Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
J Magn Reson Imaging. 2024 Mar;59(3):909-919. doi: 10.1002/jmri.28844. Epub 2023 Jun 2.
Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is associated with severe lung damage and requires specific therapeutic management. Repeated imaging is recommended to both diagnose and follow-up response to treatment of ABPA in CF. However, high risk of cumulative radiation exposure requires evaluation of free-radiation techniques in the follow-up of CF patients with ABPA.
To evaluate whether Fourier decomposition (FD) functional lung MRI can detect response to treatment of ABPA in CF patients.
Retrospective longitudinal.
Twelve patients (7M, median-age:14 years) with CF and ABPA with pre- and post-treatment MRI.
FIELD STRENGTH/SEQUENCE: 2D-balanced-steady-state free-precession (bSSFP) sequence with FD at 1.5T.
Ventilation-weighted (V) and perfusion-weighted (Q) maps were obtained after FD processing of 2D-coronal bSSFP time-resolved images acquired before and 3-9 months after treatment. Defects extent was assessed on the functional maps using a qualitative semi-quantitative score (0 = absence/negligible, 1 = <50%, 2 = >50%). Mean and coefficient of variation (CV) of the ventilation signal-intensity (VSI) and the perfusion signal-intensity (QSI) were calculated. Measurements were performed independently by three readers and averaged. Inter-reader reproducibility of the measurements was assessed. Pulmonary function tests (PFTs) were performed within 1 week of both MRI studies as markers of the airflow-limitation severity.
Comparisons of medians were performed using the paired Wilcoxon-test. Reproducibility was assessed using intraclass correlation coefficient (ICC). Correlations between MRI and PFT parameters were assessed using the Spearman-test (rho correlation-coefficient). A P-value <0.05 was considered as significant.
Defects extent on both V and Q maps showed a significant reduction after ABPA treatment (4.25 vs. 1.92 for V-defect-score and 5 vs. 2.75 for Q-defect-score). VSI_mean was significantly increased after treatment (280 vs. 167). Qualitative analyses reproducibility showed an ICC > 0.90, while the ICCs of the quantitative measurements was almost perfect (>0.99). Changes in VSI_cv and QSI_cv before and after treatment correlated inversely with changes of FEV1%p (rho = -0.68 for both).
Non-contrast-enhanced FD lung MRI has potential to reproducibly assess response to treatment of ABPA in CF patients and correlates with PFT obstructive parameters.
4 TECHNICAL EFFICACY: Stage 3.
囊性纤维化（CF）患者的变应性支气管肺曲霉病（ABPA）与严重的肺损伤有关，需要进行特定的治疗管理。为了诊断和随访 CF 患者 ABPA 的治疗反应，建议进行多次影像学检查。然而，由于累积辐射暴露的风险较高，需要评估 CF 患者 ABPA 随访中无辐射技术。
评估傅立叶分解（FD）功能肺部 MRI 是否可以检测 CF 患者 ABPA 的治疗反应。
回顾性纵向研究。
12 名患者（7 名男性，中位年龄：14 岁），CF 合并 ABPA，在治疗前后均进行 MRI 检查。
磁场强度/序列：1.5T 上的 2D 平衡稳态自由进动（bSSFP）序列加 FD。
FD 处理 2D 冠状 bSSFP 时间分辨图像后，获得通气加权（V）和灌注加权（Q）图。使用定性半定量评分（0=不存在/可忽略不计，1<50%，2>50%）在功能图上评估缺陷范围。计算通气信号强度（VSI）和灌注信号强度（QSI）的平均值和变异系数（CV）。由三位读者独立进行测量并取平均值。评估测量的读者间可重复性。在两次 MRI 研究的 1 周内进行肺功能测试（PFT），作为气流受限严重程度的标志物。
使用配对 Wilcoxon 检验比较中位数。使用组内相关系数（ICC）评估可重复性。使用 Spearman 检验（rho 相关系数）评估 MRI 和 PFT 参数之间的相关性。P 值<0.05 被认为具有统计学意义。
ABPA 治疗后，V 和 Q 图上的缺陷范围显著减少（V 缺陷评分从 4.25 降至 1.92，Q 缺陷评分从 5 降至 2.75）。VSI_mean 治疗后显著增加（280 比 167）。定性分析的可重复性显示 ICC>0.90，而定量测量的 ICC 几乎完美（>0.99）。治疗前后 VSI_cv 和 QSI_cv 的变化与 FEV1%p 的变化呈负相关（rho 分别为-0.68）。
非对比增强 FD 肺部 MRI 具有潜力，可以可靠地评估 CF 患者 ABPA 的治疗反应，并与 PFT 阻塞性参数相关。
4 级 技术功效：3 级。
