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Gao Z, Wei K, Chen R, Ye W, Li T, Su Q, Wang R, Cao W. Retrospective computed tomography assessment of chemotherapy-related pneumonia with severity screening in pediatric acute lymphoblastic leukemia by radiological imaging. Heliyon 2024; 10:e23444. [PMID: 38169788 PMCID: PMC10758811 DOI: 10.1016/j.heliyon.2023.e23444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives To evaluate the radiological imaging-guided severity along the pneumonia course and evaluate the chest computed tomography (CT) findings of chemotherapy-related pneumonia in children with acute lymphoblastic leukemia (ALL). Materials and methods A retrospective database review of children with ALL was conducted from March 2016 to August 2021 to identify cases with CT images who developed pneumonia during the chemotherapy course. A total of 51 children with ALL developed pneumonia were ultimately included (31 boys and 20 girls, mean age: 6 ± 4 years [standard deviation]). Each child's demographics, medical records, and laboratory results were collected. The CT images were then reviewed and the radiologic severity index (RSI) was calculated based on the regional opacity and implicated volume. A t-test, U test, Pearson's Chi-square test, and Fisher's exact test were performed to compare the clinical or radiologic features between the severe and moderate cases. The linear regression models were employed to analyze the correlation of RSIs with other clinical features. Results Eleven children (22 %, 11/51) displayed severe phenotypes associated with respiratory failure. The ground glass opacity (GGO) frequently appeared (65 % of CT images). The baseline RSI was positively associated with the lowest lymphocyte (p = .003), neutrophil (p = .01) counts, and the highest C-reactive protein level (p = .04). The peak RSI may predict severe phenotypes at a cutoff of 4.5 (AUC 0.76 [0.61, 0.91]) with 73 % sensitivity and 63 % specificity. Conclusion The chest CT images of children with chemotherapy-related pneumonia displayed clinically related baseline RSI and a peak RSI of >4.5 of 36 predicted severe phenotypes.
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Affiliation(s)
- Zhixin Gao
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, China
- China Medical University, No.77 Puhe Road, Shenbei New District, Shenyang, China
| | - Ke Wei
- Department of Radiology, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Ruiyuan Chen
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, China
- China Medical University, No.77 Puhe Road, Shenbei New District, Shenyang, China
| | - Wenhong Ye
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, China
| | - Tian Li
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA
| | - Qiru Su
- Institute of Pediatrics, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, China
| | - Rong Wang
- Department of Neurology, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Weiguo Cao
- Department of Radiology, Shenzhen Children's Hospital, 7019 Yitian Road, Futian District, Shenzhen, China
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Wucherpfennig L, Kauczor HU, Eichinger M, Wielpütz MO. [Magnetic resonance imaging of the lung : State of the art]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:849-862. [PMID: 37851088 DOI: 10.1007/s00117-023-01229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
Due to the low proton density of the lung parenchyma and the rapid signal decay at the air-tissue interfaces, for a long time the lungs were difficult to access using magnetic resonance imaging (MRI); however, technical advances could address most of these obstacles. Pulmonary alterations associated with tissue proliferation ("plus pathologies"), can now be detected with high diagnostic accuracy because of the locally increased proton density. Compared to computed tomography (CT), MRI provides a comprehensive range of functional imaging procedures (respiratory mechanics, perfusion and ventilation). In addition, as a radiation-free noninvasive examination modality, it enables repeated examinations for assessment of the course or monitoring of the effects of treatment, even in children. This article discusses the technical aspects, gives suggestions for protocols and explains the role of MRI of the lungs in the routine assessment of various diseases.
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Affiliation(s)
- Lena Wucherpfennig
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Hans-Ulrich Kauczor
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Monika Eichinger
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland
| | - Mark O Wielpütz
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
- Klinik für Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland.
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Sousa C, Pasini RA, Pasqualotto A, Marchiori E, Altmayer S, Irion K, Mançano A, Hochhegger B. Imaging Findings in Aspergillosis: From Head to Toe. Mycopathologia 2023; 188:623-641. [PMID: 37380874 DOI: 10.1007/s11046-023-00766-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Abstract
Aspergillosis is a mycotic infection induced by airborne fungi that are ubiquitous. Inhalation of Aspergillus conidia results in transmission through the respiratory tract. The clinical presentation is dependent on organism and host specifics, with immunodeficiency, allergies, and preexisting pulmonary disease constituting the most important risk factors. In recent decades, the incidence of fungal infections has increased dramatically, due in part to the increased number of transplants and the pervasive use of chemotherapy and immunosuppressive drugs. The spectrum of clinical manifestations can range from an asymptomatic or mild infection to a swiftly progressive, life-threatening illness. Additionally, invasive infections can migrate to extrapulmonary sites, causing infections in distant organs. Recognition and familiarity with the various radiological findings in the appropriate clinical context are essential for patient management and the prompt initiation of life-saving treatment. We discuss the radiological characteristics of chronic and invasive pulmonary aspergillosis, as well as some of the typically unexpected extrapulmonary manifestations of disseminated disease.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Alessandro Pasqualotto
- Radiology Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Edson Marchiori
- Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Klaus Irion
- Radiology Department, University of Florida, Gainesville, FL, USA
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida, Gainesville, FL, USA.
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Ankrah AO, Lawal IO, Dierckx RAJO, Sathekge MM, Glaudemans AWJM. Imaging of Invasive Fungal Infections- The Role of PET/CT. Semin Nucl Med 2023; 53:57-69. [PMID: 35933165 DOI: 10.1053/j.semnuclmed.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023]
Abstract
Over the last decades, the population at risk for invasive fungal disease (IFD) has increased because of medical therapy advances and diseases compromising patients' immune systems. The high morbidity and mortality associated with invasive fungal disease in the immunocompromised present the challenge of early diagnosis of the IFD and the need to closely monitor the infection during treatment. The definitive diagnosis of invasive fungal disease based on culture or histopathological methods often has reduced diagnostic accuracy in the immunocompromised and may be very invasive. Less invasive and indirect evidence of the fungal infection by serology and imaging has been used for the early diagnosis of fungal infection before definitive results are available or when the definitive methods of diagnosis are suboptimal. Imaging in invasive fungal disease is a non-invasive biomarker that helps in the early diagnosis of invasive fungal disease but helps follow-up the infection during treatment. Different imaging modalities are used in the workup to evaluate fungal disease. The different imaging modalities have advantages and disadvantages at different sites in the body and may complement each other in the management of IFD. Positron emission tomography integrated with computed tomography with [18F]Fluorodeoxyglucose (FDG PET/CT) has helped manage IFD. The combined functional data from PET and anatomical data from the CT from almost the whole body allows noninvasive evaluation of IFD and provides a semiquantitative means of assessing therapy. FDG PET/CT adds value to anatomic-based only imaging modalities. The nonspecificity of FDG uptake has led to the evaluation of other tracers in the assessment of IFD. However, these are mainly still at the preclinical level and are yet to be translated to humans. FDG PET/CT remains the most widely evaluated radionuclide-based imaging modality in IFD management. The limitations of FDG PET/CT must be well understood, and more extensive prospective studies in uniform populations are needed to validate its role in the management of IFD that can be international guidelines.
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Affiliation(s)
- Alfred O Ankrah
- National Centre for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra GA, Ghana; Department of Nuclear Medicine, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa; Medical Imaging Center, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands.
| | - Ismaheel O Lawal
- Department of Nuclear Medicine, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa; Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - Rudi A J O Dierckx
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Andor W J M Glaudemans
- Medical Imaging Center, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands
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5
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Bayraktaroğlu S, Çinkooğlu A, Tunakan Dalgıç C, Boğatekin G, Uysal FE, Ardeniz Ö. Comparison of chest computed tomography and 3-T magnetic resonance imaging results in patients with common variable immunodeficiency. Acta Radiol 2022; 64:1841-1850. [PMID: 36537132 DOI: 10.1177/02841851221144249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Patients with common variable immunodeficiency (CVID) have an increased incidence of pulmonary infections and require frequent follow-up computed tomography (CT) scans. Purpose To evaluate the diagnostic performance of 3-T magnetic resonance imaging (MRI) in patients with CVID. Material and Methods In this prospective study, 3-T MRI was performed in 20 patients with CVID. The patients were imaged with CT and MRI scans on the same day. The MRI protocol included a T2-weighted HASTE sequence (TR=1400 ms, TE=95 ms, slice thickness (ST)=3 mm), T2-weighted BLADE sequence (TR=5379 ms, TE=100 ms, ST=3 mm), and 3D VIBE sequence (TR=3.9 ms, TE=1.32 ms, ST=3 mm). Mediastinal and parenchymal changes were compared. A modified Bhalla scoring system was used in the evaluation of CT and MRI scans. Results A total of 17 (85%) patients had parenchymal abnormalities identified by CT or MRI. Similar findings were detected with CT and MRI in the assessment of the severity of bronchiectasis ( P=0.083), bronchial wall thickening ( P=0.157), and mucus plugging ( P=0.250). Consolidations were detected with both modalities in all patients. There was excellent concordance between the two modalities in the evaluation of nodules >5 mm (nodule size 5–10 mm, P=0.317; nodule size >10 mm, P=1). However, MRI failed to detect most of the small nodules (<5 mm). Conclusion 3-T MRI detected mediastinal and parenchymal alterations in patients with CVID and provided findings that correlated well with CT. Despite a few limitations, MRI is a well-suited radiation-free technique for patients requiring longitudinal imaging.
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Affiliation(s)
- Selen Bayraktaroğlu
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Akın Çinkooğlu
- Department of Radiology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Ceyda Tunakan Dalgıç
- Department of Allergy and Immunology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Gülhan Boğatekin
- Department of Allergy and Immunology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Funda Elmas Uysal
- Department of Respiratory Medicine, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
| | - Ömür Ardeniz
- Department of Allergy and Immunology, Ege University Faculty of Medicine, Bornova, Izmir, Turkey
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Capaccione KM, Valiplackal JP, Huang A, Roa T, Fruauff A, Liou C, Kim E, Khurana S, Maher M, Ma H, Ngyuen P, Mak S, Dumeer S, Lala S, D'souza B, Laifer-Narin S, Desperito E, Ruzal-Shapiro C, Salvatore MM. Checkpoint Inhibitor Immune-Related Adverse Events: A Multimodality Pictorial Review. Acad Radiol 2022; 29:1869-1884. [PMID: 35382975 DOI: 10.1016/j.acra.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/07/2023]
Abstract
Cancer immunotherapies are drugs that modulate the body's own immune system as an anticancer strategy. Checkpoint inhibitor immunotherapies interfere with cell surface binding proteins that function to promote self-recognition and tolerance, ultimately leading to upregulation of the immune response. Given the striking success of these agents in early trials in melanoma and lung cancer, they have now been studied in many types of cancer and have become a pillar of anticancer therapy for many tumor types. However, abundant upregulation results in a new class of side effects, known as immune-related adverse events (IRAEs). It is critical for the practicing radiologist to be able to recognize these events to best contribute to care for patients on checkpoint inhibitor immunotherapy. Here, we provide a comprehensive system-based review of immune-related adverse events and associated imaging findings. Further, we detail the best imaging modalities for each as well as describe problem solving modalities. Given that IRAEs can be subclinical before becoming clinically apparent, radiologists may be the first provider to recognize them, providing an opportunity for early treatment. Awareness of IRAEs and how to best image them will prepare radiologists to make a meaningful contribution to patient care as part of the clinical team.
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Affiliation(s)
- Kathleen M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032.
| | - Jacienta P Valiplackal
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Alice Huang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Tina Roa
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Alana Fruauff
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Connie Liou
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Eleanor Kim
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Sakshi Khurana
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Mary Maher
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hong Ma
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Pamela Ngyuen
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Serena Mak
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Shifali Dumeer
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Sonali Lala
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Belinda D'souza
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Sherelle Laifer-Narin
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Carrie Ruzal-Shapiro
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
| | - Mary M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168(th) Street, New York, New York, 10032
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Pushparaj TL, Irudaya Raj EF, Irudaya Rani EF. A detailed review of contrast-enhanced fluorescence magnetic resonance imaging techniques for earlier prediction and easy detection of COVID-19. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2022. [DOI: 10.1080/21681163.2022.2144762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - E. Fantin Irudaya Raj
- Department of Electrical and Electronics Engineering, Dr. Sivanthi Aditanar College of Engineering, India
| | - E. Francy Irudaya Rani
- Department of Electronics and Communication Engineering, Francis Xavier Engineering College, India
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8
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Feng H, Shi G, Liu H, Xu Q, Wang L, Zhang N. The Application and Value of 3T Magnetic Resonance Imaging in the Display of Pulmonary Nodules. Front Oncol 2022; 12:844514. [PMID: 35664742 PMCID: PMC9157594 DOI: 10.3389/fonc.2022.844514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study was to evaluate the sensitivity and accuracy of multi-sequence 3T magnetic resonance imaging (MRI) in the detection of different types of pulmonary nodules. Methods A total of 68 patients with pulmonary nodules identified using computed tomography (CT) subsequently underwent MRI. Using CT images with a slice thickness of 1 mm as the gold standard, the sensitivity of three MRI sequences in detecting different types of pulmonary nodules was calculated, and the image quality was also evaluated. Nodule types included solid nodules, ground glass nodules (GGN), and part-solid nodules (PSN). Statistical analyses of data were conducted using the software SPSS 21.0. The intra-class correlation coefficient was calculated in order to compare the consistency of nodule size in both MRI and CT. Results CT detected 188 pulmonary nodules in 68 patients, including 87 solid nodules and 101 sub-solid nodules, the latter comprising 46 PSNs and 55 GGNs. The average nodule diameter was approximately 7.7 mm. The sensitivity of MRI in detecting nodules ≥ 6 mm in diameter and those of > 8 mm in diameter was 92% and 100%, respectively, and the sequence with the highest detection rate was T2-BLADE. In relation to solid nodules, the sequence with the highest detection rate was T1 Star-VIBE, while the T2-BLADE sequence demonstrated the highest detection rate of sub-solid nodules. The image quality of the T1 Star-VIBE sequence was better than that of both the T2-HASTE and the T2-BLADE sequences. The consistency of CT and MRI sequences for nodule size was high with a consistency coefficient of 0.94–0.98. Conclusion The detection rate of MRI for nodules with a diameter of > 8 mm was 100%. The T2-BLADE sequence had the highest detection sensitivity. The sequence with the best image quality was the T1 Star-VIBE.
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Affiliation(s)
- Hui Feng
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gaofeng Shi
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Liu
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Xu
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lijia Wang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Zhang
- Department of Radiology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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Metz C, Böckle D, Heidenreich JF, Weng AM, Benkert T, Grigoleit GU, Bley T, Köstler H, Veldhoen S. Pulmonary Imaging of Immunocompromised Patients during Hematopoietic Stem Cell Transplantation using Non-Contrast-Enhanced Three-Dimensional Ultrashort Echo Time (3D-UTE) MRI. ROFO-FORTSCHR RONTG 2021; 194:39-48. [PMID: 34649285 DOI: 10.1055/a-1535-2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the feasibility of non-contrast-enhanced three-dimensional ultrashort echo time (3D-UTE) MRI for pulmonary imaging in immunocompromised patients during hematopoietic stem cell transplantation (HSCT). METHODS MRI was performed using a stack-of-spirals 3D-UTE sequence (slice thickness: 2.34mm; matrix: 256 × 256; acquisition time: 12.7-17.6 seconds) enabling imaging of the entire thorax within single breath-holds. Patients underwent MRI before HSCT initiation, in the case of periprocedural pneumonia, before discharge, and in the case of re-hospitalization. Two readers separately assessed the images regarding presence of pleural effusions, ground glass opacities (GGO), and consolidations on a per lung basis. A T2-weighted (T2w) multi-shot Turbo Spin Echo sequence (BLADE) was acquired in coronal orientation during breath-hold (slice thickness: 6.00mm; matrix: 320 × 320; acquisition time: 3.1-5.5 min) and read on a per lesion basis. Low-dose CT scans in inspiration were used as reference and were read on a per lung basis. Only scans performed within a maximum of three days were included in the inter-method analyses. Interrater agreement, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of 3D-UTE MRI were calculated. RESULTS 67 MRI scans of 28 patients were acquired. A reference CT examination was available for 33 scans of 23 patients. 3D-UTE MRI showed high sensitivity and specificity regarding pleural effusions (n = 6; sensitivity, 92 %; specificity, 100 %) and consolidations (n = 22; sensitivity 98 %, specificity, 86 %). Diagnostic performance was lower for GGO (n = 9; sensitivity, 63 %; specificity, 84 %). Accuracy rates were high (pleural effusions, 98 %; GGO, 79 %; consolidations 94 %). Interrater agreement was substantial for consolidations and pleural effusions (κ = 0.69-0.82) and moderate for GGO (κ = 0.54). Compared to T2w imaging, 3D-UTE MRI depicted the assessed pathologies with at least equivalent quality and was rated superior regarding consolidations and GGO in ~50 %. CONCLUSION Non-contrast 3D-UTE MRI enables radiation-free assessment of typical pulmonary complications during HSCT procedure within a single breath-hold. Yet, CT was found to be superior regarding the identification of pure GGO changes. KEY POINTS · 3D-UTE MRI of the thorax can be acquired within a single breath-hold.. · 3D-UTE MRI provides diagnostic imaging of pulmonary consolidations and pleural effusions.. · 3D-UTE sequences improve detection rates of ground glass opacities on pulmonary MRI.. · 3D-UTE MRI depicts pulmonary pathologies at least equivalent to T2-weighted Blade sequence.. CITATION FORMAT · Metz C, Böckle D, Heidenreich JF et al. Pulmonary Imaging of Immunocompromised Patients during Hematopoietic Stem Cell Transplantation using Non-Contrast-Enhanced Three-Dimensional Ultrashort Echo Time (3D-UTE) MRI. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1535-2341.
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Affiliation(s)
- Corona Metz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany
| | - David Böckle
- Department of Internal Medicine II (Hematology and Oncology), University Hospital of Würzburg, Germany
| | | | - Andreas Max Weng
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany
| | - Thomas Benkert
- Application Development, Siemens Healthcare GmbH, Erlangen, Germany
| | - Götz Ulrich Grigoleit
- Department of Internal Medicine II (Hematology and Oncology), University Hospital of Würzburg, Germany
| | - Thorsten Bley
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany
| | - Simon Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Germany
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10
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Campbell-Washburn AE, Malayeri AA, Jones EC, Moss J, Fennelly KP, Olivier KN, Chen MY. T2-weighted Lung Imaging Using a 0.55-T MRI System. Radiol Cardiothorac Imaging 2021; 3:e200611. [PMID: 34250492 DOI: 10.1148/ryct.2021200611] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023]
Abstract
Purpose To assess a 0.55-T MRI system for imaging lung disease and to compare image quality with clinical CT scans. Materials and Methods In this prospective study conducted between November 2018 and December 2019, respiratory-triggered T2-weighted turbo spin-echo MRI at 0.55 T was compared with clinical CT scans in 24 participants (mean age, 59 years ± 16 [standard deviation]; 18 women) with common lung abnormalities. MR images were reviewed and scored by experienced readers. Abnormal findings identified with MRI and CT were compared using the Cohen κ statistic. Results High-quality structural pulmonary MR images were attained with an average acquisition time of 11 minutes ± 3. MRI generated sufficient image quality to robustly detect bronchiectasis (κ = 0.61), consolidative opacities (κ = 1.00), cavitary lesions (κ = 1.00), effusion (κ = 0.64), mucus plug (κ = 0.68), and solid scattered nodularity (κ = 0.82). Diffuse disease, including ground-glass opacities (κ = 0.57) and tree-in-bud nodules (κ = 0.48), were the findings that were most difficult to discern using MRI, with false readings in four of 18 patients for each feature. Nodule size, which was measured independently at CT and MRI, was strongly correlated (R 2 = 0.99) for nodules with a measurement of 10 mm ± 5 (range, 5-23 mm). Conclusion This initial study indicates that high-performance 0.55-T MRI holds promise in the evaluation of common lung disease.Clinical trials registration no. NCT03331380Supplemental material is available for this article. Keywords: MRI, Pulmonary, Technology Assessment© RSNA, 2021.
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Affiliation(s)
- Adrienne E Campbell-Washburn
- Cardiovascular (A.E.C.W., M.Y.C.) and Pulmonary (J.M., K.P.F., K.N.O.) Branches, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Building 10, Room BID-47, 10 Center Dr, Bethesda, MD 20892; and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.A.M., E.C.J.)
| | - Ashkan A Malayeri
- Cardiovascular (A.E.C.W., M.Y.C.) and Pulmonary (J.M., K.P.F., K.N.O.) Branches, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Building 10, Room BID-47, 10 Center Dr, Bethesda, MD 20892; and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.A.M., E.C.J.)
| | - Elizabeth C Jones
- Cardiovascular (A.E.C.W., M.Y.C.) and Pulmonary (J.M., K.P.F., K.N.O.) Branches, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Building 10, Room BID-47, 10 Center Dr, Bethesda, MD 20892; and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.A.M., E.C.J.)
| | - Joel Moss
- Cardiovascular (A.E.C.W., M.Y.C.) and Pulmonary (J.M., K.P.F., K.N.O.) Branches, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Building 10, Room BID-47, 10 Center Dr, Bethesda, MD 20892; and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.A.M., E.C.J.)
| | - Kevin P Fennelly
- Cardiovascular (A.E.C.W., M.Y.C.) and Pulmonary (J.M., K.P.F., K.N.O.) Branches, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Building 10, Room BID-47, 10 Center Dr, Bethesda, MD 20892; and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.A.M., E.C.J.)
| | - Kenneth N Olivier
- Cardiovascular (A.E.C.W., M.Y.C.) and Pulmonary (J.M., K.P.F., K.N.O.) Branches, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Building 10, Room BID-47, 10 Center Dr, Bethesda, MD 20892; and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.A.M., E.C.J.)
| | - Marcus Y Chen
- Cardiovascular (A.E.C.W., M.Y.C.) and Pulmonary (J.M., K.P.F., K.N.O.) Branches, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Building 10, Room BID-47, 10 Center Dr, Bethesda, MD 20892; and Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.A.M., E.C.J.)
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11
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Alexander BD, Lamoth F, Heussel CP, Prokop CS, Desai SR, Morrissey CO, Baddley JW. Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC. Clin Infect Dis 2021; 72:S79-S88. [PMID: 33709131 DOI: 10.1093/cid/ciaa1855] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clinical imaging in suspected invasive fungal disease (IFD) has a significant role in early detection of disease and helps direct further testing and treatment. Revised definitions of IFD from the EORTC/MSGERC were recently published and provide clarity on the role of imaging for the definition of IFD. Here, we provide evidence to support these revised diagnostic guidelines. METHODS We reviewed data on imaging modalities and techniques used to characterize IFDs. RESULTS Volumetric high-resolution computed tomography (CT) is the method of choice for lung imaging. Although no CT radiologic pattern is pathognomonic of IFD, the halo sign, in the appropriate clinical setting, is highly suggestive of invasive pulmonary aspergillosis (IPA) and associated with specific stages of the disease. The ACS is not specific for IFD and occurs in the later stages of infection. By contrast, the reversed halo sign and the hypodense sign are typical of pulmonary mucormycosis but occur less frequently. In noncancer populations, both invasive pulmonary aspergillosis and mucormycosis are associated with "atypical" nonnodular presentations, including consolidation and ground-glass opacities. CONCLUSIONS A uniform definition of IFD could improve the quality of clinical studies and aid in differentiating IFD from other pathology in clinical practice. Radiologic assessment of the lung is an important component of the diagnostic work-up and management of IFD. Periodic review of imaging studies that characterize findings in patients with IFD will inform future diagnostic guidelines.
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Affiliation(s)
- Barbara D Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Frédéric Lamoth
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik gGmbH, Heidelberg, Germany.,Translational Lung Research Centre Heidelberg, Member of the German Centre for Lung Research.,Diagnostic and Interventional Radiology, Ruprecht-Karls-University, Heidelberg, Germany
| | | | - Sujal R Desai
- Department of Radiology, Royal Brompton and Harefield National Health Service Foundation Trust, London and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - John W Baddley
- Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland, USA
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12
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Vasilev YA, Sergunova KA, Bazhin AV, Masri AG, Vasileva YN, Semenov DS, Kudryavtsev ND, Panina OY, Khoruzhaya AN, Zinchenko VV, Akhmad ES, Petraikin AV, Vladzymyrskyy AV, Midaev AV, Morozov SP. Chest MRI of patients with COVID-19. Magn Reson Imaging 2021; 79:13-19. [PMID: 33727149 PMCID: PMC7955570 DOI: 10.1016/j.mri.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022]
Abstract
During the pandemic of novel coronavirus infection (COVID-19), computed tomography (CT) showed its effectiveness in diagnosis of coronavirus infection. However, ionizing radiation during CT studies causes concern for patients who require dynamic observation, as well as for examination of children and young people. For this retrospective study, we included 15 suspected for COVID-19 patients who were hospitalized in April 2020, Russia. There were 4 adults with positive polymerase chain reaction (PCR) test for COVID-19. All patients underwent magnetic resonance imaging (MRI) examinations using MR-LUND PROTOCOL: Single-shot Fast Spin Echo (SSFSE), LAVA 3D and IDEAL 3D, Echo-planar imaging (EPI) diffusion-weighted imaging (DWI) and Fast Spin Echo (FSE) T2 weighted imaging (T2WI). On T2WI changes were identified in 9 (60,0%) patients, on DWI - in 5 (33,3%) patients. In 5 (33,3%) patients lesions of the parenchyma were visualized on T2WI and DWI simultaneously. At the same time, 4 (26.7%) patients had changes in lung tissue only on T2WI. (P(McNemar) = 0,125; OR = 0,00 (95%); kappa = 0,500). In those patients who had CT scan, the changes were comparable to MRI. The results showed that in case of CT is not available, it is advisable to conduct a chest MRI for patients with suspected or confirmed COVID-19. Considering that T2WI is a fluid-sensitive sequence, if imaging for the lung infiltration is required, we can recommend the abbreviated MRI protocol consisting of T2 and T1 WI. These data may be applicable for interpreting other studies, such as thoracic spine MRI, detecting signs of viral pneumonia of asymptomatic patients. MRI can detect features of viral pneumonia.
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Affiliation(s)
- Yu A Vasilev
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia
| | - K A Sergunova
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A V Bazhin
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A G Masri
- Imed Clinic, Grozny, Chechen Republic, Russia.
| | - Yu N Vasileva
- A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
| | - D S Semenov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - N D Kudryavtsev
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - O Yu Panina
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A N Khoruzhaya
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - V V Zinchenko
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - E S Akhmad
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A V Petraikin
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A V Vladzymyrskyy
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
| | - A V Midaev
- Imed Clinic, Grozny, Chechen Republic, Russia.
| | - S P Morozov
- Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Healthcare Department, Moscow, Russia.
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13
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Sanguinetti M, Posteraro B, Beigelman-Aubry C, Lamoth F, Dunet V, Slavin M, Richardson MD. Diagnosis and treatment of invasive fungal infections: looking ahead. J Antimicrob Chemother 2020; 74:ii27-ii37. [PMID: 31222314 DOI: 10.1093/jac/dkz041] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Improved standards of care depend on the development of new laboratory diagnostic and imaging procedures and the development of new antifungal compounds. Immunochromatography technologies have led to the development of lateral flow devices for the diagnosis of cryptococcal meningitis and invasive aspergillosis (IA). Similar devices are being developed for the detection of histoplasmosis that meet the requirements for speed (∼15 min assay time) and ease of use for point-of-care diagnostics. The evolution of molecular tools for the detection of fungal pathogens has been slow but the introduction of new nucleic acid amplification techniques appears to be helpful, for example T2Candida. An Aspergillus proximity ligation assay has been developed for a rapid near-patient bedside diagnosis of IA. CT remains the cornerstone for radiological diagnosis of invasive pulmonary fungal infections. MRI of the lungs may be performed to avoid radiation exposure. MRI with T2-weighted turbo-spin-echo sequences exhibits sensitivity and specificity approaching that of CT for the diagnosis of invasive pulmonary aspergillosis. The final part of this review looks at new approaches to drug discovery that have yielded new classes with novel mechanisms of action. There are currently two new classes of antifungal drugs in Phase 2 study for systemic invasive fungal disease and one in Phase 1. These new antifungal drugs show promise in meeting unmet needs with oral and intravenous formulations available and some with decreased potential for drug-drug interactions. Novel mechanisms of action mean these agents are not susceptible to the common resistance mechanisms seen in Candida or Aspergillus. Modification of existing antifungal susceptibility testing techniques may be required to incorporate these new compounds.
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Affiliation(s)
- Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brunella Posteraro
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,Istituto di Patologia Medica e Semeiotica Medica, Università Cattolica del Sacro Cuore Rome, Italy
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratory Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Monica Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Malcolm D Richardson
- Mycology Reference Centre Manchester, ECMM Excellence Centre of Medical Mycology, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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14
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Konietzke P, Mueller J, Wuennemann F, Wagner WL, Schenk JP, Alrajab A, Kauczor HU, Stahl M, Mall MA, Wielpütz MO, Sommerburg O. The value of chest magnetic resonance imaging compared to chest radiographs with and without additional lung ultrasound in children with complicated pneumonia. PLoS One 2020; 15:e0230252. [PMID: 32191736 PMCID: PMC7082029 DOI: 10.1371/journal.pone.0230252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/25/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction In children with pneumonia, chest x-ray (CXR) is typically the first imaging modality used for diagnostic work-up. Repeated CXR or computed tomography (CT) are often necessary if complications such as abscesses or empyema arise, thus increasing radiation exposure. The aim of this retrospective study was to evaluate the potential of radiation-free chest magnetic resonance imaging (MRI) to detect complications at baseline and follow-up, compared to CXR with and without additional lung ultrasound (LUS). Methods Paired MRI and CXR scans were retrospectively reviewed by two blinded readers for presence and severity of pulmonary abscess, consolidation, bronchial wall thickening, mucus plugging and pleural effusion/empyema using a chest MRI scoring system. The scores for MRI and CXR were compared at baseline and follow-up. Furthermore, the MRI scores at baseline with and without contrast media were evaluated. Results 33 pediatric patients (6.3±4.6 years), who had 33 paired MRI and CXR scans at baseline and 12 at follow-up were included. MRI detected significantly more lung abscess formations with a prevalence of 72.7% compared to 27.3% by CXR at baseline (p = 0.001), whereas CXR+LUS was nearly as good as MRI. MRI also showed a higher sensitivity in detecting empyema (p = 0.003). At follow-up, MRI also showed a slightly better sensitivity regarding residual abscesses. The overall severity of disease was rated higher on MRI. Contrast material did not improve detection of abscesses or empyema by MRI. Conclusion CXR and LUS seem to be sufficient in most cases. In cases where LUS cannot be realized or the combination of CXR+LUS might be not sufficient, MRI, as a radiation free modality, should be preferred to CT. Furthermore, the admission of contrast media is not mandatory in this context.
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Affiliation(s)
- Philip Konietzke
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Jan Mueller
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Felix Wuennemann
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Willi L. Wagner
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Jens-Peter Schenk
- Department of Diagnostic and Interventional Radiology, Section Pediatric Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Abdulsattar Alrajab
- Department of Diagnostic and Interventional Radiology, Section Pediatric Radiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Mirjam Stahl
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Translational Pulmonology and Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Marcus A. Mall
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Translational Pulmonology and Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Olaf Sommerburg
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Translational Pulmonology and Division of Pediatric Pulmonology & Allergy and Cystic Fibrosis Center, University Hospital of Heidelberg, Heidelberg, Germany
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15
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Diagnostic accuracy of magnetic resonance imaging in the evaluation of pulmonary infections in immunocompromised patients. Pol J Radiol 2020; 85:e53-e61. [PMID: 32180855 PMCID: PMC7064014 DOI: 10.5114/pjr.2020.93258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/17/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the accuracy of magnetic resonance imaging (MRI) for diagnosing pulmonary infections in immunocompromised adults. Material and methods Computed tomography (CT) and MRI chest were performed in 35 immuno-compromised patients suspected of pulmonary infection. The MRI sequences that were performed included axial and coronal T2 half-Fourier acquisition single-shot turbo spin-echo (HASTE), spectrally attenuated inversion recovery (SPAIR), true fast imaging with steady-state free precession (TRUFI), and three-dimensional fast low angle shot (3D FLASH) using breath-hold and respiratory triggered BLADE (proprietary name for periodically rotated overlapping parallel lines with enhanced reconstruction). The presence of nodules, consolidations, and ground-glass opacities was evaluated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for MRI using CT scan as a reference standard. Results The sensitivity of MRI in nodule detection was 50% overall and 75% for nodules measuring more than 5 mm. Consolidation was detected with 100% sensitivity. Sensitivity and PPV for the detection of ground-glass opacities (GGOs) were 77.7% and 53.8%, respectively. T2 HASTE axial had the fewest image artefacts. Respiratory triggered MR pulse sequence did not add any significant diagnostic information as compared to the non-respiratory triggered MR pulse sequences. Conclusions Sensitivity for detecting small nodules and GGOs on MR is poor; CT scan remains the imaging modality of choice for the evaluation of pulmonary infections in immunocompromised patients. However, MRI can be used in the follow-up imaging of these patients.
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16
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Rana P, Sodhi KS, Bhatia A, Saxena AK, Suri D, Singh S. Diagnostic accuracy of 3-T lung magnetic resonance imaging in human immunodeficiency virus-positive children. Pediatr Radiol 2020; 50:38-45. [PMID: 31520121 DOI: 10.1007/s00247-019-04523-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 07/11/2019] [Accepted: 09/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND More than 70% of human immunodeficiency virus (HIV)-positive children sustain respiratory diseases in their lifetime. Imaging plays an important role in establishing early and correct diagnosis. OBJECTIVE To evaluate the diagnostic accuracy of 3-Tesla (T) thorax MRI in HIV-positive children, using chest CT as the gold standard. MATERIALS AND METHODS We included 25 children with confirmed HIV-positive status and pulmonary complaints who were referred for chest CT. All children had 3-T thorax MRI using T2-W turbo spin-echo sequence, steady-state free precession gradient echo sequence, T2-W turbo spin-echo MultiVane XD sequence, and T1-weighted modified Dixon sequences. We evaluated the images for various pulmonary and mediastinal findings and calculated the sensitivity and specificity of 3-T thoracic MRI. RESULTS Sensitivity of 3-T MRI was 100% for detecting nodules >4 mm (95% confidence interval [CI] 66.3-100%), pleural effusion (CI 29.2-100%) and lymphadenopathy (CI 81.5-100%). It demonstrated a specificity of 100% for nodules >4 mm (CI 79.4-100%), pleural effusion (CI 84.6-100%) and lymphadenopathy (CI 59-100%). For consolidation/collapse, sensitivity and specificity were 93.8% (CI 69.8-99.8%) and 88.9% (CI 51.8-99.7%), respectively. The sensitivity and specificity for detecting bronchiectasis were 75% (CI 42.8-94.5%) and 100% (CI 75.3-100%), respectively, while for ground-glass opacity, sensitivity and specificity were 75% (CI 34.9-96.8%) and 94.1% (CI 71.3-99.9%), respectively. Nodules <4 mm were not well detected on MRI, with sensitivity of 35% (CI 15.4-59.2%). CONCLUSION Thoracic MRI at 3 T demonstrates a high sensitivity and specificity for detecting nodules >4 mm, effusion and lymphadenopathy in HIV-positive children.
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Affiliation(s)
- Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
| | - Anmol Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Akshay Kumar Saxena
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Deepti Suri
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Surjit Singh
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
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17
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Zeng J, Liu Z, Shen G, Zhang Y, Li L, Wu Z, Luo D, Gu Q, Mao H, Wang L. MRI evaluation of pulmonary lesions and lung tissue changes induced by tuberculosis. Int J Infect Dis 2019; 82:138-146. [PMID: 30872041 DOI: 10.1016/j.ijid.2019.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the utility of magnetic resonance imaging (MRI) with an advanced motion correction technique in characterizing lung tissue changes and lesions induced by pulmonary tuberculosis (TB). METHODS Sixty-three subjects with computed tomography (CT) features of pulmonary TB underwent lung MRI. All subjects with pulmonary TB were confirmed by acid-fast bacillus (AFB) testing or the detection of Mycobacterium tuberculosis. T2-weighted turbo spin echo (TSE) sequence MRI with the MultiVane motion correction technique was used to image the lungs. Routine lung CT images were obtained as reference. MRI and CT images were reviewed by multiple readers independently. The performance of MRI in depicting abnormalities induced by pulmonary TB and their morphological changes were evaluated and compared with the performance of CT. RESULTS Lung MRI found pulmonary abnormalities in all 63 TB subjects, with satisfactory quality. With the implementation of MultiVane for T2-weighted TSE sequences to reduce the motion correction effect, MRI showed excellent agreement with CT in detecting abnormal imaging features of pulmonary TB (κ=0.88, p<0.001), such as tree-in-bud sign, ground-glass opacity, consolidation, mass, and cavitation. MRI was advantageous in identifying caseation and liquefactive necrosis based on inhomogeneous signal distribution within consolidations and also in identifying mild pleural effusion. The optimized lung MRI was comparable to CT in detecting non-calcified nodules (κ=0.90), with overall sensitivity of 50.0%, 91.1%, and 100% for nodules of size <5 mm, 5-10 mm, and >10 mm, respectively. However, MRI was less effective in identifying lesions with calcification. CONCLUSIONS The clinical implementation of an optimized MRI protocol with the MultiVane motion correction technique for imaging pulmonary TB is feasible. Lung MRI without ionizing radiation is a promising alternative to the clinical standard CT, especially for pregnant women, children, adolescents, and patients requiring short-term and repeated follow-up observations.
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Affiliation(s)
- Jianbing Zeng
- Department of Radiology, The People's Hospital of Longhua, Shenzhen, Southern Medical University, Guangdong, China
| | - Zhou Liu
- Graduate School, Medical College of Nanchang University, Nanchang, Jiangxi, China; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA; Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Guanle Shen
- Department of Respiratory, People's Hospital of Longhua, Shenzhen, Guangdong, China
| | - Yuzhong Zhang
- Department of Radiology, The People's Hospital of Longhua, Shenzhen, Southern Medical University, Guangdong, China
| | - Li Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zhiqing Wu
- Department of Radiology, The People's Hospital of Longhua, Shenzhen, Southern Medical University, Guangdong, China
| | - Dehong Luo
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Qingping Gu
- Department of Marketing, Philips Medical Systems Greater China, China
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Liya Wang
- Department of Radiology, The People's Hospital of Longhua, Shenzhen, Southern Medical University, Guangdong, China; Graduate School, Medical College of Nanchang University, Nanchang, Jiangxi, China; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
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18
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Evaluation of 3 T lung magnetic resonance imaging in children with allergic bronchopulmonary aspergillosis: Pilot study. Eur J Radiol 2019; 111:88-92. [DOI: 10.1016/j.ejrad.2018.12.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/24/2018] [Accepted: 12/28/2018] [Indexed: 11/21/2022]
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19
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Lamoth F, Calandra T. Early diagnosis of invasive mould infections and disease. J Antimicrob Chemother 2017; 72:i19-i28. [PMID: 28355464 DOI: 10.1093/jac/dkx030] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Invasive mould infections (IMIs), such as invasive aspergillosis or mucormycosis, are a major cause of death in patients with haematological cancer and in patients receiving long-term immunosuppressive therapy. Early diagnosis and prompt initiation of antifungal therapy are crucial steps in the management of patients with IMI. The diagnosis of IMI remains a major challenge, with an increased spectrum of fungal pathogens and a diversity of clinical and radiological presentations within the expanding spectrum of immunocompromised hosts. Diagnosis is difficult to establish and is expressed on a scale of probability (proven, probable and possible). Imaging (CT scan), microbiological tools (direct examination, culture, PCR, fungal biomarkers) and histopathology are the pillars of the diagnostic work-up of IMI. None of the currently available diagnostic tests provides sufficient sensitivity and specificity alone, so the optimal approach relies on a combination of multiple diagnostic strategies, including imaging, fungal biomarkers (galactomannan and 1,3-β-d-glucan) and molecular tools. In recent years, the development of PCR for filamentous fungi (primarily Aspergillus or Mucorales) and the progress made in the standardization of fungal PCR technology, may lead to future advances in the field. The appropriate diagnostic approach for IMI should be individualized to each centre, taking into account the local epidemiology of IMI and the availability of diagnostic tests.
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Affiliation(s)
- Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.,Institute of Microbiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Ekinci A, Yücel Uçarkuş T, Okur A, Öztürk M, Doğan S. MRI of pneumonia in immunocompromised patients: comparison with CT. Diagn Interv Radiol 2017; 23:22-28. [PMID: 27641778 DOI: 10.5152/dir.2016.16055] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Pneumonia is an important cause of mortality and morbidity in immunocompromised patients. Computed tomography (CT) is the most sensitive imaging modality for the diagnosis and surveillance of these patients. Since CT exposes the patient to ionizing radiation, we investigated the utility of magnetic resonance imaging (MRI) in the diagnosis and surveillance of immunocompromised patients with pneumonia. METHODS The study included 40 immunocompromised patients with pneumonia documented on CT. The patients were examined by MRI within 48 hours of CT examination. All images were obtained with three different sequences: balanced fast field echo, T1-weighted turbo spin-echo (TSE), and T2-weighted TSE. Lung abnormalities were evaluated using CT and MRI. RESULTS Infection was determined in 36 patients (90%), while the causative organism remained unknown in four patients (10%). In all the patients, the CT findings were consistent with infection, although three patients showed no abnormal findings on MRI. CT was superior to MRI in the detection of the tree-in-bud nodules, centrilobular nodules, and halo sign (P < 0.001, for all). A significant difference was observed between the MRI sequences and CT in terms of the number of detected nodules (P < 0.001). The nodule detection rate of MRI significantly increased in proportion to the size of the nodule (P < 0.001). All MRI sequences had almost perfect agreement with CT for the detection of consolidation (к=0.950, P < 0.001), patchy increased density (к=1, P < 0.001), pleural effusion (к=0.870, P < 0.001), pericardial effusion (к=1, P < 0.001), reverse halo sign, (к=1 P < 0.001), 10-20 mm, nodules (к=0.896, P < 0.001 for CT and B-FFE; к=0.948, P < 0.001 for CT and T1- or T2-weighted imaging) 10-20 mm, >20 mm nodules (к=0.844, P < 0.001). CONCLUSION Although CT is superior to MRI in the diagnosis of pneumonia in immunocompromised patients, MRI is an important imaging modality that can be used, particularly in the follow-up of these patients, thus decreasing to avoid ionizing radiation exposure.
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Affiliation(s)
- Afra Ekinci
- Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey.
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21
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Ozcan HN, Gormez A, Ozsurekci Y, Karakaya J, Oguz B, Unal S, Cetin M, Ceyhan M, Haliloglu M. Magnetic resonance imaging of pulmonary infection in immunocompromised children: comparison with multidetector computed tomography. Pediatr Radiol 2017; 47:146-153. [PMID: 27796469 DOI: 10.1007/s00247-016-3729-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/28/2016] [Accepted: 10/07/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Computed tomography (CT) is commonly used to detect pulmonary infection in immunocompromised children. OBJECTIVE To compare MRI and multidetector CT findings of pulmonary abnormalities in immunocompromised children. MATERIALS AND METHODS Seventeen neutropaenic children (6 girls; ages 2-18 years) were included. Non-contrast-enhanced CT was performed with a 64-detector CT scanner. Axial and coronal non-enhanced thoracic MRI was performed using a 1.5-T scanner within 24 h of the CT examination (true fast imaging with steady-state free precession, fat-saturated T2-weighted turbo spin echo with motion correction, T2-weighted half-Fourier single-shot turbo spin echo [HASTE], fat-saturated T1-weighted spoiled gradient echo). Pulmonary abnormalities (nodules, consolidations, ground glass opacities, atelectasis, pleural effusion and lymph nodes) were evaluated and compared among MRI sequences and between MRI and CT. The relationship between MRI sequences and nodule sizes was examined by chi- square test. RESULTS Of 256 CT lesions, 207 (81%, 95% confidence interval [CI] 76-85%) were detected at MRI. Of 202 CT-detected nodules, 157 (78%, 95% CI 71-83%) were seen at motion-corrected MRI. Of the 1-5-mm nodules, 69% were detected by motion-corrected T2-weighted MRI and 38% by HASTE MRI. CONCLUSION Sensitivity of MRI (both axial fat-saturated T2-weighted turbo spin echo with variable phase encoding directions (BLADE) images and HASTE sequences) to detect pulmonary abnormalities is promising.
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Affiliation(s)
- H Nursun Ozcan
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Ayşegul Gormez
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Yasemin Ozsurekci
- Department of Pediatric Infectious Disease, Hacettepe University School of Medicine, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Berna Oguz
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Sule Unal
- Department of Pediatric Hematology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mualla Cetin
- Department of Pediatric Hematology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mehmet Ceyhan
- Department of Pediatric Infectious Disease, Hacettepe University School of Medicine, Ankara, Turkey
| | - Mithat Haliloglu
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey.
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Syrjala H, Broas M, Ohtonen P, Jartti A, Pääkkö E. Chest magnetic resonance imaging for pneumonia diagnosis in outpatients with lower respiratory tract infection. Eur Respir J 2017; 49:13993003.01303-2016. [PMID: 27811069 DOI: 10.1183/13993003.01303-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/26/2016] [Indexed: 11/05/2022]
Abstract
We assessed whether magnetic resonance imaging (MRI) is applicable for diagnosing pneumonia among adult outpatients with lower respiratory tract infection.Patients were recruited prospectively when they had symptoms for ≤7 days and fever ≥37.8 °C. The patients underwent high-resolution computed tomography (HRCT), MRI and chest radiography, which were repeated 1 month later if necessary, to verify pneumonia. The duration of MRI examination was 3-4 min.Among 77 patients, HRCT, MRI and radiography identified 32 (41.6%), 30 (39.0%) and 23 (29.9%) cases of pneumonia, respectively (p=0.001). MRI missed two HRCT-identified pneumonia cases due to motion artefacts. Chest radiography resulted in four false-positive pneumonia findings and MRI resulted in none. When HRCT was used as a reference, MRI had a sensitivity of 0.938 (95% CI 0.799-0.983) and specificity of 0.978 (95% CI 0.884-0.996) for the diagnosis of pneumonia, whereas the sensitivity and specificity for chest radiography were 0.719 (95% CI 0.546-0.844) and 0.911 (95% CI 0.793-0.965), respectively.MRI is an accurate, fast and effective method for diagnosing outpatient pneumonia, with better accuracy compared with chest radiography and almost similar accuracy compared with HRCT.
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Affiliation(s)
- Hannu Syrjala
- Dept of Infection Control, Oulu University Hospital, Oulu, Finland .,These authors contributed equally to this work
| | - Markku Broas
- Dept of Infection Control, Lapland Central Hospital, Rovaniemi, Finland.,These authors contributed equally to this work
| | - Pasi Ohtonen
- Dept of Anesthesiology, Oulu University Hospital, Oulu, Finland
| | - Airi Jartti
- Dept of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Eija Pääkkö
- Dept of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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23
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Pulmonary Infections: Pneumonia. MRI OF THE LUNG 2017. [PMCID: PMC7176241 DOI: 10.1007/174_2017_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The different appearances of pneumonia such as ill-defined nodules, ground-glass opacities, and consolidations can be easily detected and differentiated with MRI. Since very small nodules and calcifications are extremely challenging due to rather thick slices and loss of signal, MRI is highly recommended as a follow-up tool, to avoid repetitive investigations using ionizing radiation. With the sensitivity of T2-weighted sequences and the potential of contrast-enhanced T1-weighted sequences, important differential diagnostic considerations can be provided. Additionally, developing complications, such as pericardial or pleural effusions, empyema or lung abscess, are easily recognized. Current and future studies are to demonstrate that MRI is well suited as a monitoring and follow-up tool during and after therapy and compares favorably with CT or other imaging methods regarding sensitivity and specificity.
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24
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Screening for lung cancer: Does MRI have a role? Eur J Radiol 2017; 86:353-360. [DOI: 10.1016/j.ejrad.2016.09.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/15/2016] [Indexed: 12/17/2022]
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25
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Sodhi KS, Khandelwal N, Saxena AK, Bhatia A, Bansal D, Trehan A, Singh M, Agarwal R. Rapid lung MRI - paradigm shift in evaluation of febrile neutropenia in children with leukemia: a pilot study. Leuk Lymphoma 2016; 57:70-5. [PMID: 25907426 DOI: 10.3109/10428194.2015.1041389] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Immunocompromised children with hematological malignancies are at increased risk of developing potentially fatal pulmonary infections. Early detection and prompt treatment is critical to combat morbidity and mortality in these children. Twenty-six children with leukemia (age range: 5-13years) presenting with fever and neutropenia were included in this prospective study, which was approved by the institutional ethics committee. All patients underwent HRCT and MRI of the chest on the same day. The findings of HRCT and MRI were compared, with HRCT as the standard of reference. There was perfect agreement between MRI and CT examinations findings by kappa test (κ = 1). No significant difference was observed between the two modalities by the McNemar test (p > 0.05). Rapid lung MRI is technically feasible; has a high correlation, sensitivity and specificity to CT scan; and can emerge as the first line modality for the detection of pulmonary nodules in children with leukemia and persistent febrile neutropenia.
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Affiliation(s)
- Kushaljit Singh Sodhi
- a Department of Radio Diagnosis and Imaging , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Niranjan Khandelwal
- a Department of Radio Diagnosis and Imaging , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Akshay Kumar Saxena
- a Department of Radio Diagnosis and Imaging , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Anmol Bhatia
- a Department of Radio Diagnosis and Imaging , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Deepak Bansal
- b Department of Paediatrics , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Amita Trehan
- b Department of Paediatrics , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Meenu Singh
- b Department of Paediatrics , Post Graduate Institute of Medical Education and Research , Chandigarh , India
| | - Ritesh Agarwal
- c Department of Pulmonary Medicine , Post Graduate Institute of Medical Education and Research , Chandigarh , India
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Balbinot F, da Costa Batista Guedes Á, Nascimento DZ, Zampieri JF, Alves GRT, Marchiori E, Rubin AS, Hochhegger B. Advances in Imaging and Automated Quantification of Pulmonary Diseases in Non-neoplastic Diseases. Lung 2016; 194:871-879. [PMID: 27663257 DOI: 10.1007/s00408-016-9940-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/03/2016] [Indexed: 10/21/2022]
Abstract
Histological examination has always been the gold standard for the detection and quantification of lung remodeling. However, this method has some limitations regarding the invasiveness of tissue acquisition. Quantitative imaging methods enable the acquisition of valuable information on lung structure and function without the removal of tissue from the body; thus, they are useful for disease identification and follow-up. This article reviews the various quantitative imaging modalities used currently for the non-invasive study of chronic obstructive pulmonary disease, asthma, and interstitial lung diseases. Some promising computer-aided diagnosis methods are also described.
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Affiliation(s)
- Fernanda Balbinot
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil. .,, Rua Coronel Vicente, 451, Centro, Porto Alegre, RS, 90030041, Brazil. .,Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil.
| | - Álvaro da Costa Batista Guedes
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
| | - Douglas Zaione Nascimento
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
| | - Juliana Fischman Zampieri
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
| | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rua Thomaz Cameron, 43, Valparaíso, Petrópolis, RJ, 25685120, Brazil
| | - Adalberto Sperb Rubin
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
| | - Bruno Hochhegger
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
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Vallipuram J, Dhalla S, Bell CM, Dresser L, Han H, Husain S, Minden MD, Paul NS, So M, Steinberg M, Vallipuram M, Wong G, Morris AM. Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia. Leuk Lymphoma 2016; 58:834-841. [DOI: 10.1080/10428194.2016.1213825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Nagel SN, Wyschkon S, Schwartz S, Hamm B, Elgeti T. Can magnetic resonance imaging be an alternative to computed tomography in immunocompromised patients with suspected fungal infections? Feasibility of a speed optimized examination protocol at 3 Tesla. Eur J Radiol 2016; 85:857-63. [DOI: 10.1016/j.ejrad.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/29/2016] [Accepted: 02/04/2016] [Indexed: 11/28/2022]
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29
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Kovtunov KV, Romanov AS, Salnikov OG, Barskiy DA, Chekmenev EY, Koptyug IV. Gas Phase UTE MRI of Propane and Propene. ACTA ACUST UNITED AC 2016; 2:49-55. [PMID: 27478870 PMCID: PMC4966642 DOI: 10.18383/j.tom.2016.00112] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Proton magnetic resonance imaging (1H MRI) of gases can potentially enable functional lung imaging to probe gas ventilation and other functions. Here, 1H MR images of hyperpolarized (HP) and thermally polarized propane gas were obtained using ultrashort echo time (UTE) pulse sequence. A 2-dimensional (2D) image of thermally polarized propane gas with ∼0.9 × 0.9 mm2 spatial resolution was obtained in <2 seconds, showing that even non-HP hydrocarbon gases can be successfully used for conventional proton magnetic resonance imaging. The experiments were also performed with HP propane gas, and high-resolution multislice FLASH 2D images in ∼510 seconds and non-slice-selective 2D UTE MRI images were acquired in ∼2 seconds. The UTE approach adopted in this study can be potentially used for medical lung imaging. Furthermore, the possibility of combining UTE with selective suppression of 1H signals from 1 of the 2 gases in a mixture is shown in this MRI study. The latter can be useful for visualizing industrially important processes where several gases may be present, eg, gas–solid catalytic reactions.
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Affiliation(s)
- Kirill V Kovtunov
- International Tomography Center, SB RAS, 3A Institutskaya St., 630090 Novosibirsk, Russia; Novosibirsk State University, 2 Pirogova St., 630090 Novosibirsk, Russia
| | - Alexey S Romanov
- International Tomography Center, SB RAS, 3A Institutskaya St., 630090 Novosibirsk, Russia; Novosibirsk State University, 2 Pirogova St., 630090 Novosibirsk, Russia
| | - Oleg G Salnikov
- International Tomography Center, SB RAS, 3A Institutskaya St., 630090 Novosibirsk, Russia; Novosibirsk State University, 2 Pirogova St., 630090 Novosibirsk, Russia
| | - Danila A Barskiy
- Vanderbilt University, Institute of Imaging Science (VUIIS), Department of Radiology, Department of Biomedical Engineering, Vanderbilt-Ingram Cancer Center (VICC), Nashville, Tennessee, 37232-2310, USA
| | - Eduard Y Chekmenev
- Vanderbilt University, Institute of Imaging Science (VUIIS), Department of Radiology, Department of Biomedical Engineering, Vanderbilt-Ingram Cancer Center (VICC), Nashville, Tennessee, 37232-2310, USA
| | - Igor V Koptyug
- International Tomography Center, SB RAS, 3A Institutskaya St., 630090 Novosibirsk, Russia; Novosibirsk State University, 2 Pirogova St., 630090 Novosibirsk, Russia
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30
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Stewart NJ, Wild JM. MRI methods for structural and functional assessment of the lungs: proton and multinuclear. IMAGING 2016. [DOI: 10.1183/2312508x.10002115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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31
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Hochhegger B, de Souza VVS, Marchiori E, Irion KL, Souza AS, Elias Junior J, Rodrigues RS, Barreto MM, Escuissato DL, Mançano AD, Araujo Neto CA, Guimarães MD, Nin CS, Santos MK, Silva JLPE. Chest magnetic resonance imaging: a protocol suggestion. Radiol Bras 2016; 48:373-80. [PMID: 26811555 PMCID: PMC4725399 DOI: 10.1590/0100-3984.2014.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the recent years, with the development of ultrafast sequences, magnetic
resonance imaging (MRI) has been established as a valuable diagnostic modality
in body imaging. Because of improvements in speed and image quality, MRI is now
ready for routine clinical use also in the study of pulmonary diseases. The main
advantage of MRI of the lungs is its unique combination of morphological and
functional assessment in a single imaging session. In this article, the authors
review most technical aspects and suggest a protocol for performing chest MRI.
The authors also describe the three major clinical indications for MRI of the
lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and
investigation of pulmonary abnormalities in patients who should not be exposed
to radiation.
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Affiliation(s)
- Bruno Hochhegger
- PhD, Associate Professor, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | - Edson Marchiori
- PhD, Full Professor Emeritus, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Klaus Loureiro Irion
- PhD, Consultant Radiologist, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK
| | - Arthur Soares Souza
- PhD, Professor, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | - Jorge Elias Junior
- PhD, Associate Professor, Centro de Ciências das Imagens e Física Médica (CCIFM) - Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil
| | - Rosana Souza Rodrigues
- PhD, Professor, Program of Post-graduation in Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Miriam Menna Barreto
- PhD, Professor, Program of Post-graduation in Radiology, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Dante Luiz Escuissato
- PhD, Associate Professor, Department of Medical Practice, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | | | | | - Marcos Duarte Guimarães
- PhD, Professor, Program of Post-graduation stricto sensu, A.C.Camargo Cancer Center, São Paulo, SP, Brazil
| | - Carlos Schuler Nin
- MD, Resident in Radiology and Imaging Diagnosis, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Marcel Koenigkam Santos
- PhD, Attending Physician at Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Ribeirão Preto, SP, Brazil
| | - Jorge Luiz Pereira E Silva
- PhD, Associate Professor, Department of Medicine and Diagnostic Support, Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil
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Affiliation(s)
- Carolina A Souza
- MD, PhD, Thoracic Radiologist, The Ottawa Hospital, Associate Professor, University of Ottawa Clinical Investigator, The Ottawa Hospital Research Institute, Ottawa, Canada. E-mail:
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33
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Zarnegar S, Giulino-Roth L. Reducing radiation exposure in children with febrile neutropenia: can pulmonary MRI replace CT? Leuk Lymphoma 2016; 57:4-5. [DOI: 10.3109/10428194.2015.1061192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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34
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Sodhi KS, Khandelwal N, Saxena AK, Singh M, Agarwal R, Bhatia A, Lee EY. Rapid lung MRI in children with pulmonary infections: Time to change our diagnostic algorithms. J Magn Reson Imaging 2015; 43:1196-206. [DOI: 10.1002/jmri.25082] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/06/2015] [Indexed: 12/24/2022] Open
Affiliation(s)
- Kushaljit Singh Sodhi
- Department of Radio Diagnosis and Imaging; Post Graduate Institute of Medical Education and Research; Sector-12 Chandigarh India
| | - Niranjan Khandelwal
- Department of Radio Diagnosis and Imaging; Post Graduate Institute of Medical Education and Research; Sector-12 Chandigarh India
| | - Akshay Kumar Saxena
- Department of Radio Diagnosis and Imaging; Post Graduate Institute of Medical Education and Research; Sector-12 Chandigarh India
| | - Meenu Singh
- Department of Paediatrics; Post Graduate Institute of Medical Education and Research; Sector-12 Chandigarh India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine; Post Graduate Institute of Medical Education and Research; Sector-12 Chandigarh India
| | - Anmol Bhatia
- Department of Radio Diagnosis and Imaging; Post Graduate Institute of Medical Education and Research; Sector-12 Chandigarh India
| | - Edward Y. Lee
- Departments of Radiology and Medicine; Pulmonary Division, Boston Children's Hospital and Harvard Medical School; Boston Massachusetts USA
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Maschmeyer G, Carratalà J, Buchheidt D, Hamprecht A, Heussel CP, Kahl C, Lorenz J, Neumann S, Rieger C, Ruhnke M, Salwender H, Schmidt-Hieber M, Azoulay E. Diagnosis and antimicrobial therapy of lung infiltrates in febrile neutropenic patients (allogeneic SCT excluded): updated guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Oncol 2015; 26:21-33. [PMID: 24833776 PMCID: PMC4269340 DOI: 10.1093/annonc/mdu192] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 04/29/2014] [Accepted: 05/02/2014] [Indexed: 12/13/2022] Open
Abstract
Up to 25% of patients with profound neutropenia lasting for >10 days develop lung infiltrates, which frequently do not respond to broad-spectrum antibacterial therapy. While a causative pathogen remains undetected in the majority of cases, Aspergillus spp., Pneumocystis jirovecii, multi-resistant Gram-negative pathogens, mycobacteria or respiratory viruses may be involved. In at-risk patients who have received trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis, filamentous fungal pathogens appear to be predominant, yet commonly not proven at the time of treatment initiation. Pathogens isolated from blood cultures, bronchoalveolar lavage (BAL) or respiratory secretions are not always relevant for the etiology of pulmonary infiltrates and should therefore be interpreted critically. Laboratory tests for detecting Aspergillus galactomannan, β-D-glucan or DNA from blood, BAL or tissue samples may facilitate the diagnosis; however, most polymerase chain reaction assays are not yet standardized and validated. Apart from infectious agents, pulmonary side-effects from cytotoxic drugs, radiotherapy or pulmonary involvement by the underlying malignancy should be included into differential diagnosis and eventually be clarified by invasive diagnostic procedures. Pre-emptive treatment with mold-active systemic antifungal agents improves clinical outcome, while other microorganisms are preferably treated only when microbiologically documented. High-dose TMP/SMX is first choice for treatment of Pneumocystis pneumonia, while cytomegalovirus pneumonia is treated primarily with ganciclovir or foscarnet in most patients. In a considerable number of patients, clinical outcome may be favorable despite respiratory failure, so that intensive care should be unrestrictedly provided in patients whose prognosis is not desperate due to other reasons.
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Affiliation(s)
- G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany.
| | - J Carratalà
- Department of Infectious Diseases, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - D Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Mannheim
| | - A Hamprecht
- Institution for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne
| | - C P Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, University Hospital, Heidelberg
| | - C Kahl
- Department of Hematology and Oncology, Klinikum Magdeburg, Magdeburg
| | - J Lorenz
- Department of Pneumology, Infectious Diseases, Sleep Medicine and Intensive Care, Klinikum Lüdenscheid, Lüdenscheid
| | - S Neumann
- Medical Oncology, AMO MVZ, Wolfsburg
| | - C Rieger
- Department of Medicine III, University Hospital Großhadern, München
| | - M Ruhnke
- Department of Medical Oncology and Hematology, Charité University Medicine Campus Mitte, Berlin
| | - H Salwender
- Department of Hematology, Oncology, Stem Cell Transplantation, Asklepios Klinik Altona, Hamburg
| | - M Schmidt-Hieber
- Department of Hematology, Oncology and Tumor Immunology, Helios-Klinikum Berlin-Buch, Berlin, Germany
| | - E Azoulay
- AP-HP, Hopital Saint-Louis, Service de Réanimation Médicale, Université Paris-Diderot, Sorbonne Paris-Cité, Faculté de Médecine, Paris, France
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Heussel CP. Diagnostic Radiology in Hematological Patients with Febrile Neutropenia. INFECTIONS IN HEMATOLOGY 2015. [PMCID: PMC7122774 DOI: 10.1007/978-3-662-44000-1_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Radiologists have a special role in the management of neutropenic patients. The appropriate investigational technique, specific differential diagnoses, and particular risks of these patients need to be understood by referring physicians as well as by radiologists. Thus, communication and cooperation, also including other clinical disciplines such as pulmonology, are required. Early detection of an infectious focus is the major goal in febrile neutropenic patients. As pneumonia is the most common focus, chest imaging is a special radiological task. The sensitivity of chest x-ray, especially in supine position, is low. Therefore, the very sensitive thin-section multislice CT became a gold standard in neutropenic hosts and might be cost effective in comparison to antibiotic treatment. CT-based localization can be used to guide invasive procedures in order to obtain samples for microbiological workup. Furthermore, the radiological characterization of infiltrates gives a first and rapid hint to discriminate between infectious (viral, typical bacterial, atypical bacterial, fungal) and noninfectious etiologies. Radiological follow-up has to take into account aspects according to disease, immune recovery, and treatment modalities. Due to a high incidence of fungal-related lung infiltrates, interpretation of follow-up findings must include further parameters besides lesion size. Apart from the lungs, also other organ systems such as the brain, liver, and paranasal sinuses need attention and are to be imaged with the appropriate technique.
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Yan C, Tan X, Wei Q, Feng R, Li C, Wu Y, Hao P, Chan Q, Xiong W, Xu J, Xu Y. Lung MRI of invasive fungal infection at 3 Tesla: evaluation of five different pulse sequences and comparison with multidetector computed tomography (MDCT). Eur Radiol 2014; 25:550-7. [PMID: 25231132 DOI: 10.1007/s00330-014-3432-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 08/20/2014] [Accepted: 09/03/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of five MR sequences to detect pulmonary infectious lesions in patients with invasive fungal infection (IFI), using multidetector computed tomography (MDCT) as the reference standard. METHODS Thirty-four immunocompromised patients with suspected IFI underwent MDCT and MRI. The MR studies were performed using five pulse sequences at 3.0 T: T2-weighted turbo spin echo (TSE), short-tau inversion recovery (STIR), spectrally selective attenuated inversion recovery (SPAIR), T1-weighted high resolution isotropic volume excitation (e-THRIVE) and T1-weighted fast field echo (T1-FFE). The size, lesion-to-lung contrast ratio and the detectability of pulmonary lesions on MR images were assessed. Image quality and artefacts on different sequences were also rated. RESULTS A total of 84 lesions including nodules (n = 44) and consolidation (n = 40) were present in 75 lobes. SPAIR and e-THRIVE images achieved high overall lesion-related sensitivities for the detection of pulmonary abnormalities (90.5% and 86.9%, respectively). STIR showed the highest lesion-to-lung contrast ratio for nodules (21.8) and consolidation (17.0), whereas TSE had the fewest physiological artefacts. CONCLUSIONS MRI at 3.0 T can depict clinically significant pulmonary IFI abnormalities with high accuracy compared to MDCT. SPAIR and e-THRIVE are preferred sequences for the detection of infectious lesions of 5 mm and larger. KEY POINTS • A radiation-free radiological method is desirable for assessing pulmonary infectious lesions • MRI at 3 T can depict lung infiltrates with good concordance to MDCT • SPAIR and e-THRIVE are favourable sequences for the detection of pulmonary lesions • The greatest benefit is for the diagnosis of lesions larger than 5 mm.
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Affiliation(s)
- Chenggong Yan
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong, People's Republic of China
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Wielpütz MO, Heußel CP, Herth FJ, Kauczor HU. Radiological diagnosis in lung disease: factoring treatment options into the choice of diagnostic modality. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:181-7. [PMID: 24698073 PMCID: PMC3977441 DOI: 10.3238/arztebl.2014.0181] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Chest X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) each have characteristic advantages and disadvantages that need to be considered in clinical decision-making. This point is discussed in reference to the main types of lung disease that are encountered in practice. METHOD A selective literature search was performed in the PubMed and Google Scholar databases. Existing clinical guidelines on the main types of lung disease and studies concerning radiological diagnosis were also con - sidered in this review. RESULTS There have been no more than a few large-scale, controlled comparative trials of different radiological techniques. Chest X-ray provides general orientation as an initial diagnostic study and is especially useful in the diagnosis of pneumonia, cancer, and chronic obstructive pulmonary disease (COPD). Multi-detector CT affords nearly isotropic spatial resolution at a radiation dose of only 0.2-5 mSv, much lower than before. Its main indications, according to current guidelines, are tumors, acute pulmonary embolism, pulmonary hypertension, pulmonary fibrosis, advanced COPD, and pneumonia in a high-risk patient. MRI is used in the diagnosis of cystic fibrosis, pulmonary embolism, pulmonary hypertension, and bronchial carcinoma. The positive predictive value (PPV) of a chest X-ray in outpatients with pneumonia is only 27% (gold standard, CT); in contrast, an initial, non-randomized trial of MRI in nosocomial pneumonia revealed a PPV of 95%. For the staging of mediastinal lymph nodes in bronchial carcinoma, MRI has a PPV of 88% and positron emission tomography with CT (PET/CT) has a PPV of 79%, while CT alone has a PPV of 41% (gold standard, histology). CONCLUSION The choice of radiologicalal technique for the detection, staging, follow-up, and quantification of lung disease should be based on the individual clinical options, so that appropriate treatment can be provided without excessive use of diagnostic testing.
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Affiliation(s)
- Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital
- Translational Lung Research Center (TLRC) Heidelberg, German Centre for Lung Research (DZL), Heidelberg
| | - Claus P Heußel
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital
- Translational Lung Research Center (TLRC) Heidelberg, German Centre for Lung Research (DZL), Heidelberg
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital
| | - Felix J.F Herth
- Translational Lung Research Center (TLRC) Heidelberg, German Centre for Lung Research (DZL), Heidelberg
- Department of Pneumology and Respiratory Critical Care Medicine, Thoraxklinik at Heidelberg University Hospital
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital
- Translational Lung Research Center (TLRC) Heidelberg, German Centre for Lung Research (DZL), Heidelberg
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Proton MRI in the evaluation of pulmonary sarcoidosis: Comparison to chest CT. Eur J Radiol 2013; 82:2378-85. [DOI: 10.1016/j.ejrad.2013.08.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/03/2013] [Accepted: 08/08/2013] [Indexed: 12/13/2022]
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Ben-Ami R, Halaburda K, Klyasova G, Metan G, Torosian T, Akova M. A multidisciplinary team approach to the management of patients with suspected or diagnosed invasive fungal disease. J Antimicrob Chemother 2013; 68 Suppl 3:iii25-33. [DOI: 10.1093/jac/dkt390] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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3 Tesla proton MRI for the diagnosis of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia: initial results in comparison to HRCT. Eur J Radiol 2013; 83:e61-6. [PMID: 24189389 DOI: 10.1016/j.ejrad.2013.09.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 08/20/2013] [Accepted: 09/03/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the diagnostic accuracy of 3 Tesla proton MRI for the assessment of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia. MATERIAL AND METHODS In a prospective study, 3 Tesla MRI was performed in 19 febrile neutropenic patients (5 women, 14 men; mean age 61 years ± 14.2; range 23-77 years). All patients underwent high-resolution CT less than 24h prior to MRI. The MRI protocol (Magnetom Tim Trio, Siemens) included a T2-weighted HASTE sequence (TE/TR: 49 ms/∞, slice thickness 6mm) and a high-resolution 3D VIBE sequence with an ultra-short TE<1 ms (TE/TR 0.8/2.9 ms, slice thickness 2mm). The VIBE sequence was examined before and after intravenous injection of 0.1 mmol/kg gadoterate meglumine (Dotarem, Guerbet). The presence of pulmonary abnormalities, their location within the lung, and lesion type (nodules, consolidations, glass opacity areas) were analyzed by one reader and compared to the findings of HRCT, which was evaluated by a second independent radiologist who served as the reference standard. The findings were compared per lobe in each patient and rated as true positive (TP) findings if all three characteristics (presence, location, and lesion type) listed above were concordant to HRCT. RESULTS Pulmonary abnormalities were characterized by 3 Tesla MRI with a sensitivity of 82.3% and a specificity of 78.6%, resulting in an overall accuracy of 88% (NPV/PPV 66.7%/89.5%). In 51 lobes (19 of 19 patients), pulmonary abnormalities visualized by MR were judged to be concordant in their location and in the lesion type identified by both readers. In 22 lobes (11 of 19 patients), no abnormalities were present on either MR or HRCT (true negative). In 6 lobes (5 of 19 patients), ground glass opacity areas were detected on MRI but were not visible on HRCT (false positives). In 11 lobes (7 of 19 patients), MRI failed to detect ground glass opacity areas identified by HRCT. However, since the abnormalities were disseminated in these patients, accurate treatment decisions were possible in every case based on MRI. In one case MRI showed a central area of cavitation, which was not visualized by HRCT. CONCLUSION Infectious nodules and consolidations can be detected in neutropenic patients with acute myeloid leukemia with a sufficient diagnostic accuracy by 3 Tesla MRI. Detection of ground glass opacity areas is the main limitation of 3-Tesla MRI when compared to HRCT.
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Liszewski MC, Hersman FW, Altes TA, Ohno Y, Ciet P, Warfield SK, Lee EY. Magnetic resonance imaging of pediatric lung parenchyma, airways, vasculature, ventilation, and perfusion: state of the art. Radiol Clin North Am 2013; 51:555-82. [PMID: 23830786 DOI: 10.1016/j.rcl.2013.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Magnetic resonance (MR) imaging is a noninvasive imaging modality, particularly attractive for pediatric patients given its lack of ionizing radiation. Despite many advantages, the physical properties of the lung (inherent low signal-to-noise ratio, magnetic susceptibility differences at lung-air interfaces, and respiratory and cardiac motion) have posed technical challenges that have limited the use of MR imaging in the evaluation of thoracic disease in the past. However, recent advances in MR imaging techniques have overcome many of these challenges. This article discusses these advances in MR imaging techniques and their potential role in the evaluation of thoracic disorders in pediatric patients.
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Affiliation(s)
- Mark C Liszewski
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA
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Barreto MM, Rafful PP, Rodrigues RS, Zanetti G, Hochhegger B, Souza AS, Guimarães MD, Marchiori E. Correlation between computed tomographic and magnetic resonance imaging findings of parenchymal lung diseases. Eur J Radiol 2013; 82:e492-501. [DOI: 10.1016/j.ejrad.2013.04.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 04/20/2013] [Accepted: 04/25/2013] [Indexed: 12/31/2022]
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Montella S, Mollica C, Finocchi A, Pession A, Pietrogrande MC, Trizzino A, Ranucci G, Maglione M, Giardino G, Salvatore M, Santamaria F, Pignata C. Non invasive assessment of lung disease in ataxia telangiectasia by high-field magnetic resonance imaging. J Clin Immunol 2013; 33:1185-91. [PMID: 23975689 DOI: 10.1007/s10875-013-9933-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/08/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE A sensitive imaging technique that assesses ataxia telangiectasia (AT) lung disease without ionizing radiation is highly desirable. We designed a study to evaluate lung changes using magnetic resonance imaging (MRI), and to investigate the relationships among severity and extent of pulmonary abnormalities and clinical, microbiological and functional data in children and young adults with AT. METHODS Fifteen AT patients (age, 11.3 years; range, 6-31) underwent 3.0-T MRI, spirometry, and deep throat or sputum culture. Images were scored using a modified Helbich score. RESULTS Although only 8 patients (53 %) had recurrent/chronic respiratory symptoms, MRI identified lung abnormalities in all. Bronchiectasis, peribronchial thickening, mucous plugging, and collapse/consolidation were present in 60 %, 87 %, 67 %, and 13 % of cases, respectively, with no difference between subjects with or without respiratory symptoms. No difference in changes of specific scores was found between the two groups, but the total MRI score was higher in patients with respiratory symptoms (6.5 versus 5, respectively; p = 0.02). Total or specific MRI scores were not associated with patients' age. Of all scores, only mucous plugging subscore appeared significantly related to FEV1 (r = 0.7, p = 0.04) and FEF25-75% (r = 0.9, p = 0.001). MRI scores from patients with positive (n = 5) or negative (n = 10) sputum culture were not significantly different. CONCLUSIONS MRI is valuable in the assessment of extent and severity of pulmonary changes in children and adults with AT. It represents an helpful tool for the longitudinal evaluation of patients and may be also used as an outcome surrogate to track the effects of medications.
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Affiliation(s)
- Silvia Montella
- Department of Translational Medical Sciences, "Federico II" University, Via Pansini 5, 80131, Naples, Italy
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Abstract
PURPOSE OF REVIEW The article aims to indicate the current role of radiological imaging in immune competent and immunocompromised patients with pneumonia. The radiological findings in the most common conditions will be reviewed. RECENT FINDINGS Three basic patterns of radiographic abnormality are recognized: lobar (nonsegmental) pneumonia; bronchopneumonia (lobular pneumonia); and interstitial pneumonia. The chest radiograph remains the initial radiological investigation. Computed tomography (CT) is more sensitive than the chest radiograph. The appearances on CT with certain infections such as mycoplasma, invasive aspergillosis, and pneumocystis, in the appropriate clinical setting, may allow a treatment decision to be made when obtaining fluid or tissue for culture is problematical. MRI technology is advancing and this technique may provide an option for follow-up of chronic disease in younger patients in whom radiation exposure is a concern, but MRI does not yet match CT as a diagnostic test in this field. SUMMARY Radiology retains a key role in diagnosing pneumonia, excluding pneumonia, following up patients to check for resolution and to evaluate potential complications. The chest radiograph remains the initial examination. CT is more sensitive and with certain infections more specific. MRI provides an option for monitoring progress, although cannot yet match CT as an initial diagnostic test.
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A Rationale for the Use of F18-FDG PET/CT in Fever and Inflammation of Unknown Origin. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2012; 2012:165080. [PMID: 23316356 PMCID: PMC3534311 DOI: 10.1155/2012/165080] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 11/02/2012] [Accepted: 11/05/2012] [Indexed: 12/12/2022]
Abstract
This review focuses on the diagnostic value of hybrid F18-FDG Positron Emission Tomography/Computerized tomography (PET/CT) in fever of unknown origin (FUO) and inflammation of unknown origin (IUO). Due to the wide range of possible causes both FUO and IUO remain a clinical challenge for both patients and physicians. In addition, the aetiology of IUO shows the same variation in diseases as the FUO spectrum and probably requires the same diagnostic approach as FUO. There are numerous historically used diagnostic approaches incorporating invasive and non-invasive, and imaging techniques, all with relative high specificity but limited sensitivity. This hampers the generalization of these diagnostic approaches. However, recently published reports show that F18-FDG PET/CT in FUO and IUO has a high sensitivity and a relative non-specificity for malignancy, infection and inflammation. This makes F18-FDG PET/CT an ideal diagnostic tool to start the diagnostic process and to guide subsequent focused diagnostic approaches with higher specificity. In addition, F18-FDG PET/CT has a relative high negative predictive value. Therefore F18 FDG PET/CT should be incorporated in the routine diagnostic work-up of patients with FUO and IUO, preferably at an early stage in the diagnostic process.
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Abstract
Parallel imaging is a robust method for accelerating the acquisition of magnetic resonance imaging (MRI) data, and has made possible many new applications of MR imaging. Parallel imaging works by acquiring a reduced amount of k-space data with an array of receiver coils. These undersampled data can be acquired more quickly, but the undersampling leads to aliased images. One of several parallel imaging algorithms can then be used to reconstruct artifact-free images from either the aliased images (SENSE-type reconstruction) or from the undersampled data (GRAPPA-type reconstruction). The advantages of parallel imaging in a clinical setting include faster image acquisition, which can be used, for instance, to shorten breath-hold times resulting in fewer motion-corrupted examinations. In this article the basic concepts behind parallel imaging are introduced. The relationship between undersampling and aliasing is discussed and two commonly used parallel imaging methods, SENSE and GRAPPA, are explained in detail. Examples of artifacts arising from parallel imaging are shown and ways to detect and mitigate these artifacts are described. Finally, several current applications of parallel imaging are presented and recent advancements and promising research in parallel imaging are briefly reviewed.
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Affiliation(s)
- Anagha Deshmane
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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Hochhegger B, Marchiori E, Irion K, Souza AS, Volkart J, Rubin AS. Magnetic resonance of the lung: a step forward in the study of lung disease. J Bras Pneumol 2012; 38:105-15. [PMID: 22407047 DOI: 10.1590/s1806-37132012000100015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/03/2011] [Indexed: 11/21/2022] Open
Abstract
Magnetic resonance imaging (MRI) of the lung has progressed tremendously in recent years. Because of improvements in speed and image quality, MRI is now ready for routine clinical use. The main advantage of MRI of the lung is its unique combination of structural and functional assessment in a single imaging session. We review the three major clinical indications for MRI of the lung: staging of lung tumors; evaluation of pulmonary vascular disease; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.
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Affiliation(s)
- Bruno Hochhegger
- Departamento de Pneumologia, Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brasil
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Vázquez E, Delgado I, Sánchez-Montañez A, Barber I, Sánchez-Toledo J, Enríquez G. Side effects of oncologic therapies in the pediatric central nervous system: update on neuroimaging findings. Radiographics 2012; 31:1123-39. [PMID: 21768243 DOI: 10.1148/rg.314105180] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The need for early, accurate diagnosis of central nervous system (CNS) complications occurring during and after pediatric cancer treatment is growing because of the improvement in overall survival rates related to innovative and aggressive oncologic therapies. An elevated degree of suspicion is needed to recognize the radiologic features of these CNS complications. Radiologists need familiarity with the early and late side effects of cancer therapy in the pediatric CNS (eg, toxic effects, infection, endocrine or sensory dysfunction, neuropsychologic impairment, second malignancies), in order to accelerate the imaging diagnosis and minimize as much as possible the associated morbidity. Acquisition of knowledge about these complications will enable the development of more appropriate therapeutic trials and more effective patient surveillance and will lead to an improved quality of life by decreasing the long-term sequelae in survivors.
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Affiliation(s)
- Elida Vázquez
- Department of Pediatric Radiology and Pediatric Oncohematology, Universidad Autónoma de Barcelona, Barcelona, Spain.
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Bagci U, Yao J, Wu A, Caban J, Palmore TN, Suffredini AF, Aras O, Mollura DJ. Automatic detection and quantification of tree-in-bud (TIB) opacities from CT scans. IEEE Trans Biomed Eng 2012; 59:1620-32. [PMID: 22434795 PMCID: PMC3511590 DOI: 10.1109/tbme.2012.2190984] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study presents a novel computer-assisted detection (CAD) system for automatically detecting and precisely quantifying abnormal nodular branching opacities in chest computed tomography (CT), termed tree-in-bud (TIB) opacities by radiology literature. The developed CAD system in this study is based on 1) fast localization of candidate imaging patterns using local scale information of the images, and 2) Möbius invariant feature extraction method based on learned local shape and texture properties of TIB patterns. For fast localization of candidate imaging patterns, we use ball-scale filtering and, based on the observation of the pattern of interest, a suitable scale selection is used to retain only small size patterns. Once candidate abnormality patterns are identified, we extract proposed shape features from regions where at least one candidate pattern occupies. The comparative evaluation of the proposed method with commonly used CAD methods is presented with a dataset of 60 chest CTs (laboratory confirmed 39 viral bronchiolitis human parainfluenza CTs and 21 normal chest CTs). The quantitative results are presented as the area under the receiver operator characteristics curves and a computer score (volume affected by TIB) provided as an output of the CAD system. In addition, a visual grading scheme is applied to the patient data by three well-trained radiologists. Interobserver and observer-computer agreements are obtained by the relevant statistical methods over different lung zones. Experimental results demonstrate that the proposed CAD system can achieve high detection rates with an overall accuracy of 90.96%. Moreover, correlations of observer-observer (R(2)=0.8848, and observer-CAD agreements (R(2)=0.824, validate the feasibility of the use of the proposed CAD system in detecting and quantifying TIB patterns.
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Affiliation(s)
- Ulas Bagci
- Center for Infectious Disease Imaging, Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD 20892, USA.
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