Rationale and Objectives
The objective of this study was to assess the diagnostic utility of 3-tesla (3T) magnetic resonance imaging (MRI) of lungs in the detection of interstitial lung disease (ILD) in pediatric patients.
Materials and Methods
Twelve children (mean: 8.5 years, range: 4–12 years) with ILD were consecutively enrolled in this prospective study. HRCT and 3T lung MRI were performed in all patients within 2 days of each other. The sensitivity, the specificity, the positive predictive value, and the negative predictive value of detecting lung abnormalities related to ILD with 3T lung MRI were calculated, with high-resolution computed tomography (HRCT) as a standard of reference. Agreement between HRCT and 3T lung MRI, as well as between two reviewers, was calculated with the kappa coefficient.
Results
3T lung MRI had low sensitivity (66.67%) and high specificity (97.33%) in the detection of abnormalities related to ILD when compared to HRCT in children. Although 3T lung MRI performed well in the detection of consolidation, parenchymal bands and fissural thickening with a sensitivity of 100%, the sensitivity of 3T lung MRI in the detection of septal thickening, ground-glass opacity, nodules, and cysts was relatively low (50.0%, 50.0%, 66.67%, and 25.0%, respectively). Substantial agreement was seen between HRCT and 3T lung MRI ( k = 0.7), whereas perfect agreement was seen between two reviewers in detecting abnormalities related to pediatric ILD ( k = 0.9–1.0).
Conclusions
In comparison to HRCT, 3T lung MRI with routinely available MRI protocols and sequences can also well detect abnormalities such as consolidation, parenchymal bands, and fissural thickening in children with ILD. However, evaluation of septal thickening, ground-glass opacity, nodules, and cysts is limited with 3T lung MRI.
Introduction
Interstitial lung diseases (ILDs) in pediatric populations are a heterogeneous group of disorders with diffuse lung involvement, frequently leading to significant mortality and morbidity . Unlike the adult population, the spectrum of ILD in children is entirely different, with certain diseases unique to the pediatric population . In addition, clinical manifestations of ILD in children are unfortunately nonspecific and variable, often leading to missed or delayed diagnosis.
Main investigations employed for the diagnosis of ILD include imaging, pulmonary function tests, bronchoalveolar lavage, and lung biopsy. Pulmonary function tests are difficult to perform in children because of poor cooperation , and bronchoalveolar lavage is of diagnostic value in a substantially limited number of conditions . Tissue biopsy provides a definitive diagnosis but has disadvantage of being invasive. Considering the limitations of all these currently available investigations, imaging plays a crucial role in the diagnosis and evaluation of pediatric ILD.
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Materials and Methods
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Study Population
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Imaging Technique
HRCT Protocol
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MRI Protocol
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HRCT and MR Image Evaluation
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Diagnostic Criteria
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Statistical Analysis
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Results
Study Cohort
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HRCT Findings
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Table 1
HRCT and MRI Findings in Pediatric Patients with Interstitial Lung Disease
Imaging Findings Number and Percentage of Patients on HRCT Number and Percentage of Patients on MRI Consolidation 4/12 (33%) 4/12 (33%) Ground-glass opacity 2/12 (17%) 2/12 (17%) Nodules 3/12 (25%) 2/12 (17%) Cyst 4/12 (33%) 1/12 (8%) Septal thickening 4/12 (33%) 2/12 (17%) Bronchiectasis 0/12 (0%) 1/12 (8%) Parenchymal bands 2/12 (17%) 2/12 (17%) Fissural thickening 2/12 (17%) 2/12 (17%)
HRCT, high-resolution computed tomography; MRI, magnetic resonance imaging.
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MRI Findings
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Diagnostic Performance of MRI
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Table 2
Sensitivity, Specificity, PPV, and NPV of Magnetic Resonance Imaging in Detecting Lung Abnormalities in Pediatric Patients with Interstitial Lung Disease
Imaging Finding Sensitivity (%) Specificity (%) PPV (%) NPV (%) Consolidation 100 100 100 100 Parenchymal bands 100 100 100 100 Fissural thickening 100 100 100 100 Nodules 66.7 100 100 90 Ground-glass opacity 50 90 50 90 Septal thickening 50 100 100 80 Cyst 25 100 100 73 Bronchiectasis 0 92 0 100
NPV, negative predictive value; PPV, positive predictive value.
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Agreement Between HRCT and MRI
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Table 3
Agreement Between CT and MRI
Finding Agreement Between CT and MRI (kappa) Septal thickening .571 Bronchiectasis 0 Cyst .308 Parenchymal bands 1.00 Consolidation 1.00 Fissural thickening 1.00 Nodule .75 Ground-glass opacity .40
CT, computed tomography; MRI, magnetic resonance imaging.
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Agreement Between Two Reviewers
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Discussion
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Acknowledgment
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