Jobst Bertram J, Wielpütz Mark O, Triphan Simon M F, Anjorin Angela, Ley-Zaporozhan Julia, Kauczor Hans-Ulrich, Biederer Jürgen, Ley Sebastian, Sedlaczek Oliver
Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Research Center Magnetic Resonance Bavaria (MRB), Würzburg, Germany.
PLoS One. 2015 Sep 1;10(9):e0137282. doi: 10.1371/journal.pone.0137282. eCollection 2015.
Non-invasive end-points for interventional trials and tailored treatment regimes in chronic obstructive pulmonary disease (COPD) for monitoring regionally different manifestations of lung disease instead of global assessment of lung function with spirometry would be valuable. Proton nuclear magnetic resonance imaging (1H-MRI) allows for a radiation-free assessment of regional structure and function. The aim of this study was to evaluate the short-term reproducibility of a comprehensive morpho-functional lung MRI protocol in COPD.
20 prospectively enrolled COPD patients (GOLD I-IV) underwent 1H-MRI of the lung at 1.5T on two consecutive days, including sequences for morphology, 4D contrast-enhanced perfusion, and respiratory mechanics. Image quality and COPD-related morphological and functional changes were evaluated in consensus by three chest radiologists using a dedicated MRI-based visual scoring system. Test-retest reliability was calculated per each individual lung lobe for the extent of large airway (bronchiectasis, wall thickening, mucus plugging) and small airway abnormalities (tree in bud, peripheral bronchiectasis, mucus plugging), consolidations, nodules, parenchymal defects and perfusion defects. The presence of tracheal narrowing, dystelectasis, pleural effusion, pulmonary trunk ectasia, right ventricular enlargement and, finally, motion patterns of diaphragma and chest wall were addressed.
Median global scores [10(Q1:8.00;Q3:16.00) vs.11(Q1:6.00;Q3:15.00)] as well as category subscores were similar between both timepoints, and kappa statistics indicated "almost perfect" global agreement (ĸ = 0.86, 95%CI = 0.81-0.91). Most subscores showed at least "substantial" agreement of MRI1 and MRI2 (ĸ = 0.64-1.00), whereas the agreement for the diagnosis of dystelectasis/effusion (ĸ = 0.42, 95%CI = 0.00-0.93) was "moderate" and of tracheal abnormalities (ĸ = 0.21, 95%CI = 0.00-0.75) "fair". Most MRI acquisitions showed at least diagnostic quality at MRI1 (276 of 278) and MRI2 (259 of 264).
Morpho-functional 1H-MRI can be obtained with reproducible image quality and high short-term test-retest reliability for COPD-related morphological and functional changes of the lung. This underlines its potential value for the monitoring of regional lung characteristics in COPD trials.
对于慢性阻塞性肺疾病（COPD）的介入试验和定制治疗方案而言，采用非侵入性终点来监测肺部区域不同表现，而非通过肺活量测定对肺功能进行整体评估，将具有重要价值。质子核磁共振成像（1H-MRI）能够对区域结构和功能进行无辐射评估。本研究的目的是评估COPD患者肺部综合形态功能MRI方案的短期可重复性。
20例前瞻性纳入的COPD患者（GOLD I-IV级）连续两天在1.5T条件下接受肺部1H-MRI检查，检查序列包括形态学、4D对比增强灌注和呼吸力学序列。由三名胸部放射科医生使用基于MRI的专用视觉评分系统，共同评估图像质量以及与COPD相关的形态学和功能变化。计算每个肺叶在大气道（支气管扩张、管壁增厚、黏液嵌塞）和小气道异常（树芽征、外周支气管扩张、黏液嵌塞）、实变、结节、实质缺损和灌注缺损范围方面的重测信度。检查气管狭窄、肺不张、胸腔积液、肺动脉扩张、右心室增大情况，最后检查膈肌和胸壁的运动模式。
两个时间点的总体中位数评分[10（第一四分位数：8.00；第三四分位数：16.00）对11（第一四分位数：6.00；第三四分位数：15.00）]以及分类子评分相似，kappa统计显示总体一致性“几乎完美”（κ = 0.86，95%置信区间 = 0.81 - 0.91）。大多数子评分显示MRI1和MRI2至少有“实质性”一致性（κ = 0.64 - 1.00），而肺不张/胸腔积液诊断的一致性（κ = 0.42，95%置信区间 = 0.00 - 0.93）为“中等”，气管异常诊断的一致性（κ = 0.21，95%置信区间 = 0.00 - 0.75）为“一般”。大多数MRI采集在MRI1（278例中的276例）和MRI2（264例中的259例）时至少具有诊断质量。
对于COPD相关的肺部形态学和功能变化，可获得具有可重复性图像质量和高短期重测信度的形态功能1H-MRI。这突出了其在COPD试验中监测肺部区域特征的潜在价值。
