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.
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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)
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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)
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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