Aspergillus-related lung disease in people with cystic fibrosis: can imaging help us to diagnose disease?

In people with cystic fibrosis (PwCF), viscous sputum and dysfunction of the mucociliary escalator leads to early and chronic infections. The prevalence of Aspergillus fumigatus in sputum is high in PwCF and the contribution of A. fumigatus to the progression of structural lung disease has been reported. However, overall, relatively little is known about the contribution of A. fumigatus to CF lung disease. More knowledge is needed to aid clinical decisions on whether to start antifungal treatment. In this review, we give an overview of A. fumigatus colonisation and infection in PwCF and the different types of pulmonary disease caused by it. Furthermore, we discuss the current evidence for structural lung damage associated with A. fumigatus in PwCF on chest computed tomography and magnetic resonance imaging. We conclude that radiological outcomes to identify disease caused by A. fumigatus can be important for clinical studies and management.

Download Full-text

Computed tomography and magnetic resonance imaging in cystic fibrosis lung disease

Journal of Magnetic Resonance Imaging ◽

10.1002/jmri.22374 ◽

2010 ◽

Vol 32 (6) ◽

pp. 1370-1378 ◽

Cited By ~ 45

Author(s):

Monika Eichinger ◽

Claus-Peter Heussel ◽

Hans-Ulrich Kauczor ◽

Harm Tiddens ◽

Michael Puderbach

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Cystic Fibrosis ◽

Magnetic Resonance ◽

Lung Disease ◽

Cystic Fibrosis Lung ◽

Resonance Imaging ◽

Cystic Fibrosis Lung Disease

Download Full-text

Hyperpolarized Gas Magnetic Resonance Imaging of Pediatric Cystic Fibrosis Lung Disease

Academic Radiology ◽

10.1016/j.acra.2018.04.024 ◽

2019 ◽

Vol 26 (3) ◽

pp. 344-354 ◽

Cited By ~ 17

Author(s):

Giles Santyr ◽

Nikhil Kanhere ◽

Felipe Morgado ◽

Jonathan H. Rayment ◽

Felix Ratjen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cystic Fibrosis ◽

Magnetic Resonance ◽

Lung Disease ◽

Cystic Fibrosis Lung ◽

Resonance Imaging ◽

Hyperpolarized Gas ◽

Cystic Fibrosis Lung Disease

Download Full-text

Hyperpolarised 129Xe magnetic resonance imaging to monitor treatment response in children with cystic fibrosis

European Respiratory Journal ◽

10.1183/13993003.02188-2018 ◽

2019 ◽

Vol 53 (5) ◽

pp. 1802188 ◽

Cited By ~ 18

Author(s):

Jonathan H. Rayment ◽

Marcus J. Couch ◽

Nancy McDonald ◽

Nikhil Kanhere ◽

David Manson ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cystic Fibrosis ◽

Magnetic Resonance ◽

Lung Disease ◽

Treatment Response ◽

Forced Expiratory Volume ◽

Response To Therapy ◽

Breath Hold ◽

Pulmonary Exacerbation ◽

Resonance Imaging

Pulmonary magnetic resonance imaging using hyperpolarised 129Xe gas (XeMRI) can quantify ventilation inhomogeneity by measuring the percentage of unventilated lung volume (ventilation defect per cent (VDP)). While previous studies have demonstrated its sensitivity for detecting early cystic fibrosis (CF) lung disease, the utility of XeMRI to monitor response to therapy in CF is unknown. The aim of this study was to assess the ability of XeMRI to capture treatment response in paediatric CF patients undergoing inpatient antibiotic treatment for a pulmonary exacerbation.15 CF patients aged 8–18 years underwent XeMRI, spirometry, plethysmography and multiple-breath nitrogen washout at the beginning and end of inpatient treatment of a pulmonary exacerbation. VDP was calculated from XeMRI images obtained during a static breath hold using semi-automated k-means clustering and linear binning approaches.XeMRI was well tolerated. VDP, lung clearance index and the forced expiratory volume in 1 s all improved with treatment; however, response was not uniform in individual patients. Of all outcome measures, VDP showed the largest relative improvement (−42.1%, 95% CI −52.1–−31.9%, p<0.0001).These data support further investigation of XeMRI as a tool to capture treatment response in CF lung disease.

Download Full-text

Quantitative multivolume proton-magnetic resonance imaging in patients with cystic fibrosis lung disease: comparison with clinical indicators

European Respiratory Journal ◽

10.1183/13993003.02020-2017 ◽

2019 ◽

Vol 53 (5) ◽

pp. 1702020 ◽

Cited By ~ 4

Author(s):

Francesca Pennati ◽

Caterina Salito ◽

Irene Borzani ◽

Giulia Cervellin ◽

Simone Gambazza ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cystic Fibrosis ◽

Magnetic Resonance ◽

Lung Disease ◽

Proton Magnetic Resonance ◽

Magnetic Resonance Images ◽

Imaging Biomarkers ◽

Resonance Imaging ◽

Clinical Indicators ◽

Proton Magnetic Resonance Imaging

This cross-sectional study aims to verify the relationship between quantitative multivolume proton-magnetic resonance imaging (1H-MRI) and clinical indicators of ventilatory abnormalities in cystic fibrosis (CF) lung disease.Non-enhanced chest MRI, spirometry and multiple breath washout was performed by 28 patients (10–27 years) with CF lung disease. Images acquired at end-inspiration and end-expiration were registered by optical flow to estimate expiratory–inspiratory proton-density change (Δ1H-MRI) as a measure of regional ventilation. Magnetic resonance images were also evaluated using a CF-specific scoring system.Biomarkers of CF ventilation impairment were defined from the Δ1H-MRI as follows: Δ1H-MRI median, Δ1H-MRI quartile coefficient of variation (QCV) and percentage of low-ventilation volume (%LVV). Imaging biomarkers correlated to all the clinical measures of ventilation abnormality, with the strongest correlation between Δ1H-MRI median and forced expiratory volume in 1 s (r2=0.44, p<0.001), Δ1H-MRI QCV and lung clearance index (LCI) (r2=0.51, p<0.001) and %LVV and LCI (r2=0.66, p<0.001). Correlations were also found between imaging biomarkers of ventilation and morphological scoring.The study showed a significant correlation between quantitative multivolume MRI and clinical indicators of CF lung disease. MRI, as a non-ionising imaging technique, may be particularly attractive in CF care for longitudinal evaluation, providing a new imaging biomarker to detect early ventilatory abnormalities.

Download Full-text