Morpho-Functional 1H-MRI of the Lung in COPD: Short-Term Test-Retest Reliability

Bertram J Jobst; Mark O Wielpütz; Simon M F Triphan; Angela Anjorin; Julia Ley-Zaporozhan; Hans-Ulrich Kauczor; Jürgen Biederer; Sebastian Ley; Oliver Sedlaczek

doi:10.1371/journal.pone.0137282

Morpho-Functional 1H-MRI of the Lung in COPD: Short-Term Test-Retest Reliability

PLoS One. 2015 Sep 1;10(9):e0137282. doi: 10.1371/journal.pone.0137282. eCollection 2015.

Authors

Bertram J Jobst¹, Mark O Wielpütz¹, Simon M F Triphan², Angela Anjorin¹, Julia Ley-Zaporozhan³, Hans-Ulrich Kauczor¹, Jürgen Biederer⁴, Sebastian Ley⁵, Oliver Sedlaczek¹

Affiliations

¹ Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany.
² Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Research Center Magnetic Resonance Bavaria (MRB), Würzburg, Germany.
³ Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
⁴ Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Radiologie Darmstadt, Department of Radiology, County Hospital Gross-Gerau, Gross-Gerau, Germany.
⁵ Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Department of Diagnostic & Interventional Radiology, Surgical Hospital Dr. Rinecker, Munich, Germany.

Abstract

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. Proton nuclear magnetic resonance imaging (1H-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 1H-MRI of the lung 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 (ĸ = 0.86, 95%CI = 0.81-0.91). Most subscores showed at least "substantial" agreement of MRI1 and MRI2 (ĸ = 0.64-1.00), whereas the agreement for the diagnosis of dystelectasis/effusion (ĸ = 0.42, 95%CI = 0.00-0.93) was "moderate" and of tracheal abnormalities (ĸ = 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 1H-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.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Bronchiectasis / pathology
Female
Humans
Lung / pathology*
Magnetic Resonance Imaging / methods
Male
Middle Aged
Mucus / physiology
Perfusion / methods
Prospective Studies
Pulmonary Disease, Chronic Obstructive / pathology*
Reproducibility of Results
Respiratory Mechanics / physiology

Grants and funding

This work has been supported by the Competence Network on Asthma/COPD (ASCONET) through a grant from the Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF) of the federal government of Germany (01GI0870, www.bmbf.de/en). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors declare no conflict of interest with regard to the study at hand.