Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
Eur Radiol. 2024 Sep;34(9):5597-5609. doi: 10.1007/s00330-024-10610-0. Epub 2024 Feb 12.
A prospective, multi-centre study to evaluate concordance of morphologic lung MRI and CT in chronic obstructive pulmonary disease (COPD) phenotyping for airway disease and emphysema.
A total of 601 participants with COPD from 15 sites underwent same-day morpho-functional chest MRI and paired inspiratory-expiratory CT. Two readers systematically scored bronchial wall thickening, bronchiectasis, centrilobular nodules, air trapping and lung parenchyma defects in each lung lobe and determined COPD phenotype. A third reader acted as adjudicator to establish consensus. Inter-modality and inter-reader agreement were assessed using Cohen's kappa (im-κ and ir-κ).
The mean combined MRI score for bronchiectasis/bronchial wall thickening was 4.5/12 (CT scores, 2.2/12 for bronchiectasis and 6/12 for bronchial wall thickening; im-κ, 0.04-0.3). Expiratory right/left bronchial collapse was observed in 51 and 47/583 on MRI (62 and 57/599 on CT; im-κ, 0.49-0.52). Markers of small airways disease on MRI were 0.15/12 for centrilobular nodules (CT, 0.34/12), 0.94/12 for air trapping (CT, 0.9/12) and 7.6/12 for perfusion deficits (CT, 0.37/12 for mosaic attenuation; im-κ, 0.1-0.41). The mean lung defect score on MRI was 1.3/12 (CT emphysema score, 5.8/24; im-κ, 0.18-0.26). Airway-/emphysema/mixed COPD phenotypes were assigned in 370, 218 and 10 of 583 cases on MRI (347, 218 and 34 of 599 cases on CT; im-κ, 0.63). For all examined features, inter-reader agreement on MRI was lower than on CT.
Concordance of MRI and CT for phenotyping of COPD in a multi-centre setting was substantial with variable inter-modality and inter-reader concordance for single diagnostic key features.
MRI of lung morphology may well serve as a radiation-free imaging modality for COPD in scientific and clinical settings, given that its potential and limitations as shown here are carefully considered.
• In a multi-centre setting, MRI and CT showed substantial concordance for phenotyping of COPD (airway-/emphysema-/mixed-type). • Individual features of COPD demonstrated variable inter-modality concordance with features of pulmonary hypertension showing the highest and bronchiectasis showing the lowest concordance. • For all single features of COPD, inter-reader agreement was lower on MRI than on CT.
一项前瞻性、多中心研究旨在评估形态学肺部 MRI 和 CT 在慢性阻塞性肺疾病（COPD）气道疾病和肺气肿表型中的一致性。
来自 15 个地点的 601 名 COPD 患者在同一天接受了形态功能胸部 MRI 和吸气-呼气 CT 检查。两位读者系统地对每个肺叶的支气管壁增厚、支气管扩张、小叶中心结节、空气潴留和肺实质缺损进行评分，并确定 COPD 表型。第三位读者作为裁决者以建立共识。使用 Cohen's kappa（im-κ 和 ir-κ）评估两种模态和两位读者之间的一致性。
支气管扩张/支气管壁增厚的平均联合 MRI 评分分别为 4.5/12（CT 评分分别为支气管扩张 2.2/12 和支气管壁增厚 6/12；im-κ 为 0.04-0.3）。MRI 上观察到右侧/左侧支气管呼气性塌陷的比例分别为 51 和 47/583（CT 为 62 和 57/599；im-κ 为 0.49-0.52）。MRI 上小气道疾病的标志物分别为小叶中心结节 0.15/12（CT 为 0.34/12）、空气潴留 0.94/12（CT 为 0.9/12）和灌注缺损 0.94/12（CT 为马赛克衰减的 0.37/12；im-κ 为 0.1-0.41）。MRI 上的平均肺缺损评分分别为 1.3/12（CT 肺气肿评分分别为 5.8/24；im-κ 为 0.18-0.26）。在 583 例患者中，370 例、218 例和 10 例分别被分配为气道型/肺气肿型/混合型 COPD 表型，在 599 例患者中，347 例、218 例和 34 例分别被分配为气道型/肺气肿型/混合型 COPD 表型（CT；im-κ 为 0.63）。对于所有检查的特征，MRI 上的两位读者之间的一致性均低于 CT。
在多中心环境中，MRI 和 CT 对 COPD 表型的一致性是显著的，对于单个诊断关键特征存在可变的模态间和读者间一致性。
鉴于这里显示的 MRI 的潜力和局限性，肺部形态学 MRI 作为 COPD 的无辐射成像方式，在科学和临床环境中可能很好用。
在多中心环境中，MRI 和 CT 对 COPD（气道型/肺气肿型/混合型）表型的一致性很高。
COPD 的各个特征表现出不同的模态间一致性，其中肺动脉高压的特征表现出最高的一致性，而支气管扩张的特征表现出最低的一致性。
对于 COPD 的所有单个特征，MRI 上的读者间一致性均低于 CT。
