Department of Radiology, The People's Hospital of Longhua, Shenzhen, Southern Medical University, Guangdong, China.
Graduate School, Medical College of Nanchang University, Nanchang, Jiangxi, China; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.
Int J Infect Dis. 2019 May;82:138-146. doi: 10.1016/j.ijid.2019.03.004. Epub 2019 Mar 12.
To evaluate the utility of magnetic resonance imaging (MRI) with an advanced motion correction technique in characterizing lung tissue changes and lesions induced by pulmonary tuberculosis (TB).
Sixty-three subjects with computed tomography (CT) features of pulmonary TB underwent lung MRI. All subjects with pulmonary TB were confirmed by acid-fast bacillus (AFB) testing or the detection of Mycobacterium tuberculosis. T2-weighted turbo spin echo (TSE) sequence MRI with the MultiVane motion correction technique was used to image the lungs. Routine lung CT images were obtained as reference. MRI and CT images were reviewed by multiple readers independently. The performance of MRI in depicting abnormalities induced by pulmonary TB and their morphological changes were evaluated and compared with the performance of CT.
Lung MRI found pulmonary abnormalities in all 63 TB subjects, with satisfactory quality. With the implementation of MultiVane for T2-weighted TSE sequences to reduce the motion correction effect, MRI showed excellent agreement with CT in detecting abnormal imaging features of pulmonary TB (κ=0.88, p<0.001), such as tree-in-bud sign, ground-glass opacity, consolidation, mass, and cavitation. MRI was advantageous in identifying caseation and liquefactive necrosis based on inhomogeneous signal distribution within consolidations and also in identifying mild pleural effusion. The optimized lung MRI was comparable to CT in detecting non-calcified nodules (κ=0.90), with overall sensitivity of 50.0%, 91.1%, and 100% for nodules of size <5 mm, 5-10 mm, and >10 mm, respectively. However, MRI was less effective in identifying lesions with calcification.
The clinical implementation of an optimized MRI protocol with the MultiVane motion correction technique for imaging pulmonary TB is feasible. Lung MRI without ionizing radiation is a promising alternative to the clinical standard CT, especially for pregnant women, children, adolescents, and patients requiring short-term and repeated follow-up observations.
评估磁共振成像（MRI）结合先进的运动校正技术在描述肺结核（TB）引起的肺组织变化和病变中的应用价值。
63 例 CT 表现为肺结核的患者进行了肺部 MRI 检查。所有肺结核患者均经抗酸杆菌（AFB）检测或结核分枝杆菌检测证实。使用多叶运动校正技术的 T2 加权涡轮自旋回波（TSE）序列 MRI 对肺部进行成像。作为参考，获得常规肺 CT 图像。多名读者独立对 MRI 和 CT 图像进行了评估。评估并比较了 MRI 对肺结核引起的异常及其形态变化的描述能力与 CT 的性能。
肺部 MRI 在所有 63 例 TB 患者中均发现肺部异常，图像质量良好。通过多叶运动校正技术对 T2 加权 TSE 序列进行实施，以降低运动校正效果，MRI 在检测肺结核的异常影像学特征方面与 CT 具有极好的一致性（κ=0.88，p<0.001），例如树芽征、磨玻璃影、实变、肿块和空洞。MRI 有利于根据实变内部不均匀的信号分布识别干酪样坏死和液化性坏死，也有利于识别轻度胸腔积液。优化后的肺部 MRI 在检测非钙化结节方面与 CT 相当（κ=0.90），大小<5mm、5-10mm 和>10mm 的结节的总敏感性分别为 50.0%、91.1%和 100%。然而，MRI 在识别钙化病变方面效果较差。
使用多叶运动校正技术的优化 MRI 方案在肺结核成像方面的临床应用是可行的。无电离辐射的肺部 MRI 是临床标准 CT 的一种有前途的替代方法，尤其适用于孕妇、儿童、青少年和需要短期和重复随访观察的患者。
