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3-T MRI for Differentiating Inflammation- and Fibrosis-Predominant Lesions of Usual and Nonspecific Interstitial Pneumonia: Comparison Study with Pathologic Correlation

¹ Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Gangnam-gu, Seoul 135-710, Korea.
² Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
³ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

OBJECTIVE. The purpose of our study was to evaluate the utility of 3-T MRI of the lung for differentiating inflammation- and fibrosis-predominant lesions in the usual and nonspecific types of interstitial pneumonia.

SUBJECTS AND METHODS. The subjects were 26 patients (10 men, 16 women; mean age, 57 ± 9 [SD] years; 16 with nonspecific interstitial pneumonia; 10 with usual interstitial pneumonia) who underwent 3-T MRI of the lung and surgical biopsy. A total of 54 biopsy sites were classified histopathologically into two groups: inflammation predominant and fibrosis predominant. After a T2-weighted triple-inversion black blood turbo spin-echo (TSE) sequence, dynamic MRI was performed with a T1-weighted 3D turbo field-echo sequence (coronal images with 2.5-mm slice thickness) before and 1, 3, 5, and 10 minutes after IV contrast injection. The chi-square test was used to compare differences in signal intensity on T2-weighted triple-inversion black blood TSE MR images and visually assessed enhancement patterns at dynamic MRI for the inflammation- and fibrosis-predominant sites.

RESULTS. Inflammation-predominant specimens were obtained from 31% (17 of 54) of the biopsy sites. Inflammation-predominant biopsy sites had an early enhancement pattern (82%, 14 of 17 sites, p < 0.001) on dynamic studies and high signal intensity (53%, nine of 17 sites, p = 0.001) on T2-weighted triple-inversion black blood TSE images.

CONCLUSION. Multiphase dynamic enhancement studies with a turbo field-echo sequence and T2-weighted triple-inversion black blood TSE images on 3-T MRI appear to be useful for differentiating inflammation- and fibrosis-predominant lesions.

Keywords: idiopathic interstitial pneumonia • MRI • 3 T