Lung MRI to predict response or lack of response to treatment in interstitial lung disease: initial observations on SSFSE/PROPELLER T2 match/mismatch

ABSTRACT

Background

Ground-glass opacities (GGO) are frequently found in interstitial lung diseases (ILD) and may represent either active inflammation or subresolution interstitial fibrosis. We sought to investigate the ability of lung MRI to predict treatment response in individuals with ILD presenting with predominant GGO. Methods: prospective cohort, 15 participants 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. SSFSE/PROPELLER T2 mismatch sign, relative signal intensity on T2-weighted images and relative enhancement of lung lesions were compared to functional response, defined as a greater than 10% increase in forced vital capacity in 10 weeks (primary endpoint).

Results

SSFSE/PROPELLER T2 match/mismatch was able to discriminate responders from nonresponders for the primary endpoint 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 interrater 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).

Conclusions

SSFSE-PROPELLER T2 match/mismatch was predictive of treatment response status in this group of ILD patients.

Abbreviations

FVC: forced vital capacityGGO; ground-glass opacities; HRCT: High-Resolution Computed Tomography; ILD: interstitial lung disease; LAVA: Liver Acquisition with Volume Acceleration; mMRC: modified Medical Research Council dyspnea score; MRI: Magnetic Resonance Image; PROPELLER: Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction; SI: signal intensity; SSFSE: Single-Shot Fast Spin Echo

KEYWORDS:

• Interstitial lung disease
• magnetic resonance imaging
• treatment outcome
• ground-glass opacities
• connective tissue disease

Article highlights

• Pulmonary ground-glass opacities (GGO) on HRCT can represent either reversible inflammation or subresolution irreversible fibrosis.

• Treatment with anti-inflammatory or immunosuppressive drugs may be detrimental in patients with fibrotic ILD and should be avoided.

• Lung MRI can depict GGO with distinct appearances in different pulse sequences.

• SSFSE/PROPELLER T2 match/mismatch may help predict response to anti-inflammatory/immunosuppressive agents in ILD presenting with predominant GGO, with high accuracy and high interrater agreement.

Acknowledgments

The authors thank Dr. Mayra Veloso Ayrimoraes Soares and Dr. Vitor Xavier de Oliveira Neto for their invaluable contribution as readers for the interrater agreement assessment.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

Each author has made substantial contributions to this paper and has approved the submitted version. Wagner Diniz de Paula wrote the majority of the paper, discussed the conception and design, acquired radiological data and took part in analyses and interpretation. Marcelo Palmeira Rodrigues discussed the conception and design, acquired clinical data and took part in analyses and interpretation, and revised extensively the text. Nathali Mireise Costa Ferreira discussed the conception and design, acquired clinical data and took part in analyses and interpretation. Viviane Vieira Passini discussed the conception and design, acquired clinical data and took part in analyses and interpretation. César Augusto Melo e Silva discussed the conception and design, took part in analyses and interpretation, and revised extensively the text

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.