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Assessment of Morphological MRI for Pulmonary Changes in Cystic Fibrosis (CF) Patients: Comparison to Thin-Section CT and Chest X-ray

Puderbach, Michael MD*; Eichinger, Monika MD*; Haeselbarth, Julie MD; Ley, Sebastian MD; Kopp-Schneider, Annette PhD; Tuengerthal, Siegfried MD, PhD; Schmaehl, Astrid MD; Fink, Christian MD*∥; Plathow, Christian MD*††; Wiebel, Matthias MD**; Demirakca, Sueha MD‡‡; Müller, Frank-Michael MD, PhD; Kauczor, Hans-Ulrich MD, PhD*

doi: 10.1097/RLI.0b013e318074fd81
Original Article

Objectives: As pulmonary complications are life limiting in patients with cystic fibrosis (CF), repeated chest imaging [chest x-ray, computed tomography (CT)] is needed for follow up. With the continuously rising life expectancy of CF patients, magnetic resonance imaging (MRI) as a radiation-free imaging modality might become more and more attractive. The goal of this study was to prospectively assess the value of MRI for evaluation of morphologic pulmonary CF-changes in comparison to established imaging modalities.

Materials and Methods: Thirty-one CF patients (19 female, 12 male; mean age 16.7 years) with stable lung disease were examined by MRI: HASTE, coronal/transversal (TR/TE/α/TA: infinite/28 ms/180°/18 s), multi-detector computed tomography (MDCT) (30 patients): 120 kV, dose modulated mAs, and chest x-ray (21 patients). Image evaluation: random order, 4 chest radiologists in consensus; chest x-ray: modified Chrispin-Norman score; CT and MRI: modified Helbich score. The maximal attainable score for chest x-ray was 34, for MRI and CT 25. Median scores, Pearson correlation coefficients, Bland-Altman plots, and concordance of MRI to CT on a lobar and segmental basis were calculated.

Results: The median MRI and MDCT scores were 13 (min 3, max 20) respectively 13.5 (min 0, max 20). The median chest x-ray score was 14 (min 5, max 32). Pearson correlation coefficients: MRI/CT = 0.80, P < 0.0001; MRI/chest x-ray = 0.63, P < 0.0018; chest x-ray/CT = 0.75, P < 0.0001. The median lobe related concordance was 80% for bronchiectasis, 77% for mucus plugging, 93%, for sacculation/abscesses, and 100% for collapse/consolidation.

Conclusions: Morphologic MRI of the lung in CF patients demonstrates comparable results to MDCT and chest x-ray. Because radiation exposure is an issue in CF patients, MRI might have the ability to be used as an appropriate alternative method for pulmonary imaging.

From the Departments of *Radiology (E010) and †Biostatistics, DKFZ, Heidelberg, Germany; Departments of ‡Pediatric Pulmonology, Cystic Fibrosis Center and Infectious Diseases and §Pediatric Radiology, University of Heidelberg, Heidelberg, Germany; Departments of ¶Radiology and **Pulmonology, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany; ∥Department of Radiology, University Munich, Munich, Germany; ††Department of Radiology, University Tübingen, Tübingen, Germany; and ‡‡Faculty of Medicine Mannheim, Department of Pediatrics, University Heidelberg, Mannheim, Germany.

Received February 26, 2007, and accepted for publication, after revision, April 17, 2007.

Supported by the “Forschungsgemeinschaft Mukoviszidose” (S06/04).

The first two authors contributed equally to this paper.

Reprints: Michael Puderbach, MD, Department of Radiology (E010), DKFZ, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.