Pneumologie 2015; 69 - A24
DOI: 10.1055/s-0035-1556616

Morpho-functional Lung MRI in COPD: Short-term Test-retest Reliability

B Jobst 1, 2, 3, MO Wielpütz 1, 2, 3, S Triphan 1, 2, 4, A Anjorin 1, 2, 3, J Ley-Zaporozhan 1, 2, 5, HU Kauczor 1, 2, 3, J Biederer 1, 2, 6, S Ley 1, 2, 7, O Sedlaczek 1, 2, 3
  • 1Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg
  • 2Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg
  • 3Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg
  • 4Research Center Magnetic Resonance Bavaria (MRB), Würzburg
  • 5Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich
  • 6Radiologie Darmstadt, Department of Radiology, County Hospital Groß-Gerau
  • 7Department of Diagnostic & Interventional Radiology, Surgical Hospital Dr. Rinecker, Munich

Purpose: Non-invasive end-points for interventional trials and tailored treatment regimes in chronic obstructive pulmonary disease (COPD) for monitoring regionally different manifestations of lung disease instead of global assessment of lung function with spirometry would be valuable. Lung magnetic resonance imaging (MRI) allows for a radiation-free assessment of regional structure and function. The aim of this study was to evaluate the short-term reproducibility of a comprehensive morpho-functional lung MRI protocol in COPD.

Materials and Methods: 20 prospectively enrolled COPD patients (GOLD I-IV) underwent lung MRI at 1.5T on two consecutive days, including sequences for morphology, 4D contrast-enhanced perfusion, and respiratory mechanics. Image quality and COPD-related morphological and functional changes were evaluated in consensus by three chest radiologists using a dedicated MRI-based visual scoring system. Test-retest reliability was calculated per each individual lung lobe for the extent of large airway (bronchiectasis, wall thickening, mucus plugging) and small airway abnormalities (tree-in-bud, peripheral bronchiectasis, mucus plugging), consolidations, nodules, parenchymal defects and perfusion defects. The presence of tracheal narrowing, dystelectasis, pleural effusion, pulmonary trunk ectasia, right ventricular enlargement and, finally, motion patterns of diaphragma and chest wall were addressed.

Results: Median global scores [10 (Q1:8.00; Q3:16.00) vs. 11 (Q1:6.00; Q3:15.00)] as well as category subscores were similar between both timepoints, and kappa statistics indicated “almost perfect” global agreement (κ= 0.86, 95%CI = 0.81 – 0.91). Most subscores showed at least “substantial” agreement of MRI1 and MRI2 (κ= 0.64 – 1.00), whereas the agreement for the diagnosis of dystelectasis/effusion (κ= 0.42, 95% CI = 0.00 – 0.93) was “moderate” and of tracheal abnormalities (κ= 0.21, 95% CI = 0.00 – 0.75) “fair”. Most MRI acquisitions showed at least diagnostic quality at MRI1 (276 of 278) and MRI2 (259 of 264).

Conclusion: Morpho-functional MRI can be obtained with reproducible image quality and high short-term test-retest reliability for COPD-related morphological and functional changes of the lung. This underlines its potential value for the monitoring of regional lung characteristics in COPD trials.

*Presenting author