Delayed contrast dynamics as marker of regional impairment in pulmonary fibrosis using 5D MRI - a pilot study.
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<h4>Objective</h4>To analyse delayed contrast dynamics of fibrotic lesions in interstitial lung disease (ILD) using five dimensional (5D) MRI and to correlate contrast dynamics with disease severity.<h4>Methods</h4>20 patients (mean age: 71 years; M:F, 13:7), with chronic fibrosing ILD: <i>n</i> = 12 idiopathic pulmonary fibrosis (IPF) and <i>n</i> = 8 non-IPF, underwent thin-section multislice CT as part of the standard diagnostic workup and additionally MRI of the lung. 2 min after contrast injection, a radial gradient echo sequence with golden-angle spacing was acquired during 5 min of free-breathing, followed by 5D image reconstruction. Disease was categorized as severe or non-severe according to CT morphological regional severity. For each patient, 10 lesions were analysed.<h4>Results</h4>IPF lesions showed later peak enhancement compared to non-IPF (severe: <i>p</i> = 0.01, non-severe: <i>p</i> = 0.003). Severe lesions showed later peak enhancement compared to non-severe lesions, in non-IPF (<i>p</i> = 0.04), but not in IPF (<i>p</i> = 0.35). There was a tendency towards higher accumulation and washout rates in IPF compared to non-IPF in non-severe disease. Severe lesions had lower washout rate than non-severe ones in both IPF (<i>p</i> = 0.003) and non-IPF (<i>p</i> = 0.005). Continuous contrast agent accumulation, without washout, was found only in IPF lesions.<h4>Conclusions</h4>Contrast agent dynamics are influenced by type and severity of pulmonary fibrosis, which might enable a more thorough characterisation of disease burden. The regional impairment is of particular interest in the context of antifibrotic treatments and was characterised using a non-invasive, non-irradiating, free-breathing method.<h4>Advances in knowledge</h4>Delayed contrast enhancement patterns allow the assessment of regional lung impairment which could represent different disease stages or phenotypes in ILD.
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Lung Diseases, Interstitial
Connective Tissue Diseases
Magnetic Resonance Imaging
Severity of Illness Index
Principal Component Analysis
Image Processing, Computer-Assisted
Idiopathic Interstitial Pneumonias
Idiopathic Pulmonary Fibrosis
Multidetector Computed Tomography
Radiotherapy Physics Modelling
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The British journal of radiology, 2020, 93 (1113), pp. 20190121 - ?