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Multi-modal Pulmonary Imaging: Using Complementary Information from CT and Hyperpolarized 129Xe MRI to Evaluate Lung Structure-Function
Published on: April 12, 2024
MRI of pneumonia in immunocompromised patients: comparison with CT
Afra Ekinci1, Tuba Yücel Uçarkuş, Aylin Okur
1Department of Radiology, Erciyes University School of Medicine, Kayseri, Turkey. drafrayildirim@hotmail.com.
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.
Insights
Computed tomography (CT) is superior for diagnosing pneumonia in immunocompromised patients. However, magnetic resonance imaging (MRI) is valuable for follow-up, reducing radiation exposure.
Area of Science:
- Radiology
- Medical Imaging
- Immunocompromised Patients
Background:
- Pneumonia poses significant risks in immunocompromised individuals.
- Computed tomography (CT) is the primary imaging tool for diagnosis and monitoring.
- Ionizing radiation from CT necessitates exploring alternative imaging methods.
Purpose of the Study:
- To evaluate the utility of magnetic resonance imaging (MRI) for diagnosing and monitoring pneumonia in immunocompromised patients.
- To compare MRI's effectiveness against CT in this patient group.
Main Methods:
- 40 immunocompromised patients with CT-confirmed pneumonia were included.
- MRI scans were performed within 48 hours of CT.
- Three MRI sequences (balanced fast field echo, T1-weighted TSE, T2-weighted TSE) were used to evaluate lung abnormalities.
Main Results:
- CT detected abnormalities in all patients; MRI missed findings in three.
- CT outperformed MRI in identifying tree-in-bud nodules, centrilobular nodules, and halo sign.
- MRI showed high agreement with CT for consolidation, patchy density, pleural effusion, pericardial effusion, and nodules >10mm.
Conclusions:
- CT remains superior for initial pneumonia diagnosis in immunocompromised patients.
- MRI is a viable alternative for patient follow-up, minimizing radiation exposure.
- MRI's diagnostic performance for pneumonia in this population is promising, especially for larger nodules and certain findings.
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