Three-dimensional magnetic resonance imaging ultrashort echo-time cones for assessing lung density in pediatric patients
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ORIGINAL ARTICLE
Three-dimensional magnetic resonance imaging ultrashort echo-time cones for assessing lung density in pediatric patients Konstantinos G. Zeimpekis 1,2
&
Julia Geiger 3,4 & Florian Wiesinger 5 & Gaspar Delso 5 & Christian J. Kellenberger 3,4
Received: 11 December 2019 / Revised: 18 May 2020 / Accepted: 29 July 2020 # The Author(s) 2020
Abstract Background MRI of lung parenchyma is challenging because of the rapid decay of signal by susceptibility effects of aerated lung on routine fast spin-echo sequences. Objective To assess lung signal intensity in children on ultrashort echo-time sequences in comparison to a fast spin-echo technique. Materials and methods We conducted a retrospective study of lung MRI obtained in 30 patients (median age 5 years, range 2 months to 18 years) including 15 with normal lungs and 15 with cystic fibrosis. On a fast spin-echo sequence with radial readout and an ultrashort echo-time sequence, both lungs were segmented and signal intensities were extracted. We compared lung-to-background signal ratios and histogram analysis between the two patient cohorts using non-parametric tests and correlation analysis. Results On ultrashort echo-time the lung-to-background ratio was age-dependent, ranging from 3.15 to 1.33 with high negative correlation (Rs = −0.86). Signal in posterior dependent portions of the lung was 18% and 11% higher than that of the anterior lung for age groups 0–2 and 2–18 years, respectively. The fast spin-echo sequence showed no variation of signal ratios by age or location, with a median of 0.99 (0.98–1.02). Histograms of ultrashort echo-time slices between controls and children with aggravated cystic fibrosis with mucus plugging and wall thickening exhibited significant discrepancies that differentiated between normal and pathological lungs. Conclusion Signal intensity of lung on ultrashort echo-time is higher than that on fast spin-echo sequences, is age-dependent and shows a gravity-dependent anterior to posterior gradient. This signal variation appears similar to lung density described on CT. Keywords Adolescents . Children . Cones . Cystic fibrosis . Lung density . Magnetic resonance imaging . Ultra-short echo time
Introduction Computed tomography (CT) is considered the reference standard for imaging the lung parenchyma. Nonetheless MRI is
* Konstantinos G. Zeimpekis [email protected] 1
Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
2
Department of Information Technology and Electrical Engineering, ETH, Zürich, Switzerland
3
Department of Diagnostic Imaging, University Children’s Hospital Zürich, Zürich, Switzerland
4
Children’s Research Center, University Children’s Hospital Zürich, Zürich, Switzerland
5
GE Healthcare, Waukesha, WI, USA
being used increasingly for assessing the lung and airways in children [1–4]. Newer MRI techniques such as ultrashort echo-time and zero echo-time sequences have recently boosted the clinical MRI application to lung morphology and path
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