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Assessment of CF lung disease using motion corrected PROPELLER MRI: a comparison with CT

  • Chest
  • Published:
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Abstract

Objectives

To date, PROPELLER MRI, a breathing-motion-insensitive technique, has not been assessed for cystic fibrosis (CF) lung disease. We compared this technique to CT for assessing CF lung disease in children and adults.

Methods

Thirty-eight stable CF patients (median 21 years, range 6-51 years, 22 female) underwent MRI and CT on the same day. Study protocol included respiratory-triggered PROPELLER MRI and volumetric CT end-inspiratory and -expiratory acquisitions. Two observers scored the images using the CF-MRI and CF-CT systems. Scores were compared with intra-class correlation coefficient (ICC) and Bland-Altman plots. The sensitivity and specificity of MRI versus CT were calculated.

Results

MRI sensitivity for detecting severe CF bronchiectasis was 0.33 (CI 0.09-0.57), while specificity was 100 % (CI 0.88-1). ICCs for bronchiectasis and trapped air were as follows: MRI-bronchiectasis (0.79); CT-bronchiectasis (0.85); MRI-trapped air (0.51); CT-trapped air (0.87). Bland-Altman plots showed an MRI tendency to overestimate the severity of bronchiectasis in mild CF disease and underestimate bronchiectasis in severe disease.

Conclusions

Motion correction in PROPELLER MRI does not improve assessment of CF lung disease compared to CT. However, the good inter- and intra-observer agreement and the high specificity suggest that MRI might play a role in the short-term follow-up of CF lung disease (i.e. pulmonary exacerbations).

Key Points

• PROPELLER MRI does not match CT sensitivity to assess CF lung disease.

• PROPELLER MRI has lower sensitivity than CT to detect severe bronchiectasis.

• PROPELLER MRI has good to very good intra- and inter-observer variability.

• PROPELLER MRI can be used for short-term follow-up studies in CF.

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Abbreviations

CF:

Cystic fibrosis

CT:

Computed tomography

CXR:

Chest X-ray

MRI:

Magnetic resonance imaging

PFT:

Pulmonary function tests

PROPELLER:

Periodically Rotated Overlapping ParallEL Lines with Enhanced Reconstruction

TE:

Echo time

TR:

Repetition time

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Acknowledgments

P.C. acknowledges financial support from the Italian Cystic Fibrosis League (Lega Italiana Fibrosi Cistica, LIFC). 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. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. Sandra Spronk, statistician, kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained from all participating centres. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, comparative cross-sectional, multicentre study.

Author information

Authors and Affiliations

  1. Radiology Department, General Hospital Ca’ Foncello, Treviso, Italy

    Pierluigi Ciet, Silvia Bertolo & Giovanni Morana

  2. Pediatric Pulmonology Erasmus MC, Sophia Children’s Hospital, Rotterdam, The Netherlands

    Pierluigi Ciet & Harm. A. W. M Tiddens

  3. Radiology, Erasmus MC, Rotterdam, The Netherlands

    Pierluigi Ciet, Sandra Spronk & Harm. A. W. M Tiddens

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

    Goffredo Serra & Carlo Catalano

  5. Epidemiology, Erasmus MC, Rotterdam, The Netherlands

    Sandra Spronk

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

    Mirco Ros

  7. Institute of Nuclear Medicine, University College London (UCL), London, UK

    Francesco Fraioli

  8. Pediatrics, University of Rome Sapienza, Rome, Italy

    Serena Quattrucci

  9. Verona CF Center, Azienda Ospedaliera di Verona, Verona, Italy

    M. Baroukh Assael

  10. Department of Medicine-DIMED, University of Padova, Padova, Italy

    Fabio Pomerri

Authors
  1. Pierluigi Ciet
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  2. Goffredo Serra
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  11. Harm. A. W. M Tiddens
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Corresponding author

Correspondence to Giovanni Morana.

Electronic supplementary material

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ESM 1

Bland-Altman plot of MRImean obs 1+2 vs. CTmean obs 1+2. All scoring data are numerical and scores are expressed as percentage of the maximal possible score. Horizontal axis: average air wall thickening subscore [(MRImean + CTmean)/2]; vertical axis = difference in the air wall thickening sub-score (MRImean -CTmean). Red and green lines represent mean and ±2 standard deviations (SD) respectively. (GIF 156 kb)

High Resolution Image (TIFF 261 kb)

ESM 2

Bland-Altman plot of MRImean obs 1+2 vs. CTmean obs 1+2. All scoring data are numerical and scores are expressed as percentage of the maximal possible score. Horizontal axis: average mucus sub-score [(MRImean + CTmean)/2]; vertical axis = difference in the mucus sub-score (MRImean - CTmean). Red and green lines represent mean and ±2 standard deviations (SD) respectively. (GIF 156 kb)

High Resolution Image (TIFF 231 kb)

ESM 3

Bland-Altman plot of MRImean obs 1+2 vs. CTmean obs 1+2. All scoring data are numerical and scores are expressed as percentage of the maximal possible score. Horizontal axis: average parenchyma sub-score [(MRImean + CTmean)/2]; vertical axis = difference in the parenchyma sub-score (MRImean - CTmean). Red and green lines represent mean and ±2 standard deviations (SD) respectively. (GIF 160 kb)

High Resolution Image (TIFF 237 kb)

ESM 4

Bland-Altman plot of MRImean obs 1+2 vs. CTmean obs 1+2. All scoring data are numerical and scores are expressed as percentage of the maximal possible score. Horizontal axis: average total-score [(MRImean + CTmean)/2]; vertical axis = difference in the total score (MRImean - CTmean). Red and green lines represent mean and ±2 standard deviations (SD) respectively. (GIF 148 kb)

High Resolution Image (TIFF 232 kb)

ESM 5

Bland-Altman plot of MRImean obs 1+2 vs. CTmean obs 1+2. All scoring data are numerical and scores are expressed as percentage of the maximal possible score. Horizontal axis: average trapped air sub-score [(MRImean + CTmean)/2]; vertical axis = difference in the trapped-air sub-score (MRImean - CTmean). Red and green lines represent mean and ±2 standard deviations (SD) respectively. (GIF 149 kb)

High Resolution Image (TIFF 233 kb)

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Ciet, P., Serra, G., Bertolo, S. et al. Assessment of CF lung disease using motion corrected PROPELLER MRI: a comparison with CT. Eur Radiol 26, 780–787 (2016). https://doi.org/10.1007/s00330-015-3850-9

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  • DOI: https://doi.org/10.1007/s00330-015-3850-9

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