From the Center for Cardiothoracic Research of Bordeaux, University of Bordeaux, Bordeaux, France (G.D., P.B., L.D., M.M., J.F.C., R.M., M.F., F.L.); Inserm, Center for Cardiothoracic Research of Bordeaux, U1045, CIC 1401, F-33000, 146 rue Léo Saignat, 33076 Bordeaux, France (G.D., P.B., L.D., M.M., R.M., M.F., F.L.); Thoracic and Cardiovascular Imaging Service, Service for Respiratory Diseases, Service for Exploration of Respiratory Function, CHU of Bordeaux, Pessac, France (G.D., P.B., J.R., J.M., M.M., O.C., R.M., F.L.); and Service for Imaging in Women and Children, Pediatric Pneumonology Unit, Laboratory of Parasitology-Mycology, CHU of Bordeaux, Bordeaux, France (S.B., L.D., J.F.C., M.F.).
Radiology. 2017 Oct;285(1):261-269. doi: 10.1148/radiol.2017162350. Epub 2017 May 22.
Purpose To assess the diagnostic accuracy of mucus contrast characterization by using magnetic resonance (MR) imaging to discriminate allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF). Materials and Methods The study was approved by the local Ethics Committee, and all patients or their parents gave written informed consent. One hundred ten consecutive patients with CF were screened between January 2014 and July 2015. All patients underwent a non-contrast material-enhanced MR protocol that included routine T1-weighted and T2-weighted sequences. The presence of mucus with both high T1 and low T2 signal intensities and the so-called inverted mucoid impaction signal (IMIS) sign was qualitatively and quantitatively assessed by two physicians who were blinded to all other data. The reference standard for a diagnosis of ABPA was the criteria of the Cystic Fibrosis Foundation Consensus Conference. ABPA status was followed up for 1 year. Reproducibility was assessed by using the κ test, correlation was assessed by using the Spearman coefficient, and diagnostic accuracy was assessed by calculating the sensitivity and specificity of IMIS. Results One hundred eight patients with CF were included (mean age, 20 years ± 11 [standard deviation]; range, 6-53 years): 18 patients with ABPA and 90 patients without ABPA. At the lobar level, inter- and intrareader reproducibility were very good (κ > 0.90). IMIS had 94% sensitivity (95% confidence interval [CI]: 73%, 99%) and 100% specificity (95% CI: 96%, 100%) for the diagnosis of ABPA. A complete resolution of IMIS was observed in patients with ABPA after 3 months of specific treatment that was significantly correlated with decrease in total immunoglobulin E level (ρ = 0.47; P = .04). Conclusion The IMIS sign was both specific and sensitive for the diagnosis of ABPA in CF. Allergic fungal inflammation appears to induce characteristic modifications of mucus contrasts that are assessable by using a noninvasive, contrast material-free, and radiation-free method. RSNA, 2017 Online supplemental material is available for this article.
目的 利用磁共振（MR）成像评估黏液特征性对比，以鉴别囊性纤维化（CF）中的变应性支气管肺曲霉病（ABPA）。
材料与方法 本研究经当地伦理委员会批准，所有患者或其父母均签署书面知情同意书。2014 年 1 月至 2015 年 7 月，连续筛查 110 例 CF 患者。所有患者均行非对比增强 MR 检查，包括常规 T1WI 和 T2WI。两名不知晓其他数据的医师对具有高 T1 和低 T2 信号强度的黏液以及所谓的反转黏液性嵌塞信号（IMIS）征象进行定性和定量评估。ABPA 的诊断标准采用囊性纤维化基金会共识会议标准。对 ABPA 状态进行为期 1 年的随访。采用κ检验评估重复性，采用 Spearman 系数评估相关性，通过计算 IMIS 的敏感性和特异性评估诊断准确性。
结果 108 例 CF 患者纳入本研究（平均年龄，20 岁±11[标准差]；范围，6-53 岁）：18 例 ABPA 患者，90 例非 ABPA 患者。在肺叶水平，观察者内和观察者间的重复性极好（κ＞0.90）。IMIS 对 ABPA 的诊断具有 94%的敏感性（95%置信区间：73%，99%）和 100%的特异性（95%置信区间：96%，100%）。ABPA 患者接受特异性治疗 3 个月后，IMIS 完全消失，且与总免疫球蛋白 E 水平下降呈显著相关（ρ=0.47；P=0.04）。
结论 IMIS 征象对 CF 中的 ABPA 具有特异性和敏感性。变应性真菌感染似乎会引起黏液对比的特征性改变，这种改变可以通过非侵入性、无对比剂和无辐射的方法来评估。
放射学学会，2017 年
在线补充材料为本研究提供。
