A team of researchers discovered that dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) can be used to detect changes in the microvasculature and extravascular extracellular space of the lungs in patients with idiopathic pulmonary fibrosis (IPF). The new study was published in ERJ Open Research.
Medical literature suggests IPF is associated with pulmonary circulatory abnormalities that eventually cause an increase in vascular permeability, which might confer important prognostic information. How can these changes be tracked best?
“DCE-MRI is a powerful technique whereby continuous, sequential imaging is performed before, during and after the injection of an intravenous contrast agent,” Montesi et al wrote. They hypothesized that it could be used to monitor microvascular changes in IPF.
The research team recruited 16 patients with IPF and 17 healthy controls and performed a DCE-MRI of the thorax using the contrast agent gadoterate meglumine. They defined 4 regions of interest:
- Upper: level of aortic arch
- Middle: level of the bifurcation of the pulmonary artery trunk
- Lower: just above the diaphragm
- Whole lung: lung parenchyma across all imaging slices.
For the patients with IPF, they tracked disease progression by referring to their medical records for pulmonary function test results. These included parameters such as forced vital capacity and diffusing capacity for carbon monoxide corrected for hemoglobin.
Read more about IPF testing
“When compared to healthy controls, IPF subjects had reduced peak enhancement and kwashin [rate of contrast arrival], parameters reflective of the microvasculature, in all measured lung regions on unadjusted analyses, and only reductions in kwashin in the whole lung, lower axial and posterior coronal regions remained statistically significant when adjusting for age,” Montesi and colleagues wrote.
In addition, the research team discovered that DCE-MRI can be used to clearly discriminate between IPF patients with stable disease and those with rapidly progressive disease. They concluded that information revealed through DCE-MRI can have prognostic and therapeutic implications for IPF patients.
Montesi SB, Zhou IY, Liang LL, et al. Dynamic contrast-enhanced magnetic resonance imaging of the lung reveals important pathobiology in idiopathic pulmonary fibrosis. ERJ Open Res. Published online November 8, 2021. doi:10.1183/23120541.00907-2020