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Diffusion weighted imaging in cystic fibrosis disease: beyond morphological imaging

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Abstract

Objectives

To explore the feasibility of diffusion-weighted imaging (DWI) to assess inflammatory lung changes in patients with Cystic Fibrosis (CF)

Methods

CF patients referred for their annual check-up had spirometry, chest-CT and MRI on the same day. MRI was performed in a 1.5 T scanner with BLADE and EPI-DWI sequences (b = 0–600 s/mm2). End-inspiratory and end-expiratory scans were acquired in multi-row scanners. DWI was scored with an established semi-quantitative scoring system. DWI score was correlated to CT sub-scores for bronchiectasis (CF-CTBE), mucus (CF-CTmucus), total score (CF-CTtotal-score), FEV1, and BMI. T-test was used to assess differences between patients with and without DWI-hotspots.

Results

Thirty-three CF patients were enrolled (mean 21 years, range 6–51, 19 female). 4 % (SD 2.6, range 1.5-12.9) of total CF-CT alterations presented DWI-hotspots. DWI-hotspots coincided with mucus plugging (60 %), consolidation (30 %) and bronchiectasis (10 %). DWItotal-score correlated (all p < 0.0001) positively to CF-CTBE (r = 0.757), CF-CTmucus (r = 0.759) and CF-CTtotal-score (r = 0.79); and negatively to FEV1 (r = 0.688). FEV1 was significantly higher (p < 0.0001) in patients without DWI-hotspots.

Conclusions

DWI-hotspots strongly correlated with radiological and clinical parameters of lung disease severity. Future validation studies are needed to establish the exact nature of DWI-hotspots in CF patients.

Key Points

• DWI hotspots only partly overlapped structural abnormalities on morphological imaging

• DWI strongly correlated with radiological and clinical indicators of CF-disease severity

• Patients with more DWI hotspots had lower lung function values

• Mucus score best predicted the presence of DWI-hotspots with restricted diffusion.

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Acknowledgments

The authors thank Elizabeth Salamon, Department of Respiratory Medicine, Royal Perth Hospital, for offering invaluable detailed advice on grammar and organization of the manuscript. The authors also thank Thorsten Feiweier, Siemens Healthcare Erlangen, Germany, for technical advice in critically reviewing the manuscript. The researchers also wish to express their deepest gratitude to all CF patients, who participated in the study.

The scientific guarantor of this publication is Dr. Giovanni Morana, chief of the Radiology Department at Ca’Foncello General Hospital, Treviso, Italy. The authors of this manuscript declare relationships with the following companies: Bracco Imaging (not related to this article). The authors of this manuscript declare no other relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by the Italian cystic fibrosis league (Lega Italiana Fibrosi Cistica, LIFC) to cover the travel expenses of the first author.

Eleni Rosalina Andrinopoulou, statistician, kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained in all participating centres. Written informed consent was obtained from all subjects (patients) in this study. Study subjects have been previously reported in Assessment of CF lung disease using motion corrected PROPELLER MRI: a comparison with CT. European Radiology DOI: 10.1007/s00330-015-3850-9 . Methodology: prospective, cross sectional study, observational, multicenter study.

Author information

Authors and Affiliations

  1. Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands

    Pierluigi Ciet & Harm A. W. M. Tiddens

  2. Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children’s Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands

    Pierluigi Ciet & Harm A. W. M. Tiddens

  3. Department of Radiology, Ca’ Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy

    Pierluigi Ciet, Silvia Bertolo & Giovanni Morana

  4. Department of Radiology, University of Rome “Sapienza”, Rome, Italy

    Goffredo Serra & Carlo Catalano

  5. Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands

    Eleni Rosalina Andrinopoulou

  6. Department of Pediatrics, Ca’ Foncello Hospital, Treviso, Italy

    Mirco Ros

  7. Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi., Largo Brambilla 3, Florence, 50134, Italy

    Stefano Colagrande

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  1. Pierluigi Ciet
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Corresponding author

Correspondence to Giovanni Morana.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Online supplement digital content 1

DWI scoring sheet. DWI signal is assessed in highest b-value images (b = 600 s/mm2). Signal intensity (SI) of DWI hotspots is compared to SI of the spine and scored 1 when SI hotspots is lower than SI spine, or scored 2 when SI hotspot is equal or greater of SI spine. The number of hotspots is counted per lobe, with the lingula considered a separate lobe. Moreover, each hotspot is identified in the same categories defined in the CF-CT and CF-MRI scoring system. RUL= Right upper lobe, RML=Right middle lobe, RLL=Right lower lobe, LUL=Left upper lobe, Lin=Lingula, LLL=Left lower lobe (JPG 8 kb)

High Resolution Image (TIF 2209 kb)

Online supplement digital content 2

(DOCX 17 kb)

Online supplement digital content 3

A) Bland-Altman for total number of DWI hotspots identified by observer 1 (Obs1) and observer 2 (Obs2). Thick line is the mean, dashed lines are ± 2 standard deviations (SD). B) Identity Plot total DWI hotspots Obs1 versus Obs2. The continuous line is the identity line (y = 1*x + 0), dashed line is the correlations line. Note that that Obs2 detected more hotspots than Obs1 (mean difference ~ 3). (JPG 3 kb)

(JPG 3 kb)

High Resolution Image (TIF 943 kb)

High Resolution Image (TIF 940 kb)

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Ciet, P., Serra, G., Andrinopoulou, E.R. et al. Diffusion weighted imaging in cystic fibrosis disease: beyond morphological imaging. Eur Radiol 26, 3830–3839 (2016). https://doi.org/10.1007/s00330-016-4248-z

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  • DOI: https://doi.org/10.1007/s00330-016-4248-z

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