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. 2023 Jul;33(7):4767-4779.
doi: 10.1007/s00330-023-09458-7. Epub 2023 Feb 24.

Congenital lung abnormalities on magnetic resonance imaging: the CLAM study

Bernadette B L J Elders  1   2 , Casper M Kersten  3 , Sergei M Hermelijn  3 , Piotr A Wielopolski  2 , Harm A W M Tiddens  1   2 , J Marco Schnater  3 , Pierluigi Ciet  4   5   6
Affiliations

Congenital lung abnormalities on magnetic resonance imaging: the CLAM study

Bernadette B L J Elders et al. Eur Radiol. 2023 Jul.

Abstract

Objectives: Follow-up of congenital lung abnormalities (CLA) is currently done with chest computer tomography (CT). Major disadvantages of CT are exposure to ionizing radiation and need for contrast enhancement to visualise vascularisation. Chest magnetic resonance imaging (MRI) could be a safe alternative to image CLA without using contrast agents. The objective of this cohort study was to develop a non-contrast MRI protocol for the follow-up of paediatric CLA patients, and to compare findings on MRI to postnatal CT in school age CLA patients.

Methods: Twenty-one CLA patients, 4 after surgical resection and 17 unoperated (mean age 12.8 (range 9.4-15.9) years), underwent spirometry and chest MRI. MRI was compared to postnatal CT on appearance and size of the lesion, and lesion associated abnormalities, such as hyperinflation and atelectasis.

Results: By comparing school-age chest MRI to postnatal CT, radiological appearance and diagnostic interpretation of the type of lesion changed in 7 (41%) of the 17 unoperated patients. In unoperated patients, the relative size of the lesion in relation to the total lung volume remained stable (0.9% (range - 6.2 to + 6.7%), p = 0.3) and the relative size of lesion-associated parenchymal abnormalities decreased (- 2.2% (range - 0.8 to + 2.8%), p = 0.005).

Conclusion: Non-contrast-enhanced chest MRI was able to identify all CLA-related lung abnormalities. Changes in radiological appearance between MRI and CT were related to CLA changes, patients' growth, and differences between imaging modalities. Further validation is needed for MRI to be introduced as a safe imaging method for the follow-up of paediatric CLA patients.

Key points: • Non-contrast-enhanced chest MRI is able to identify anatomical lung changes related to congenital lung abnormalities, including vascularisation. • At long-term follow-up, the average size of congenital lung abnormalities in relation to normal lung volume remains stable. • At long-term follow-up, the average size of congenital lung abnormalities associated parenchymal abnormalities such as atelectasis in relation to normal lung volume decreases.

Keywords: CT; Congenital lung abnormalities; Imaging; MRI; Paediatric.

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Conflict of interest statement

The authors of this manuscript declare relationships with the following companies:

H. Tiddens:

Novartis (partner in IMI project), Thirona (joint PPS grant), Vectura Group (unconditional grand for PhD research program), Insmed (consultant for clinical trial design), Novartis (Consultant), Thirona (consultant) and Vertex (faculty member for advance course).

P. Ciet:

Editamed (funding unrelated to submitted work).

Figures

Fig. 1
Fig. 1
Flowchart of the study design and included patients. CHIL, surgical long-term follow-up outpatient clinic; CLA, congenital lung abnormality; CT, computed tomography; MRI, magnetic resonance imaging
Fig. 2
Fig. 2
Example of an axial postnatal CT (a) and school-age MRI (c) in a patient with a CPAM of the left lower lobe. Both images show a multicystic, air-filled lesion. CLAQ scoring (b) shows normal lung tissue (green), lesion-associated parenchymal abnormalities (atelectasis, blue) and the lesion (red); the CLAM scoring (d) shows normal lung tissue (green) and the lesion (red)
Fig. 3
Fig. 3
Overview of the change in percentage of lung affected by the CLA on postnatal CT compared to school-age MRI
Fig. 4
Fig. 4
Example images of changed appearance of CLA between postnatal CT and school-age MRI. Patient 1: axial postnatal CT showing an air-filled multicystic CPAM and BA in the left lower lobe (a) and an axial T2-weighted PROPELLER image at school-age showing only BA in the left lower lobe (arrow) (b). Patient 2: axial postnatal CT showing an air-filled CPAM surrounded by lesion-associated parenchymal atelectasis (asterisk) (a) and an axial SPGR expiratory image at school-age showing an air-filled CPAM without lesion-associated parenchymal abnormalities (b)
Fig. 5
Fig. 5
Plot of the changes in (a) size of the CLA lesion in relation to total lung volume between postnatal CT and school-age MRI and (b) size of lesion-associated parenchymal abnormalities between postnatal CT and school-age MRI. Lines in green indicate a decrease in relative size; lines in red indicate an increase in relative size
Fig. 6
Fig. 6
Visualisation of lesion vascularisation on axial contrast-enhanced postnatal CT (a and d), MRA FIESTA (b and e), and T2-w PROPELLER (c and f) in a patient with BPS. Images show venous drainage of the lesion into the hemiazygos vein (thin arrow on a, b, c) and a bronchele (thick arrow on a, b, c) and arterial supply from the aorta descendens (arrow on d, e, f). BPS, bronchopulmonary sequester; CECT, contrast-enhanced computed tomography; MRA FIESTA, magnetic resonance angiography; PROPELLER, periodically overlapping parallel lines with enhanced reconstruction
See this image and copyright information in PMC

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