Chin A Yi MD, PhD, Abstract Co-Author: Nothing to Disclose

Kyung Soo Lee MD, Abstract Co-Author: Nothing to Disclose

Man Pyo Chung MD, Abstract Co-Author: Nothing to Disclose

Joungho Han, Abstract Co-Author: Nothing to Disclose

Kyung Min Shin MD, Abstract Co-Author: Nothing to Disclose

Ho Yun Lee MD, Presenter: Nothing to Disclose

Myung Jin Chung MD, Abstract Co-Author: Nothing to Disclose

Tae Sung Kim MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To analyze retrospectively enhancement patterns at dynamic MRI and the extent of lung parenchymal abnormalities at HRCT and to seek prognostic determinants that can predict disease improvement in IIPs.

We included 42 patients (M:F = 16:26, age 58 ± 8 years) with surgically proven IIPs; 20 with NSIP and 22 with IPF. Patients underwent HRCT and dynamic MRI (T1W 3D TFE sequences before and 1, 3, 5, and 10 minutes after IV contrast injection) at presentation and were followed-up by HRCT (11 ± 6 months). Two chest radiologists scored, independently to the nearest 5% level, each parenchymal lesion extent, fibrotic score (summation of the extent of reticulation and honeycombing) and overall lesions detected at initial and final follow-up CT. The presence of early enhancement (peak enhancement ≤ 3 min) was visually assessed and dynamic parameters (signal intensity [SI] % at 1 minute, slope, time to peak [TTP], and washout) were measured at dynamic MRI. A decrease of > 10% in the overall extent of parenchymal lesions at follow-up HRCT was considered to represent improvement. Each lesion extent at HRCT and dynamic parameter at MRI were analyzed by ROC curve for the prediction of improvement.

The improvement of disease was more frequently observed in patients with NSIP (n = 10, 50%) than in patients with IPF (n = 2, 9%) (P = .003). ROC curves for the prediction of disease improvement disclosed fair performance in fibrotic score (AUC = 0.740, cut-off value ≤ 10%) and in the extent of consolidation (AUC = 0.746, cut-off value ≥ 5%) at HRCT and in TTP (AUC = 0.735, cut-off value ≤ 3 min) and washout (AUC = 0.744, cut-off value ≥ 6 SI%) at dynamic MRI. In pair-wise comparisons, no significant difference was seen between these parameters (P > .05). Using early enhancement pattern at dynamic MRI as a favorable indicator for the improvement of disease, the positive and negative predictive values were 64% and 89% respectively.

Both HRCT features and dynamic MR parameters appear to be useful indicators for the prediction of disease improvement in patients with IIP. In addition, the presence of early enhancement at dynamic MRI suggests disease improvement at follow-up CT.

By noticing the presence of early enhancement at dynamic MRI, the improvement of IIP can be predicted as much as it can be done by scoring the extent of fibrosis and consolidation at HRCT.

Yi, C, Lee, K, Chung, M, Han, J, Shin, K, Lee, H, Chung, M, Kim, T, et al, , Characteristics at Dynamic MRI and HRCT in Idiopathic Interstitial Pneumonias (IIPs): Prognostic Determinant Evaluation.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6015277.html