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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.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —48-year-old woman with nonspecific interstitial pneumonia (group 1, cellular). Photograph of pathologic specimen at low magnification shows predominant inflammation. Scores for individual histologic features were interstitial mononuclear cell infiltration, 2; intraalveolar macrophages and exudates, 2; established fibrosis, 10. (H and E, x100)

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —47-year-old woman with nonspecific interstitial pneumonia (group 3, fibrotic). Photograph of pathologic specimen at high magnification shows advanced fibrosis. Scores for individual histologic features were interstitial mononuclear cell infiltration, 1; intraalveolar macrophages and exudates, 1; established fibrosis, 50. (H and E, x200)

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —59-year-old woman with active inflammatory idiopathic interstitial pneumonia: nonspecific interstitial pneumonia (group 1, cellular) with acute exacerbation. Coronal T2-weighted triple-inversion black blood turbo spin-echo image shows bilateral high-signal-intensity lesions (arrows) in lower lung zones. Histopathologic examination of biopsy specimen obtained from right lower lobe disclosed active inflammatory disease.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —64-year-old woman with fibrotic idiopathic interstitial pneumonia: nonspecific interstitial pneumonia (group 3, fibrotic). Coronal T2-weighted triple-inversion black blood turbo spin-echo image shows signal intensity of lesions (arrows) in both lower lobes is similar to that of adjacent chest wall muscles. Histopathologic examination of biopsy specimen obtained from left lower lobe disclosed advanced pulmonary fibrosis.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —55-year-old woman with pattern 1 nonspecific interstitial pneumonia (group 1, cellular) exhibiting early enhancement and washout. Transverse high-resolution CT scan (1.25-mm section thickness) at level of liver dome shows subpleural patchy parenchymal opacities (arrows) in both lungs.

View larger version (101K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —55-year-old woman with pattern 1 nonspecific interstitial pneumonia (group 1, cellular) exhibiting early enhancement and washout. Serial dynamic MR images show early enhancement with delayed washout pattern (arrow). Biopsy was performed on lesions in left upper and lower lobes. Pathologic specimens disclosed inflammation-predominant nonspecific interstitial pneumonia (group 1, cellular).

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —55-year-old woman with pattern 1 nonspecific interstitial pneumonia (group 1, cellular) exhibiting early enhancement and washout. Serial dynamic MR images show early enhancement with delayed washout pattern (arrow). Biopsy was performed on lesions in left upper and lower lobes. Pathologic specimens disclosed inflammation-predominant nonspecific interstitial pneumonia (group 1, cellular).

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —55-year-old woman with pattern 1 nonspecific interstitial pneumonia (group 1, cellular) exhibiting early enhancement and washout. Serial dynamic MR images show early enhancement with delayed washout pattern (arrow). Biopsy was performed on lesions in left upper and lower lobes. Pathologic specimens disclosed inflammation-predominant nonspecific interstitial pneumonia (group 1, cellular).

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —55-year-old woman with pattern 1 nonspecific interstitial pneumonia (group 1, cellular) exhibiting early enhancement and washout. Serial dynamic MR images show early enhancement with delayed washout pattern (arrow). Biopsy was performed on lesions in left upper and lower lobes. Pathologic specimens disclosed inflammation-predominant nonspecific interstitial pneumonia (group 1, cellular).

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5F —55-year-old woman with pattern 1 nonspecific interstitial pneumonia (group 1, cellular) exhibiting early enhancement and washout. Serial dynamic MR images show early enhancement with delayed washout pattern (arrow). Biopsy was performed on lesions in left upper and lower lobes. Pathologic specimens disclosed inflammation-predominant nonspecific interstitial pneumonia (group 1, cellular).

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —70-year-old man with pattern 2 usual interstitial pneumonia exhibiting slight enhancement. Coronal thin-section (2.5-mm section thickness) CT scan shows subpleural honeycombing and reticulation (arrows) in both lungs.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —70-year-old man with pattern 2 usual interstitial pneumonia exhibiting slight enhancement. Serial dynamic MR images show slight enhancement. Biopsy was performed on lesions in right lower lobe. Pathologic specimens disclosed fibrosis-predominant usual interstitial pneumonia.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —70-year-old man with pattern 2 usual interstitial pneumonia exhibiting slight enhancement. Serial dynamic MR images show slight enhancement. Biopsy was performed on lesions in right lower lobe. Pathologic specimens disclosed fibrosis-predominant usual interstitial pneumonia.

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —70-year-old man with pattern 2 usual interstitial pneumonia exhibiting slight enhancement. Serial dynamic MR images show slight enhancement. Biopsy was performed on lesions in right lower lobe. Pathologic specimens disclosed fibrosis-predominant usual interstitial pneumonia.

View larger version (175K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E —70-year-old man with pattern 2 usual interstitial pneumonia exhibiting slight enhancement. Serial dynamic MR images show slight enhancement. Biopsy was performed on lesions in right lower lobe. Pathologic specimens disclosed fibrosis-predominant usual interstitial pneumonia.

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6F —70-year-old man with pattern 2 usual interstitial pneumonia exhibiting slight enhancement. Serial dynamic MR images show slight enhancement. Biopsy was performed on lesions in right lower lobe. Pathologic specimens disclosed fibrosis-predominant usual interstitial pneumonia.

View larger version (103K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —48-year-old woman with pattern 3 nonspecific interstitial pneumonia (group 3) exhibiting delayed persistent enhancement. Transverse high-resolution CT scan (1.25-mm section thickness) at liver dome level shows patchy ground-glass opacities (arrows) containing reticulation and traction bronchiectasis in both lower lobes.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —48-year-old woman with pattern 3 nonspecific interstitial pneumonia (group 3) exhibiting delayed persistent enhancement. Serial dynamic MR images show delayed persistent enhancement. Biopsy was performed on lesions in left lower lobe. Pathologic specimens disclosed fibrosis-predominant nonspecific interstitial pneumonia (group 3).

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —48-year-old woman with pattern 3 nonspecific interstitial pneumonia (group 3) exhibiting delayed persistent enhancement. Serial dynamic MR images show delayed persistent enhancement. Biopsy was performed on lesions in left lower lobe. Pathologic specimens disclosed fibrosis-predominant nonspecific interstitial pneumonia (group 3).

View larger version (161K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7D —48-year-old woman with pattern 3 nonspecific interstitial pneumonia (group 3) exhibiting delayed persistent enhancement. Serial dynamic MR images show delayed persistent enhancement. Biopsy was performed on lesions in left lower lobe. Pathologic specimens disclosed fibrosis-predominant nonspecific interstitial pneumonia (group 3).

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7E —48-year-old woman with pattern 3 nonspecific interstitial pneumonia (group 3) exhibiting delayed persistent enhancement. Serial dynamic MR images show delayed persistent enhancement. Biopsy was performed on lesions in left lower lobe. Pathologic specimens disclosed fibrosis-predominant nonspecific interstitial pneumonia (group 3).

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7F —48-year-old woman with pattern 3 nonspecific interstitial pneumonia (group 3) exhibiting delayed persistent enhancement. Serial dynamic MR images show delayed persistent enhancement. Biopsy was performed on lesions in left lower lobe. Pathologic specimens disclosed fibrosis-predominant nonspecific interstitial pneumonia (group 3).

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