Wagner Diniz de Paula
◽
Marcelo Palmeira Rodrigues
◽
Nathali Mireise Costa Ferreira
◽
Viviane Vieira Passini
◽
César Augusto Melo e Silva
Abstract
BackgroundHigh-resolution chest computed tomography (HRCT) signs of interstitial lung disease (ILD) are varied, some corresponding to irreparable parenchymal destruction and fibrosis, others representing potentially reversible changes, such as fine reticulation and ground-glass opacities (GGO). GGO frequently correspond to sites of active inflammation that may be responsive to steroids or immunosuppressive agents, but they might also represent intralobular interstitial fibrosis not resolved by current HRCT technique. Our aim was to investigate the ability of lung MRI to predict treatment response in individuals with ILD presenting with predominant GGO.MethodsIn this prospective cohort, 15 participants (4 male and 11 female) aged 38–84 years, presenting with ILD manifested as predominant GGO and referred for a new treatment regimen with a systemic glucocorticoid and/or an immunosuppressive agent, underwent 1.5 T lung MRI with breath-hold (SSFSE) and respiratory-gated (PROPELLER) T2-weighted pulse sequences, and with dynamic contrast-enhanced fat-suppressed T1-weighted pulse sequence (LAVA). Relative signal intensity on T2-weighted images and relative enhancement of lung lesions were compared to functional response in a dichotomous fashion (response versus non-response) with t test for independent samples. SSFSE/PROPELLER T2 mismatch was compared to response with Fisher’s exact test. Inter-rater agreement was evaluated with Cohen’s kappa coefficient. The primary endpoint for response was a greater than 10% increase in forced vital capacity in 10 weeks.ResultsResponders (4/15, 27%) and non-responders (11/15, 73%) showed similar relative signal intensity on T2-weighted images and relative enhancement measurements. SSFSE/PROPELLER T2 mismatch was able to discriminate responders from non-responders in 12 of 15 participants (80% accuracy, p = 0.026) for readers 1 and 2, and in 13 of 15 participants (87% accuracy, p = 0.011) for reader 3, with inter-rater agreement of 87% between readers 1 and 2 (Cohen’s kappa coefficient of 0.732) and 93% between readers 1/2 and 3 (Cohen’s kappa coefficient of 0.865).ConclusionsSSFSE-PROPELLER T2 mismatch was predictive of lack of response to treatment in this small group of ILD patients presenting with predominant GGO at HRCT.Key PointSSFSE/PROPELLER T2 mismatch may help predict lack of response to anti-inflammatory/immunosuppressive treatment in interstitial lung disease, with high accuracy and high inter-rater agreement.