Clinical usability of 3D gradient-echo-based ultrashort echo time imaging: Is it enough to facilitate diagnostic decision in real-world practice?

Our plain-English summary of Clinical usability of 3D gradient-echo-based ultrashort echo time imaging: Is it enough to facilitate diagnostic decision in real-world practice?, by S.H. Bak, J. Park, S. Lee, et al (PloS One, 2024).

The study

• Authors: S.H. Bak, J. Park, S. Lee, J.H. Kim, H.Y. Lee, J.Y. Park
• Journal: PloS One
• Published: 2024;19(5):e0296696
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: With recent advances in magnetic resonance imaging (MRI) technology, the practical role of lung MRI is expanding despite the inherent challenges of the thorax. The purpose of our study was to evaluate the current status of the concurrent dephasing and excitation (CODE) ultrashort echo-time sequence and the T1-weighted volumetric interpolated breath-hold examination (VIBE) sequence in the evaluation of thoracic disease by comparing it with the gold standard computed tomography (CT).

Methods: Twenty-four patients with lung cancer and mediastinal masses underwent both CT and MRI including T1-weighted VIBE and CODE. For CODE images, data were acquired in free breathing and end-expiratory images were reconstructed using retrospective respiratory gating. All images were evaluated through qualitative and quantitative approaches regarding various anatomical structures and lesions (nodule, mediastinal mass, emphysema, reticulation, honeycombing, bronchiectasis, pleural plaque and lymphadenopathy) inside the thorax in terms of diagnostic performance in making specific decisions.

Results: Depiction of the lung parenchyma, mediastinal and pleural lesion was not significant different among the three modalities (p > 0.05). Intra-tumoral and peritumoral features of lung nodules were not significant different in the CT, VIBE or CODE images (p > 0.05). However, VIBE and CODE had significantly lower image quality and poorer depiction of airway, great vessels, and emphysema compared to CT (p < 0.05). Image quality of central airways and depiction of bronchi were significantly better in CODE than in VIBE (p < 0.001 and p = 0.005). In contrast, the depiction of the vasculature was better for VIBE than CODE images (p = 0.003). The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were significant greater in VIBE than CODE except for SNRlung and SNRnodule (p < 0.05).

Conclusions: Our study showed the potential of CODE and VIBE sequences in the evaluation of localized thoracic abnormalities including solid pulmonary nodules.

Copyright: © 2024 Bak et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

In plain English

This prospective study compared two chest magnetic resonance imaging (MRI) methods, VIBE and CODE, with computed tomography (CT), which the authors used as the reference standard. The article does not mention asbestos. It included 24 patients (17 males, 7 females) scanned between June 2019 and January 2020 for lung cancer (20 patients) or a mediastinal mass (4 patients). Both MRI methods had significantly lower image quality than CT for large airways and great vessels. Emphysema was significantly less well shown than on CT with VIBE but not with CODE, and emphysema severity scores were significantly lower with both MRI methods. Apart from emphysema, image quality for lung, mediastinal and pleural lesions did not differ significantly among the three methods. Only one patient had a pleural plaque. It was seen on CT and on both MRI methods. Its scores were 5.0 for CT and 3.0 plus or minus 2.8 for each MRI method, not a statistically significant difference. CODE showed the large airways and bronchi better than VIBE. The authors concluded that the study showed the potential of both MRI methods for localized chest abnormalities, including solid lung nodules. They said larger studies are needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective imaging comparison study: chest MRI with two sequences (VIBE and CODE) compared against CT as the reference standard in the same patients
• Who was studied: 24 patients (17 males, 7 females; mean age 60.3 years, range 16.0 to 77.0) with both chest CT and MRI, out of 26 consecutive patients scanned from June 2019 to January 2020; MRI ordered for lung cancer (n = 20) or mediastinal mass (n = 4)
• Exposure: Not applicable: no asbestos or occupational exposure was studied, and the article does not mention asbestos. What was compared was imaging methods: CT versus MRI with T1-weighted VIBE and CODE ultrashort echo-time sequences.
• Main results:
  • Compared with CT, both VIBE and CODE MRI had significantly lower image quality and poorer depiction of airways and great vessels (p less than 0.05 for each comparison in Table 1)
  • Depiction of emphysema (9 patients): CT 5.0 ± 0.0, VIBE 3.7 ± 1.3, CODE 3.9 ± 1.4. This was significantly poorer than CT for VIBE (p = 0.042) but not for CODE (p = 0.101).
  • Emphysema severity score (24 patients): CT 2.6 ± 0.5, VIBE 1.8 ± 0.4, CODE 1.9 ± 0.3. Both MRI methods were significantly lower than CT (p = 0.003 for VIBE, p = 0.010 for CODE).
  • Except for emphysema, image quality of lung parenchymal, mediastinal and pleural lesions did not differ significantly among CT, VIBE and CODE (p greater than 0.05)
  • Pleural plaque was present in only one patient (N = 1). It was shown on CT and on both MRI sequences. Mean scores were CT 5.0 ± 0.0, VIBE 3.0 ± 2.8 and CODE 3.0 ± 2.8 (overall p = 0.650, not statistically significant).
  • Image quality of the central airway and depiction of bronchi were significantly better with CODE (4.1±0.4 and 3.9±0.5) than with VIBE (3.0±0.8 and 3.4±0.7; p less than 0.001 and p = 0.005)
  • Depiction of the intrapulmonary vasculature was better with VIBE (5.0±0.0) than with CODE (4.8±0.4, p = 0.003)
  • For the 23 lung nodules, intra-tumoral and peritumoral features did not differ significantly between CT, VIBE and CODE (p greater than 0.05)
  • Signal-to-noise ratio of the lung parenchyma was significantly lower with VIBE (21.1 ± 12.9) than with CODE (91.2 ± 12.3, p less than 0.001)
  • Mean scan time was 12.38 seconds for VIBE and 10 minutes 40 seconds for CODE
• The authors' conclusion: The authors concluded that the study showed the potential of CODE and VIBE sequences for evaluating localized thoracic abnormalities, including solid pulmonary nodules
• Limitations the authors state:
  • Apart from lung nodules, the number of other lesions was very small, limiting evaluation
  • Few part-solid and ground-glass nodules, so their evaluation was limited
  • Further validation is needed in large prospective studies
  • Differences in slice thickness and respiratory gating between VIBE and CODE may affect image quality evaluation
  • CODE can show streak artifacts if the field of view is not large enough
  • CODE takes much longer to scan than VIBE

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Thorax, Lung Cancer, Emphysema, Honeycombing, Pleural Plaques, Lymphadenopathy, Parenchyma, Bronchus.

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