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Comparative Study
. 2017 Mar-Apr;23(2):106-111.
doi: 10.5152/dir.2016.15331.

Pulmonary fibrosis: tissue characterization using late-enhanced MRI compared with unenhanced anatomic high-resolution CT

Lisa P Lavelle  1 , Darragh Brady, Sinead McEvoy, David Murphy, Brian Gibney, Annika Gallagher, Marcus Butler, Fionnula Shortt, Marie McMullen, Aurelie Fabre, David A Lynch, Michael P Keane, Jonathan D Dodd
Affiliations
Comparative Study

Pulmonary fibrosis: tissue characterization using late-enhanced MRI compared with unenhanced anatomic high-resolution CT

Lisa P Lavelle et al. Diagn Interv Radiol. 2017 Mar-Apr.

Abstract

Purpose: We aimed to prospectively evaluate anatomic chest computed tomography (CT) with tissue characterization late gadolinium-enhanced magnetic resonance imaging (MRI) in the evaluation of pulmonary fibrosis (PF).

Methods: Twenty patients with idiopathic pulmonary fibrosis (IPF) and twelve control patients underwent late-enhanced MRI and high-resolution CT. Tissue characterization of PF was depicted using a segmented inversion-recovery turbo low-angle shot MRI sequence. Pulmonary arterial blood pool nulling was achieved by nulling main pulmonary artery signal. Images were read in random order by a blinded reader for presence and extent of overall PF (reticulation and honeycombing) at five anatomic levels. Overall extent of IPF was estimated to the nearest 5% as well as an evaluation of the ratios of IPF made up of reticulation and honeycombing. Overall grade of severity was dependent on the extent of reticulation and honeycombing.

Results: No control patient exhibited contrast enhancement on lung late-enhanced MRI. All IPF patients were identified with late-enhanced MRI. Mean signal intensity of the late-enhanced fibrotic lung was 31.8±10.6 vs. 10.5±1.6 for normal lung regions, P < 0.001, resulting in a percent elevation in signal intensity from PF of 204.8%±90.6 compared with the signal intensity of normal lung. The mean contrast-to-noise ratio was 22.8±10.7. Late-enhanced MRI correlated significantly with chest CT for the extent of PF (R=0.78, P = 0.001) but not for reticulation, honeycombing, or coarseness of reticulation or honeycombing.

Conclusion: Tissue characterization of IPF is possible using inversion recovery sequence thoracic MRI.

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Conflict of interest statement

Conflict of interest disclosure

The authors declared no conflicts of interest.

Figures

Figure 1. a, b
Figure 1. a, b
A 53-year-old control subject. High-resolution computed tomography (HRCT) image (a) shows normal lungs with no areas of high signal. Late-enhanced magnetic resonance imaging (MRI) (b) shows homogenous low signal throughout the lungs with no contrast-enhancement.
Figure 2. a, b
Figure 2. a, b
A 75-year-man with moderate idiopathic pulmonary fibrosis (IPF). HRCT image (a) demonstrates asymmetric extensive subpleural fibrosis (arrows) in the upper lobes, worse in the left upper lobe. Late-enhanced MRI of the thorax (b) shows extensive areas of late-enhancement (arrows) corresponding to the areas of fibrosis on HRCT. Note the ability to depict honeycombing and traction bronchiectasis in both upper lobes.
Figure 3. a, b
Figure 3. a, b
A 58-year-old man with mild IPF. HRCT image (a) shows symmetric mild subpleural fibrosis (arrows) in the lower lobes, with microcystic honeycombing. Late-enhanced MRI of the thorax (b) shows areas of late-enhancement and subpleural microcystic honeycombing (arrows) corresponding to the appearances on HRCT.
Figure 4. a, b
Figure 4. a, b
A 40-year-old man with moderate IPF. HRCT image (a) shows extensive macrocystic honeycombing throughout the left lower lobe (arrowheads). Less severe fibrotic changes are noted in the right lower lobe (arrowheads). Late-enhanced MRI of the thorax (b) shows corresponding extensive late-enhancement (arrowheads) throughout the lower lobes in keeping with diffuse fibrosis. Honeycombing is noted in the left lower lobe.
See this image and copyright information in PMC

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