD, 4D perfusion imaging in coronal orientation with a resolution of 1.2×1.7×5.0 mm in patients aged ≤6 years to 2.2×1.6×5.0 mm in school-age children and adults was performed in a series of 20–30 whole-lung volumes at a temporal resolution of ∼1.5 s −1 during injection of 0.1 mmol·kg −1 body weight of a macrocyclic gadolinium-based contrast material (Dotarem; Guerbet, Villepinte, France or Gadovist; Bayer Schering, Leverkusen, Germany) at 2–5 mL·s −1 followed by a saline chaser ( supplementary figure E2 ). An additional MR angiography at higher spatial resolution of 1.1×1.1×1.6 mm was acquired in adults [ 6 , 33 ]. MR angiography was performed in two phases with an average of 16 s acquisition time each and a fixed delay of 10 s in between to allow for short respiration in between, in order to achieve pulmonary and systemic arterial enhancement.…”

“…1.5 s -1 during injection of 0.1 mmol/kg body weight of a macrocyclic Gadolinium(Gd)-based contrast material (Dotarem, Guerbet, Villepinte, France; or Gadovist, Bayer Schering, Leverkusen, Germany) at 2 -5 ml/s followed by a saline chaser (Supplemental Figure E2). An additional MR angiography at higher spatial resolution of 1.1x1.1x1.6 mm was acquired in adults [6,33]. MR angiography was performed in two phases with an average of 16s acquisition time each and a fixed delay of 10s in between to allow for short respiration in between, in order to achieve pulmonary and systemic arterial enhancement.…”

“…A dedicated chest MRI scoring system has been validated to grade disease severity [12], and was shown to be sensitive to detect response to antibiotic therapy for pulmonary exacerbation including improvement of airway mucus plugging and of lung perfusion abnormalities in preschool and school-age children with CF [6,8]. More recently, studies investigating the effects of highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy with elexacaftor/tezacaftor/ivacaftor in adolescent and adult patients with at least one F508del mutation also demonstrated improvements in the MRI score, but failed to detect improvements in perfusion abnormalities [13,14].…”