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. 2023 Nov 2;23(1):175.
doi: 10.1186/s12880-023-01130-2.

Three-dimensional ultrashort echo time magnetic resonance imaging in pediatric patients with pneumonia: a comparative study

Yan Sun  1   2 , Yujie Chen  1   2 , Xuesheng Li  1   2 , Yi Liao  1   2 , Xijian Chen  1   2 , Yu Song  1   2 , Xinyue Liang  3 , Yongming Dai  3 , Dapeng Chen  2   4 , Gang Ning  5   6
Affiliations

Three-dimensional ultrashort echo time magnetic resonance imaging in pediatric patients with pneumonia: a comparative study

Yan Sun et al. BMC Med Imaging. .

Abstract

Background: UTE has been used to depict lung parenchyma. However, the insufficient discussion of its performance in pediatric pneumonia compared with conventional sequences is a gap in the existing literature. The objective of this study was to compare the diagnostic value of 3D-UTE with that of 3D T1-GRE and T2-FSE sequences in young children diagnosed with pneumonia.

Methods: Seventy-seven eligible pediatric patients diagnosed with pneumonia at our hospital, ranging in age from one day to thirty-five months, were enrolled in this study from March 2021 to August 2021. All patients underwent imaging using a 3 T pediatric MR scanner, which included three sequences: 3D-UTE, 3D-T1 GRE, and T2-FSE. Subjective analyses were performed by two experienced pediatric radiologists based on a 5-point scale according to six pathological findings (patchy shadows/ground-glass opacity (GGO), consolidation, nodule, bulla/cyst, linear opacity, and pleural effusion/thickening). Additionally, they assessed image quality, including the presence of artifacts, and evaluated the lung parenchyma. Interrater agreement was assessed using intraclass correlation coefficients (ICCs). Differences among the three sequences were evaluated using the Wilcoxon signed-rank test.

Results: The visualization of pathologies in most parameters (patchy shadows/GGO, consolidation, nodule, and bulla/cyst) was superior with UTE compared to T2-FSE and T1 GRE. The visualization scores for linear opacity were similar between UTE and T2-FSE, and both were better than T1-GRE. In the case of pleural effusion/thickening, T2-FSE outperformed the other sequences. However, statistically significant differences between UTE and other sequences were only observed for patchy shadows/GGO and consolidation. The overall image quality was superior or at least comparable with UTE compared to T2-FSE and T1-GRE. Interobserver agreements for all visual assessments were significant and rated "substantial" or "excellent."

Conclusions: In conclusion, UTE MRI is a useful and promising method for evaluating pediatric pneumonia, as it provided better or similar visualization of most imaging findings compared with T2-FSE and T1-GRE. We suggest that the UTE MRI is well-suited for pediatric population, especially in younger children with pneumonia who require longitudinal and repeated imaging for clinical care or research and are susceptible to ionizing radiation.

Keywords: Lung; Magnetic resonance imaging; Neonates; Pediatric pneumonia; Ultrashort echo time.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patchy increased intensity. Patchy increased intensity in a 3-month-old boy with pneumonia. UTE, T1WI and T2WI were shown above in sequence. UTE sequence better delineate the patchy increased intensity than T2-FSE and 3D-T1 GRE
Fig. 2
Fig. 2
Atelectasis/consolidation. Consolidation in a 4-month-old boy with pneumonia. UTE, T1WI and T2WI were shown above in sequence. UTE sequence better delineate the consolidation than T2-FSE and 3D-T1 GRE
Fig. 3
Fig. 3
Nodule/mass. Nodule in a 16-day-old boy with pneumonia. UTE, T1WI and T2WI were shown above in sequence. UTE sequence better delineate the nodule than T2-FSE and 3D-T1 GRE
Fig. 4
Fig. 4
Bulla/cyst. Bullae in a 5-month-old boy with cough. UTE, T1WI and T2WI were shown above in sequence. UTE sequence better delineate the bullae (Red arrow) than T2-FSE and 3D-T1 GRE
Fig. 5
Fig. 5
Interstitial lung disease/pulmonary fibrosis. Pulmonary fibrosis in a 5-month-old boy with pneumonia. UTE, T1WI and T2WI were shown above in sequence. UTE sequence better delineate the pulmonary fibrosis than 3D-T1 GRE, and comparable
Fig. 6
Fig. 6
Pleural effusion/ thickening. Pleural effusion in a 18-day-old boy with neonatal pneumonia. UTE, T1WI and T2WI were shown above in sequence. T2-FSE was preferably depicted the pleural effusion (Red arrowhead) with favorable contrast than 3D-T1 GRE and UTE
Fig. 7
Fig. 7
Comparison of image quality ratings for the artifacts. The image artifacts were slightly higher for TUE and T2-FSE than for T1-GRE, while there was no significant difference between TUE and T2-FSE
Fig. 8
Fig. 8
Comparison of visibility of lung parenchyma. The image quality of the lung parenchyma on UTE was significantly better than T2-FSE and T1-GRE, and the lung parenchyma was imaged better in T2-FSE than in T1-GRE
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