New severity assessment in cystic fibrosis: signal intensity and lung volume compared to LCI and FEV1: preliminary results
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Magnetic resonance imaging (MRI) aids diagnosis in cystic fibrosis (CF) but its use in quantitative severity assessment is under research. This study aims to assess changes in signal intensity (SI) and lung volumes (Vol) during functional MRI and their use as a severity assessment tool in CF patients.
The CF intra-hospital standard chest 1.5 T MRI protocol comprises of very short echo-time sequences in submaximal in- and expiration for functional information. Quantitative measurements (Vol/SI at in- and expiration, relative differences (Vol_delta/SI_delta), and cumulative histograms for normalized SI values across the expiratory lung volume) were assessed for correlation to pulmonary function: lung clearance index (LCI) and forced expiratory volume in 1 s (FEV1).
In 49 patients (26 male, mean age 17 ± 7 years) significant correlation of Vol_delta and SI_delta (R = 0.86; p < 0.0001) during respiration was observed. Individual cumulated histograms enabled severity disease differentiation (mild, severe) to be visualized (defined by functional parameter: LCI > 10). The expiratory volume at a relative SI of 100% correlated significantly to LCI (R = 0.676 and 0.627; p < 0.0001) and FEV1 (R = − 0.847 and − 0.807; p < 0.0001). Clustering patients according to Vol_SI_100 showed that an amount of ≤ 4% was related to normal, while an amount of > 4% was associated with pathological pulmonary function values.
Functional pulmonary MRI provides a radiation-free severity assessment tool and can contribute to early detection of lung impairment in CF. Lung volume with SI below 100% of the inspiratory volume represents overinflated tissue; an amount of 4% of the expiratory lung volume was a relevant turning point.
• Signal intensity and lung volumes are used as potential metric parameters for lung impairment.
• Quantification of trapped air impacts on therapy management.
• Functional pulmonary MRI can contribute to early detection of lung impairment.
KeywordsPediatrics Pulmonary cystic fibrosis Lung volume measurements Functional magnetic resonance imaging Respiratory function tests
Forced expiratory volume in 1 s
Lung clearance index
Magnetic resonance imaging
Pulmonary function test
Signal intensity/volume difference between in- and expiration
In-/expiratory signal intensity
We would like to separately acknowledge with gratitude the substantial work of the late Dr. Riethmueller toward this project and his meaningful close collaboration. We would also like to thank Dr. Andrew Dickinson for his help editing this manuscript.
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Prof. JF Schäfer.
Conflict of interest
The authors declare that they have no conflict of interest.
Statistics and biometry
One of the authors has significant statistical expertise and no complex statistical methods were necessary for this paper.
Written informed consent was obtained from all patients in this study.
Institutional Review Board approval was obtained.
• diagnostic study
• performed at one institution
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