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Chest MR imaging in the follow-up of pulmonary alterations in paediatric patients with middle lobe syndrome: comparison with chest X-ray

La risonanza magnetica nel follow-up delle alterazioni polmonari in pazienti pediatrici con sindrome del lobo medio: confronto con la radiografia tradizionale

  • Paediatric Radiology / Radiologia Pediatrica
  • Published:
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Abstract

Purpose

The authors evaluated the role of magnetic resonance (MR) imaging of the chest in comparison with chest X-ray in the follow-up of pulmonary abnormalities detected by computed tomography (CT) in paediatric patients with middle lobe syndrome.

Materials and methods

Seventeen patients with middle lobe syndrome (mean age 6.2 years) underwent chest CT at the time of diagnosis (100 kV, CARE dose with quality reference of 70 mAs; collimation 24×1.2 mm; rotation time 0.33 s; scan time 5 s); at follow-up after a mean of 15.3 months, all patients were evaluated with chest MR imaging with a respiratory-triggered T2-weighted BLADE sequence (TR 2,000; TE 27 ms; FOV 400 mm; flip angle 150°; slice thickness 5 mm) and chest X-ray. Images from each modality were assessed for the presence of pulmonary consolidations, bronchiectases, bronchial wall thickening and mucous plugging. Hilar and mediastinal lymphadenopathies were assessed on CT and MR images.

Results

Baseline CT detected consolidations in 100% of patients, bronchiectases in 35%, bronchial wall thickening in 53% and mucous plugging in 35%. MR imaging and chest X-ray identified consolidations in 65% and 35%, bronchiectases in 35% and 29%, bronchial wall thickening in 59% and 6% and mucous plugging in 25% and 0%, respectively. Lymphadenopathy was seen in 64% of patients at CT and in 47% at MR imaging.

Conclusions

Patients with middle lobe syndrome show a wide range of parenchymal and bronchial abnormalities at diagnosis. Compared with MR imaging, chest X-ray seems to underestimate these changes. Chest MR imaging might represent a feasible and radiation-free option for an overall assessment of the lung in the follow-up of patients with middle lobe syndrome.

Riassunto

Obiettivo

Scopo del presente lavoro è valutare il possibile ruolo della risonanza magnetica (RM) del torace, in confronto con l’Rx, nel follow-up delle alterazioni polmonari identificate con esame di tomografia computerizzata (TC) di diagnosi in un gruppo di pazienti pediatrici con sindrome del lobo medio (SLM).

Materiali e metodi

Diciassette pazienti (età media: 6,2 anni) hanno eseguito un esame TC del torace al momento della diagnosi (100 kV, CARE dose con riferimento di qualità: 70 mAs; collimation: 24×1,2 mm; rotation-time: 0,33 s; scan-time: 5 s); al follow-up (intervallo temporale medio: 15,3 mesi), tutti i pazienti hanno eseguito una RM polmonare [sequenza T2-pesata BLADE con triggeringrespiratorio: tempo di ripetizione (TR): 2000; tempo di eco (TE): 27 ms; campo di vista (FOV): 400 mm; flip-angle: 150°; spessore: 5 mm) ed un esame Rx del torace. La presenza di consolidazioni, bronchiectasie, ispessimento delle pareti bronchiali e mucous plugging (tappi di muco) è stato riportato per ogni modalità d’esame. La presenza di linfoadenopatie ilo-mediastiniche è stata riportata per TC ed RM.

Risultati

La TC di diagnosi ha riportato consolidazioni nel 100% dei pazienti; bronchiectasie: 35%; ispessimento delle pareti bronchiali: 53%; mucous plugging: 35%. RM/Rx hanno riportato, rispettivamente, consolidazioni: 65%/35%; bronchiectasie: 35%/29%; ispessimento delle pareti bronchiali: 59%/6%; mucous-plugging: 25%/0%. Linfoadenopatie sono state riportate nel 64% dei pazienti in TC e 47% in RM.

Conclusioni

I pazienti con SLM mostrano un ampio corteo di alterazioni polmonari sin dal momento della diagnosi. L’esame Rx sembra sottostimare, in confronto alla RM, la frequenza di tali alterazioni nel corso del follow-up; la RM polmonare può rappresentare una metodica promettente e priva di radiazioni ionizzanti nel follow-up di questi pazienti.

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Authors and Affiliations

  1. Department of Radiological Sciences, University of Rome “Sapienza”, Viale Regina Elena 324, 00161, Rome, Italy

    F. Fraioli, G. Serra, G. Ciarlo, S. Liberali, A. Fiorelli & C. Catalano

  2. Department of Pediatrics, University of Rome “Sapienza”, Viale Regina Elena 324, 00161, Rome, Italy

    V. Massaccesi & F. Macrì

Authors
  1. F. Fraioli
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  2. G. Serra
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  3. G. Ciarlo
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  4. V. Massaccesi
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  5. S. Liberali
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  6. A. Fiorelli
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  7. F. Macrì
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  8. C. Catalano
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Correspondence to F. Fraioli.

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Fraioli, F., Serra, G., Ciarlo, G. et al. Chest MR imaging in the follow-up of pulmonary alterations in paediatric patients with middle lobe syndrome: comparison with chest X-ray. Radiol med 118, 444–455 (2013). https://doi.org/10.1007/s11547-012-0889-3

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  • DOI: https://doi.org/10.1007/s11547-012-0889-3

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