Chronic Infiltrative Lung Diseases: Value of Gadolinium-Enhanced MRI in the Evaluation of Disease Activity-Early Report

doi:10.1378/chest.117.4.1173

Chest

Volume 117, Issue 4, April 2000, Pages 1173-1178

https://doi.org/10.1378/chest.117.4.1173 Get rights and content

Study objective

To determine the value of gadolinium-enhanced MRI in the assessment of disease activity in chronic infiltrative lung diseases (CILDs).

Design

Retrospective study.

Setting

University hospital.

Materials and Methods

Twenty-five consecutive patients with CILD were studied. The following diseases were diagnosed: sarcoidosis (n = 10), bronchiolitis obliterans organizing pneumonia (n = 3), usual interstitial pneumonia (n = 4), radiation pneumonia (n = 2), desquamative interstitial pneumonia (n = 1), rheumatoid lung (n = 1), vasculitis (n = 1), alveolar proteinosis (n = 1), bronchioloalveolar carcinoma (n = 1), and chronic eosinophilic pneumonia (n = 1). In each patient, the disease activity was assessed by one or more of the following studies: BAL (n = 18), gallium-radioisotope lung scanning (n = 6), serum angiotensin-converting enzyme assay (n = 10), and open lung biopsy (n = 4). T1-weighted breath-hold MRI studies were obtained before and after IV injection of gadolinium. The MRI examinations were analyzed to assess the presence or absence of lesional enhancement.

Results

The presence of enhanced pulmonary lesions was seen in 14 patients. All of these patients had active disease. Of the 17 patients with active disease, 14 had enhanced lesions, and 3 had unenhanced lesions. Pulmonary lesions were not enhanced in any patients with inactive disease. The difference was statistically significant (Fisher Exact Test, p < 0.05).

Conclusion

Gadolinium-enhanced MRI may prove to be a useful tool in assessing disease activity in CILDs.

Section snippets

Patient Population

The study included 25 consecutive patients who had parenchymal opacification on CT scans and a definitive diagnosis made on the basis of findings at examinations of specimens obtained by means of open lung (n = 8), transbronchial (n = 12), or percutaneous needle biopsy (n = 5). Our study group consisted of 16 men and 9 women, ages 35 to 67 years, with clinical symptoms or radiographic findings that were present for > 1 month (from 40 days to 3 years). In these 25 patients, 10 diseases were

Results

The patients were divided into two groups (Table 1). Group 1 consisted of 14 patients in whom pulmonary lesion enhancement was present (positive enhancement). Two types of enhancement were observed: (1) enhancement of lesions that were not visible on unenhanced MRI (nine patients; Fig 1, top, middle, and bottom); and (2) enhancement of lesions that were visible also on unenhanced MRI (five patients; Fig 2, top, middle, and bottom). Group 2 consisted of 11 patients in whom no enhancement of the

Discussion

Despite the wide range of origins of CILD, the sequence of pathologic changes that lead to chronic fibrotic interstitial lung disease can be grouped broadly into three phases.⁴ The first stage of injury is an early exudative phase, with an accumulation of inflammatory cells in the alveolar septa and airspaces. This phase results, in part, from injury to the capillary endothelium. The second phase is an intermediate organizing phase with collagen derangement. The third phase culminates in severe

Conclusion

Our study had the following limitations: (1) the small number of patients included, (2) the heterogeneity of diseases investigated, (3) the lack of follow-up studies to assess the value of gadolinium-enhanced MRI in the therapeutic management of patients with CILD, and (4) the lack of a reliable “gold standard” for disease activity. The presence of gadolinium enhancement has not been directly compared with histologic presence of inflammation. Ideal pathologic correlation with MRI findings would

References (19)

S Abe et al.
Gallium-67 scintigraphy, bronchoalveolar lavage, and pathologic changes in patients with pulmonary sarcoidosis
Chest
(1984)
TV Colby et al.
Infiltrative lung disease
AN Leung et al.
Parenchymal opacification in chronic infiltrative lung diseases: CT-pathologic correlation
Radiology
(1993)
JD Fulmer et al.
Interstitial lung disease
Curr Pulmonol
(1979)
HY Reynolds
Classification, definition, and correlation between clinical and histologic staging of interstitial lung diseases
Semin Respir Med
(1984)
OP Sharma
Pulmonary sarcoidosis and corticosteroids
Am Rev Respir Dis
(1993)
CB Carrington et al.
Natural history and treated course of usual and desquamative interstitial pneumonia
N Engl J Med
(1978)
AH Niden et al.
67-Gallium citrate lung scans in interstitial lung disease
Chest
(1986)
A Alavi et al.
Gallium-67-citrate scanning in the assessment of disease activity in sarcoidosis
J Nucl Med
(1992)

There are more references available in the full text version of this article.

Cited by (33)

Overview on Radiologic Patterns in Interstitial Lung Disease
2021, Encyclopedia of Respiratory Medicine, Second Edition
High resolution computed tomography (HRCT) plays a central role in the diagnostic process of interstitial lung disease (ILD). Although the HRCT findings usually correspond to recognizable chest radiography abnormalities, they are much more clearly identifiable on HRCT. In this chapter the role of chest radiography and HRCT in the diagnostic process of ILD are discussed. Main HRCT findings in ILD are described with a focus on specific situations where HRCT has a particular diagnostic importance and on the prognostic utility of specific CT patterns. The role of magnetic resonance imaging (MRI) and positron emission tomography (PET) in ILD patients is also discussed.
Magnetic resonance imaging of interstitial lung diseases: A state-of-the-art review
2019, Respiratory Medicine
Citation Excerpt :
Contrast-enhanced MRI sequences are also useful in the evaluation of ILDs. In previous series, early-enhanced lesions were an accurate indicator of active disease, while late-enhancement was a characteristic of fibrotic-predominant lesions [25,27,35]. Molecules of gadolinium can freely diffuse across the capillary's endothelium into the extravascular spaces of lung interstitium and later reenter the intravascular space [36,37].
Magnetic resonance imaging (MRI) has been emerging as an imaging modality to assess interstitial lung diseases (ILD). An optimal chest MRI protocol for ILDs should include non-contrast breath-holding sequences, steady-state free-precession sequences, and contrast-enhanced sequences. One of the main MRI applications in ILDs is the differentiation between areas of active inflammation (i.e. reversible stage) and fibrosis. Alveolitis presents high signal intensity on T2-weighted sequences (WS) and early-enhancement on contrast-enhanced MR sequences, while fibrotic-predominant lesions present low signal and late-enhancement in these sequences, respectively. MRI can be useful in connective tissue diseases, idiopathic pulmonary fibrosis, and sarcoidosis. The aim of this state-of-the-art review was to perform a state-of-the-art review on the use of MRI in ILDs, and propose the optimal MRI protocols for imaging ILDs.
Proton MRI in the evaluation of pulmonary sarcoidosis: Comparisonto chest CT
2013, European Journal of Radiology
The purpose of this study was to determine the feasibility of proton MRI of the lung in sarcoidosis patients and the agreement between the imaging appearance of pulmonary sarcoidosis on MRI and CT.
Chest CT scans and dedicated pulmonary MRI scans (including HASTE, VIBE, and TrueFISP sequences) were performed within 90 days of each other in 29 patients. The scans were scored for gross parenchymal opacification, reticulation, nodules, and masses using a 3-point lobar scale. Total and subset scores for corresponding MRI and CT scans were compared using the Spearman correlation test, Bland–Altman plots, and Cohen's quadratic-weighted kappa analysis. MRI scores were compared to CT by lobe and disease category, using percentage agreement, Spearman rank correlation, and Cohen's quadratic-weighted kappa.
The mean (±s.d.) time between MRI and CT scans was 33 ± 32 days. There was substantial correlation and agreement between total disease scoring on MRI and CT with a Spearman correlation coefficient of 0.774 (p < 0.0001) and a Cohen's weighted kappa score of 0.646. Correlation and agreement were highest for gross parenchymal opacification (0.695, 0.528) and reticulation (0.609, 0.445), and lowest in the setting of nodules (0.501, 0.305). Agreement testing was not performed for mass scores due to low prevalence. Upper lobe scoring on MRI and CT demonstrated greater agreement compared to the lower lobes (average difference in Cohen's weighted kappa score of 0.112).
There is substantial correlation and agreement between MRI and CT in the scoring of pulmonary sarcoidosis, though MRI evaluation in the upper lobes may be more accurate than in the lower lobes.
MRI differentiation of pneumonia-like mucinous adenocarcinoma and infectious pneumonia
2012, European Journal of Radiology
Citation Excerpt :
Third, due to retrospective design of the study we have not performed diffusion-weighted imaging. Since the raise of interest about MRI of the lung [19,20], a prospective study should be performed in the evaluation of the role of diffusion-weighted imaging in the distinction of chronic consolidations. A final limitation that merits to be considered is that patients in this study were examined over a wide time range of 12 years.
To evaluate the role of MRI water-sensitive sequences in the differential diagnosis between pneumonia-like mucinous adenocarcinoma and infectious pneumonia.
Twenty-three patients with pneumonia-like mucinous adenocarcinoma and 30 patients with infectious pneumonia underwent computed tomography (CT) and MRI. Two blinded and independent readers evaluated CT and MR images using a 3-level confidence scale in two separate sessions. Results were tested for statistical significance using the Fisher's exact test and the Cohen's k test.
On CT, the two readers respectively made correct diagnoses of mucinous adenocarcinoma in 17 out of 23 cases (73.9%), and in 15 out of 23 cases (65.2%). A correct diagnosis of infectious pneumonia was made in 22 out of 30 cases (73.3%), and in 24 out of 30 cases (80.0%). On MRI, both readers made correct diagnoses of mucinous adenocarcinoma in 23 out of 23 (100%) cases, and of infectious pneumonia in 30 out of 30 (100%) cases.
Fisher's exact test showed a significant difference in the diagnosis of mucinous adenocarcinoma between MRI and CT for both readers, P = 0.01 for reader 1 and P = 0.002 for reader 2, respectively. A good agreement (k = 0.73) was found between the two readers on CT evaluation, whereas an almost perfect agreement (k = 1.00) was found for MRI.
MRI with “water-sensitive” sequences should be added in the diagnostic protocol of every patient with pulmonary consolidation suspected to be mucinous adenocarcinoma.
Segmentation-Based Analysis of T2- and T1-Weighted Dynamic Magnetic Resonance Images Provides Adequate Observer Agreement in the Evaluation of Interstitial Lung Disease
2024, Journal of Computer Assisted Tomography
Molecular imaging of pulmonary inflammation and infection
2020, International Journal of Molecular Sciences

View all citing articles on Scopus

View full text

Chest

Preliminary ReportChronic Infiltrative Lung Diseases: Value of Gadolinium-Enhanced MRI in the Evaluation of Disease Activity-Early Report

Study objective

Design

Setting

Materials and Methods

Results

Conclusion

Section snippets

Patient Population

Results

Discussion

Conclusion

Chest

Infiltrative lung disease

Parenchymal opacification in chronic infiltrative lung diseases: CT-pathologic correlation

Radiology

Interstitial lung disease

Curr Pulmonol

Classification, definition, and correlation between clinical and histologic staging of interstitial lung diseases

Semin Respir Med

Pulmonary sarcoidosis and corticosteroids

Am Rev Respir Dis

Natural history and treated course of usual and desquamative interstitial pneumonia

N Engl J Med

67-Gallium citrate lung scans in interstitial lung disease

Chest

Gallium-67-citrate scanning in the assessment of disease activity in sarcoidosis

J Nucl Med

Preliminary Report
Chronic Infiltrative Lung Diseases: Value of Gadolinium-Enhanced MRI in the Evaluation of Disease Activity-Early Report