•CALIPER distinguishes between treated and untreated patients during follow-up.•CALIPER correlates with pulmonary function tests at baseline and during follow-up.•CALIPER correlates with prognosis in ...idiopathic pulmonary fibrosis patients.
To investigate the role of a quantitative analysis software (CALIPER) in identifying HRCT thresholds predicting IPF patients’ survival and lung function decline and its role in detecting changes of HRCT abnormalities related to treatment and their correlation with Forced Vital Capacity (FVC).
This retrospective study included 105 patients with a multidisciplinary diagnosis of IPF for whom one HRCT at baseline and concomitant FVC were available.
HRCTs were evaluated with CALIPER and the correlation between FVC and radiological features were assessed. Radiological thresholds for survival prediction and functional decline were calculated for all patients. Fifty-nine patients with at least 2 serial HRCTs were classified into two groups based on treatment. For patients for whom a FVC within 3 months of the HRCT was available (n = 44), the correlation of radiological and clinical progression was evaluated.
The correlation between FVC and CALIPER-derived features at baseline was significant and strong. A baseline CALIPER-derived interstitial lung disease (ILD%) extent higher than 20 % and pulmonary vascular related structures (PVRS%) score greater than 5 % defined a worse prognosis.
A significant progression of CALIPER-derived features in all patients was found with a faster increase in untreated patients. ILD% and PVRS% changes during follow-up demonstrated strong correlations with FVC changes.
CALIPER quantification of fibrosis and vascular involvement could distinguish disease progression in treated versus untreated patients and predict the survival. The changes in CALIPER-derived variables over time were significantly correlated to changes in FVC.
Thin-slices multi-detector computed tomography (MDCT) plays a key role in the differential diagnosis of interstitial lung disease (ILD). However, thin-slices MDCT has a limited ability to detect ...active inflammation, which is an important target of newly developed ILD drug therapy. Magnetic resonance imaging (MRI), thanks to its multi-parameter capability, provides better tissue characterisation than thin-slices MDCT.Our aim was to summarise the current status of MRI applications in ILD and to propose an ILD-MRI protocol. A systematic literature search was conducted for relevant studies on chest MRI in patients with ILD.We retrieved 1246 papers of which 55 original papers were selected for the review. We identified 24 studies comparing image quality of thin-slices MDCT and MRI using several MRI sequences. These studies described new MRI sequences to assess ILD parenchymal abnormalities, such as honeycombing, reticulation and ground-glass opacity. Thin-slices MDCT remains superior to MRI for morphological imaging. However, recent studies with ultra-short echo-time MRI showed image quality comparable to thin-slices MDCT. Several studies demonstrated the added value of chest MRI by using functional imaging, especially to detect and quantify inflammatory changes.We concluded that chest MRI could play a role in ILD patients to differentiate inflammatory and fibrotic changes and to assess efficacy of new ILD drugs.
Introduction/objectives
Interstitial lung disease (ILD) is frequent and highly disabling in systemic sclerosis (SSc). Magnetic resonance imaging (MRI) is not routinely used to evaluate the lung, due ...to poorer spatial resolution compared to high-resolution computed tomography (HRCT). We aimed to compare lung MRI signal with HRCT and evaluate the role of MRI in predicting ILD progression.
Methods
Thirty SSc patients underwent lung MRI and HRCT. STIR and T1 mapping sequences were acquired before and after gadolinium injection. Patients were classified as
normal
(group 1 with normal HRCT and MRI),
discordant
(group 2 without ILD signs on HRCT but areas of hyperintensity on MRI), and
abnormal
(group 3 with ILD signs on HRCT and areas of hyperintensity on MRI). Patients were followed up for ILD progression.
Results
Mean STIR and T1 values were different between the three groups (
p
< 0.0001). STIR values correlated with HRCT score (
R
= 0.79,
p
< 0.0001), lung ultrasound B-lines (
R
= 0.73,
p
< 0.0001), and %DLco (
R
= − 0.63,
p
= 0.0001). Nine events were recorded during a follow-up of 25 ± 20 months. Continuous STIR values were independently associated with events (HR 1.018; CI 1.005–1.031,
p
= 0.005). A STIR value >90 ms discriminated patients at a higher risk of worsening pulmonary involvement (HR 8.80; CI 1.81–42.74;
p
< 0.007).
Conclusions
Lung MRI can detect SSc-related ILD, with good correlations with other ILD markers. STIR values, independently of HRCT appearance, may predict worsening lung involvement. Lung MRI, although very preliminary, is a promising tool that in a near future could help selecting patients for an early treatment of SSc-related ILD and a more appropriate use of HRCT.
Key points
•
Lung MRI has the potential to differentiate inflammation-predominant
versus
fibrosis-predominant lesions, but it is not currently used in routine clinical practice to assess SSc-related ILD.
•
Lung MRI STIR and T1 values are significantly different between patients with and without SSc-related ILD. STIR values, independently of HRCT appearance, are also able to predict worsening lung involvement over time.
•
These preliminary data suggest that, in a near future, MRI could support the choice for an early treatment of SSc-related ILD, as well as a more appropriate use of HRCT.
Smoking is the main risk factor for lung cancer (LC), which is the leading cause of cancer-related death worldwide. Independent randomized controlled trials, governmental and inter-governmental task ...forces, and meta-analyses established that LC screening (LCS) with chest low dose computed tomography (LDCT) decreases the mortality of LC in smokers and former smokers, compared to no-screening, especially in women. Accordingly, several Italian initiatives are offering LCS by LDCT and smoking cessation to about 10,000 high-risk subjects, supported by Private or Public Health Institutions, envisaging a possible population-based screening program. Because LDCT is the backbone of LCS, Italian radiologists with LCS expertise are presenting this position paper that encompasses recommendations for LDCT scan protocol and its reading. Moreover, fundamentals for classification of lung nodules and other findings at LDCT test are detailed along with international guidelines, from the European Society of Thoracic Imaging, the British Thoracic Society, and the American College of Radiology, for their reporting and management in LCS. The Italian College of Thoracic Radiologists produced this document to provide the basics for radiologists who plan to set up or to be involved in LCS, thus fostering homogenous evidence-based approach to the LDCT test over the Italian territory and warrant comparison and analyses throughout National and International practices.
Coagulation factor Xa appears involved in the pathogenesis of pulmonary fibrosis. Through its interaction with protease activated receptor-1, this protease signals myofibroblast differentiation in ...lung fibroblasts. Although fibrogenic stimuli induce factor X synthesis by alveolar cells, the mechanisms of local posttranslational factor X activation are not fully understood. Cell-derived microparticles are submicron vesicles involved in different physiological processes, including blood coagulation; they potentially activate factor X due to the exposure on their outer membrane of both phosphatidylserine and tissue factor. We postulated a role for procoagulant microparticles in the pathogenesis of interstitial lung diseases. Nineteen patients with interstitial lung diseases and 11 controls were studied. All subjects underwent bronchoalveolar lavage; interstitial lung disease patients also underwent pulmonary function tests and high resolution CT scan. Microparticles were enumerated in the bronchoalveolar lavage fluid with a solid-phase assay based on thrombin generation. Microparticles were also tested for tissue factor activity. In vitro shedding of microparticles upon incubation with H₂O₂ was assessed in the human alveolar cell line, A549 and in normal bronchial epithelial cells. Tissue factor synthesis was quantitated by real-time PCR. Total microparticle number and microparticle-associated tissue factor activity were increased in interstitial lung disease patients compared to controls (84±8 vs. 39±3 nM phosphatidylserine; 293±37 vs. 105±21 arbitrary units of tissue factor activity; mean±SEM; p<.05 for both comparisons). Microparticle-bound tissue factor activity was inversely correlated with lung function as assessed by both diffusion capacity and forced vital capacity (r² = .27 and .31, respectively; p<.05 for both correlations). Exposure of lung epithelial cells to H₂O₂ caused an increase in microparticle-bound tissue factor without affecting tissue factor mRNA. Procoagulant microparticles are increased in interstitial lung diseases and correlate with functional impairment. These structures might contribute to the activation of factor X and to the factor Xa-mediated fibrotic response in lung injury.
The ITALUNG trial started in 2004 and compared lung cancer (LC) and other-causes mortality in 55-69 years-aged smokers and ex-smokers who were randomized to four annual chest low-dose CT (LDCT) or ...usual care. ITALUNG showed a lower LC and cardiovascular mortality in the screened subjects after 13 years of follow-up, especially in women, and produced many ancillary studies. They included recruitment results of a population-based mimicking approach, development of software for computer-aided diagnosis (CAD) and lung nodules volumetry, LDCT assessment of pulmonary emphysema and coronary artery calcifications (CAC) and their relevance to long-term mortality, results of a smoking-cessation intervention, assessment of the radiations dose associated with screening LDCT, and the results of biomarkers assays. Moreover, ITALUNG data indicated that screen-detected LCs are mostly already present at baseline LDCT, can present as lung cancer associated with cystic airspaces, and can be multiple. However, several issues of LC screening are still unaddressed. They include the annual vs. biennial pace of LDCT, choice between opportunistic or population-based recruitment. and between uni or multi-centre screening, implementation of CAD-assisted reading, containment of false positive and negative LDCT results, incorporation of emphysema. and CAC quantification in models of personalized LC and mortality risk, validation of ultra-LDCT acquisitions, optimization of the smoking-cessation intervention. and prospective validation of the biomarkers.
Abstract Purpose To present diffusion and perfusion magnetic resonance imaging (MRI) characteristics of focal nodular hyperplasia (FNH) of the liver. Materials and Methods Thirty-five patients with ...52 FNHs (21 were pathologically-confirmed) underwent MRI at 1.5-T device. MR diffusion diffusion-weighted imaging (DWI) was performed using a free-breathing single-shot, spin-echo, echo-planar sequence with b gradient factor value of 500 s/mm². MR perfusion perfusion-weighted imaging (PWI) consisted of a 3D free-breathing LAVA sequence repeated up to 5 minutes after injection of 7 mL Gd-BOPTA (MultiHance, Bracco, Italy) and 20 mL saline flush at a flow rate of 4 mL/s. Apparent diffusion coefficient (ADC) and time-signal intensity curve (TSIC) were obtained for both normal liver and each FNH by two reviewers in conference; maximum enhancement (ME) percentage, time to peak enhancement (TTP), and maximal slope (MS) were also calculated. Results On DWI mean ADC value was 1.624×10 − 3 mm2 /s for normal liver and 1.629×10 − 3 mm2 /s for FNH. ADC value for each FNH and the normal liver was not statistically different ( P = .936). On PWI, TSIC-Type 1 (quick and marked enhancement and quick decay followed by slowly decaying) was observed in all 52 FNHs, and TSIC-Type 2 (fast enhancement followed by slowly decaying plateau) in all normal livers. The mean ME, TTP and MS values were significantly different for FNH and normal liver ( P = .005). Conclusion FNHs of the liver showed typical diffusion and perfusion MRI characteristics in all cases. On the ADC map, we could get similar value between the FNHs and the background parenchyma. On the perfusion imaging, FNHs showed a different pattern distinguished from the background liver.
Abstract Purpose To evaluate the usefulness of diffusion-weighted magnetic resonance imaging (DW-MRI) in the differentiation of cystic pancreatic lesions. Materials and Methods Institutional review ...board approval was obtained, and written informed consent was taken from all enrolled subjects. Fifty-four patients with cystic pancreatic lesions of at least 1 cm in diameter (range:10–96 mm) at ultrasonography and/or computed tomography and 10 normal subjects underwent MRI at 1.5 T. These subjects included thirty-four patients with intraductal papillary mucinous tumors (IPMTs), 10 with pseudocysts, 5 with serous cystoadenoma and 5 with mucinous cystoadenoma. The MR protocol included axial T1 w and T2 w sequences and coronal MR cholangiopancreatography images. DW-MRI was performed using a breath-hold single-shot echo-planar sequence with a b gradient factor value of 500 s/mm2 in the three orthogonal axes. Apparent diffusion coefficient (ADC) was calculated for cerebrospinal fluid, normal pancreatic parenchyma, and for each focal pancreatic lesion. Imaging results were correlated with endoscopic retrograde cholangiopancreatography, endoscopic ultrasound-guided fine needle aspiration, surgery and/or imaging follow-up. Results Mean ADC value was 4.1×10−3 mm2 /s for cerebrospinal fluid, 1.73×10−3 mm2 /s for normal pancreatic parenchyma, 4.09×10−3 mm2 /s for IPMT, 3.89×10−3 mm2 /s for mucinous cystoadenoma, 3.65×10−3 mm2 /s for serous cystoadenoma and 2.83×10−3 mm2 /s for pseudocyst. Mean ADC values of each of the different types of pancreatic lesions were statistically different ( P <.05). Conclusion DW-MRI may be helpful in the differential diagnosis of cystic pancreatic lesions.
We assessed with computed tomography (CT) densitometry the prevalence of emphysema in 266 (175 men and 91 women; mean age 64 ± 4 years) smokers and former smokers enrolled in the ITALUNG trial of ...lung cancer screening with low-dose thin-slice CT. Whole-lung volume and the relative area at −950 Hounsfield units (RA
950
) and mean lung attenuation (MLA) in 1 of every 10 slices (mean, 24 slices per subject) were measured. Lung volume, MLA and RA950 significantly correlated each other and with age. Average RA950 >6.8% qualifying for emphysema was present in 71 (26.6%) of 266 subjects, with a higher prevalence in men than in women (30.3% vs 19.8%; p = 0.003). Only in smokers was a weak (r = 0.18; p = 0.05) correlation between RA950 and packs/year observed. In multiple regression analysis, the variability of RA950 (R2 = 0.24) or MLA (R2 = 0.34) was significantly, but weakly explained by age, lung volume and packs/year. Other factors besides smoking may also have a significant role in the etiopathogenesis of pulmonary emphysema.
•Biliary complications (BCs) after liver transplant represent important causes of morbidity and graft dysfunction.•MR is actually the preferred non-invasive imaging modality to identify ...post-transplant BCs.•3 T MRCP and MRI can predict post-transplant BCs in at least 95%, and exclude them in 99% of cases.•MRCP and MRI at 3 T device are extremely reliable for detecting BCs in liver transplant recipients.•3 T MRCP and MRI should be recommended before any invasive diagnostic procedure.
Our study was aimed to assess the diagnostic value of MR cholangiopancreatography (MRCP) and MR imaging at 3 T device when evaluating biliary adverse events after liver transplantation.
A series of 384 MR examinations in 232 liver transplant subjects with suspected biliary complications (impaired liver function tests and/or biliary abnormalities on ultrasound) were performed at 3 T device (GE-DISCOVERY MR750; GE Healthcare). After the acquisition of axial 3D dual-echo T1-weighted images and T2-weighted sequences (propeller and SS-FSE), MRCP was performed through coronal thin-slab 3D-FRFSE and coronal oblique thick-slab SSFSE T2w sequences. DW-MRI of the liver was performed using an axial spin-echo echo-planar sequence with multiple b values (150, 500, 1000, 1500 s/mm2) in all diffusion directions. Contrast-enhanced MRCP was performed in 25/232 patients. All MR images were blindly evaluated by two experienced abdominal radiologists in consensus to determine the presence of biliary complications, whose final diagnosis was based on direct cholangiography, surgery and integrating clinical follow-up with ultrasound and/or MRI findings.
In 113 patients no biliary abnormality was observed. The remaining 119 subjects were affected by one or more of the following complications: non-anastomotic strictures including typical ischemic-type biliary lesions (n = 67), anastomotic strictures (n = 34), ampullary dysfunction (n = 4), anastomotic leakage (n = 4), stones, sludge and casts (n = 65), vanishing bile duct (n = 1). The sensitivity, specificity, PPV, NPV and diagnostic accuracy of the reviewers for the detection of all types of biliary complications were 99%, 96%, 95%, 99% and 97%, respectively.
MR cholangiopancreatography and MR imaging at 3 T device are extremely reliable for detecting biliary complications after liver transplantation.
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