Non-Contrast-Enhanced Functional Lung MRI to Evaluate Treatment Response of Allergic Bronchopulmonary Aspergillosis in Patients With Cystic Fibrosis: A Pilot Study

Ilyes Benlala (1, 2) , Rabea Klaar (2) , Thomas Gaass (2) , Julie Macey (3, 4) , Stéphanie Bui (3, 4) , Baudouin Denis de Senneville (5, 6) , Patrick Berger (1, 4) , François Laurent (1, 4) , Gael Dournes (1, 4) , Julien Dinkel (2)

1 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
2 LMU - Ludwig Maximilian University [Munich] = Ludwig Maximilians Universität München
3 CHU Bordeaux
4 CIC Bordeaux
5 IMB - Institut de Mathématiques de Bordeaux
6 MONC - Modélisation Mathématique pour l'Oncologie

Background: Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is associated with severe lung damage and requires specific therapeutic management. Repeated imaging is recommended to both diagnose and follow-up response to treatment of ABPA in CF. However, high risk of cumulative radiation exposure requires evaluation of free-radiation techniques in the follow-up of CF patients with ABPA. Purpose: To evaluate whether Fourier decomposition (FD) functional lung MRI can detect response to treatment of ABPA in CF patients. Study Type: Retrospective longitudinal. Population: Twelve patients (7M, median-age:14 years) with CF and ABPA with pre- and post-treatment MRI. Field Strength/Sequence: 2D-balanced-steady-state free-precession (bSSFP) sequence with FD at 1.5T. Assessment: Ventilation-weighted (V) and perfusion-weighted (Q) maps were obtained after FD processing of 2D-coronal bSSFP time-resolved images acquired before and 3–9 months after treatment. Defects extent was assessed on the functional maps using a qualitative semi-quantitative score (0 = absence/negligible, 1 = <50%, 2 = >50%). Mean and coefficient of variation (CV) of the ventilation signal-intensity (VSI) and the perfusion signal-intensity (QSI) were calculated. Measurements were performed independently by three readers and averaged. Inter-reader reproducibility of the measurements was assessed. Pulmonary function tests (PFTs) were performed within 1 week of both MRI studies as markers of the airflow-limitation severity. Statistical Tests: Comparisons of medians were performed using the paired Wilcoxon-test. Reproducibility was assessed using intraclass correlation coefficient (ICC). Correlations between MRI and PFT parameters were assessed using the Spearman-test (rho correlation-coefficient). A P-value <0.05 was considered as significant. Results: Defects extent on both V and Q maps showed a significant reduction after ABPA treatment (4.25 vs. 1.92 for V-defect-score and 5 vs. 2.75 for Q-defect-score). VSI_mean was significantly increased after treatment (280 vs. 167). Qualitative analyses reproducibility showed an ICC > 0.90, while the ICCs of the quantitative measurements was almost perfect (>0.99). Changes in VSI_cv and QSI_cv before and after treatment correlated inversely with changes of FEV1%p (rho = −0.68 for both). Data Conclusion: Non-contrast-enhanced FD lung MRI has potential to reproducibly assess response to treatment of ABPA in CF patients and correlates with PFT obstructive parameters. Evidence Level: 4 Technical Efficacy: Stage 3

Mots clés: ABPA; CF; ventilation; perfusion; Fourier decomposition

Domaines: Imagerie; Allergologie; Maladies infectieuses; Pneumologie et système respiratoire

Ilyes Benlala, Rabea Klaar, Thomas Gaass, Julie Macey, Stéphanie Bui, et al.. Non-Contrast-Enhanced Functional Lung MRI to Evaluate Treatment Response of Allergic Bronchopulmonary Aspergillosis in Patients With Cystic Fibrosis: A Pilot Study. Journal of Magnetic Resonance Imaging, In press, ⟨10.1002/jmri.28844⟩. ⟨hal-04268654⟩