Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
Eur J Radiol. 2021 Jun;139:109653. doi: 10.1016/j.ejrad.2021.109653. Epub 2021 Mar 31.
This study aimed to assess the feasibility of Self-gated Non-Contrast-Enhanced Functional Lung (SENCEFUL) MRI for detection of pulmonary perfusion deficits in patients with cystic fibrosis.
Twenty patients with cystic fibrosis and 20 matched healthy controls underwent SENCEFUL-MRI at 1.5 T with reconstruction of perfusion and perfusion phase maps (i.e. comparable to pulse wave delays). Four blinded readers rated both types of maps separately followed by simultaneous assessment thereof. Perfusion phase data was plotted in histograms and a Peak-to-Offset ratio was calculated for comparison to subjective scoring and correlation (Spearman) to lung function parameters. Sensitivity, specificity and positive and negative predictive values were calculated for subjective scoring and Peak-to-Offset ratios. Intraclass correlation (ICC) was used to assess the interrater agreement.
Readers attributed pathological ratings 2.2-3.5 times more frequently to the CF-group. The sensitivity with regard to a correct assignment to CF was similar between ratings (perfusion only vs. perfusions phase only vs. simultaneous assessment: 0.54-0.56), while specificity increased from 0.75 to 0.85 for simultaneous assessment. ICC was 0.77-0.84 for subjective scoring. ROC-analysis of Peak-to-Offset ratios on a mean per-subject basis revealed a sensitivity of 0.75 and specificity of 0.85 (PPV 0.83, NPV 0.77). Functional pulmonary parameters indicative of bronchial obstruction and Peak-to-Offset ratios showed positive correlation (FEV1: 0.77; FEF75: 0.76).
SENCEFUL-MRI bears the potential for monitoring CF including disease-associated patterns of altered pulmonary perfusion. The proposed Peak-to-Offset ratio derived from pulmonary perfusion phase measurements could represent an objective future marker for perfusion impairment.
本研究旨在评估 Self-gated Non-Contrast-Enhanced Functional Lung（SENCEFUL）MRI 检测囊性纤维化患者肺灌注缺损的可行性。
20 例囊性纤维化患者和 20 例匹配的健康对照者在 1.5T 下进行 SENCEFUL-MRI 检查，重建灌注和灌注相位图（即与脉冲波延迟相当）。4 位盲法读者分别对两种类型的图像进行评分，然后同时进行评估。绘制灌注相位数据直方图，并计算峰到偏移比，以便与主观评分和相关性（Spearman）进行比较，与肺功能参数进行比较。计算主观评分和峰到偏移比的敏感性、特异性、阳性和阴性预测值。采用组内相关系数（ICC）评估评分者间的一致性。
读者对 CF 组的病理评分频率是健康对照组的 2.2-3.5 倍。评分正确分配到 CF 组的敏感性在灌注（仅灌注与仅灌注相位评估、同时评估）之间相似（0.54-0.56），而特异性则从 0.75 提高到 0.85（同时评估）。主观评分的 ICC 为 0.77-0.84。基于每位受试者的平均 Peak-to-Offset 比的 ROC 分析显示，敏感性为 0.75，特异性为 0.85（PPV 为 0.83，NPV 为 0.77）。提示气道阻塞的功能肺参数和 Peak-to-Offset 比之间存在正相关（FEV1：0.77；FEF75：0.76）。
SENCEFUL-MRI 具有监测 CF 的潜力，包括与疾病相关的肺灌注改变模式。从肺灌注相位测量得出的建议的峰到偏移比可以作为未来灌注损伤的客观标志物。
