Shanghai Institute of Medical Imaging, Shanghai, Fudan university, Shanghai, China; Department of Radiology, Shanghai public health clinical center, Shanghai, China.
Department of Radiology, Shanghai public health clinical center, Shanghai, China.
Int J Infect Dis. 2020 Apr;93:287-294. doi: 10.1016/j.ijid.2020.02.006. Epub 2020 Feb 13.
To evaluate image quality and detection rate of four 3T magnetic resonance imaging (MRI) sequences and MRI performances in pulmonary tuberculosis (TB) when compared to computed tomography (CT).
Forty patients with pulmonary tuberculosis separately underwent CT and 3T-MRI with T1-weighted free-breathing star-volumetric interpolated breath-hold examination (Star-VIBE) and standard VIBE, T2-weighted two-dimensional fast BLADE turbo spin-echo (2D-fBLADE TSE) and three-dimensional isotropic turbo spin-echo (3D-SPACE). Four MRI sequences were compared in terms of detection rate and image quality, which consisted of signal to noise ratio (SNR), contrast to noise ratio (CNR) and 5-point scoring scale. The total sensitivity was also compared between CT and MRI. Inter-observer agreement on 5-point scoring scale was calculated by Cohen's kappa (k). SNR, CNR and 5-point scoring scale were compared using two-tailed pared t-test. Using CT as a reference, the MRI detection rate of pulmonary abnormality was evaluated by Pearson's Chi-square test. Furthermore, the sizes of the nodules (≥5 mm) were compared using intraclass correlation coefficient.
In this study, Free-breathing Star-VIBE had significantly better SNR and identical CNR compared with standard VIBE. 2D-fBLADE TSE had statistically higher SNR but uniform or inferior CNR compared with 3D-SPACE. Inter-observers showed excellent agreement on 5-point scoring scale. The average score of Star-VIBE and VIBE had no difference. The average score of 2D-fBLADE TSE was higher than 3D-SPACE. There were no statistical differences in the detection rates of non-calcified parenchymal lesions between Star-VIBE and standard VIBE, 2D-fBALDE TSE and 3D-SPACE. MRI is comparable to CT in detecting consolidation, cavity, non-calcified nodules of ≥5 mm and tree-in-bud signs compared to CT. MRI detected non-calcified nodules of ＜5 mm, 5-10 mm, ≥10 mm and calcified nodules with sensitivity of 69.6%, 90.6%, 100% and 89.5% respectively. In addition, the sizes of the nodules (≥5 mm) had statistical consistency. MRI is more sensitive in detecting caseous necrosis, liquefaction, active cavity, abnormalities of lymph nodes and pleura.
T1-weighted free-breathing Star-VIBE and T2-weighted 2D-fBLADE TSE, both with satisfactory image quality, are suitable for patients with pulmonary TB who need long-term follow-ups in clinical routine, especially for children, young women and pregnant women.
评估四种 3T 磁共振成像（MRI）序列的图像质量和检出率，并与计算机断层扫描（CT）相比，评估 MRI 在肺结核（TB）中的表现。
40 例肺结核患者分别接受 CT 和 3T-MRI 检查，包括 T1 加权自由呼吸星容积内插屏气检查（Star-VIBE）和标准 VIBE、T2 加权二维快速 BLADE 涡轮自旋回波（2D-fBLADE TSE）和三维各向同性涡轮自旋回波（3D-SPACE）。从检出率和图像质量两个方面比较四种 MRI 序列，包括信噪比（SNR）、对比噪声比（CNR）和 5 分制评分。还比较了 CT 和 MRI 的总灵敏度。采用 Cohen's kappa（k）计算 5 分制评分的观察者间一致性。采用双侧配对 t 检验比较 SNR、CNR 和 5 分制评分。以 CT 为参照，采用 Pearson 卡方检验评估肺部异常的 MRI 检出率。进一步采用组内相关系数比较结节（≥5mm）的大小。
本研究中，自由呼吸 Star-VIBE 的 SNR 明显优于标准 VIBE，CNR 相同。2D-fBLADE TSE 的 SNR 具有统计学意义，但 CNR 均匀或低于 3D-SPACE。观察者间 5 分制评分具有极好的一致性。Star-VIBE 和 VIBE 的平均评分无差异。2D-fBLADE TSE 的平均评分高于 3D-SPACE。Star-VIBE 与标准 VIBE、2D-fBLADE TSE 与 3D-SPACE 之间非钙化实质病变的检出率无统计学差异。与 CT 相比，MRI 在检测实变、空洞、非钙化结节（≥5mm）和树芽征方面与 CT 相当。MRI 检测非钙化结节（＜5mm、5-10mm、≥10mm）和钙化结节的灵敏度分别为 69.6%、90.6%、100%和 89.5%。此外，结节（≥5mm）的大小具有统计学一致性。MRI 更敏感于检测干酪样坏死、液化、活动空洞、淋巴结和胸膜异常。
T1 加权自由呼吸 Star-VIBE 和 T2 加权 2D-fBLADE TSE 均具有满意的图像质量，适用于临床常规需要长期随访的肺结核患者，特别是儿童、年轻女性和孕妇。
