RPS 1304 - Advances in MRI for pulmonary imaging

Author Block: N. D. I. Colomba, P. Bica, F. Corrao, C. Zichichi, M. Molino; Trapani/IT
Purpose: Interstitial lung disease (ILD) is a common complication in patients with connective tissue disease (CTD). The ILD is generally quantified with HRCT. The purpose of the study is to identify a qualitative evaluation of the CTD-ILD and eventually a biomarker of worsening with the MRI.
Methods or Background: We optimized an MRI thorax protocol with a T2W fat sat breath-gated sequences which enhance the fluids. The study started in January 2025 and we selected so far twelve patients with mild to advanced stage CTD-ILD. Only patient with serological or sistemic simphtoms worsening has been enrolled. All patients took a first MRI scan followed by a second scan six months later.
Results or Findings: We found a similar pattern in almost all patient with hyperintensity in the subpleural regions of the inferior lobes usually in the context of honey combing areas. Since only water has a high signal in the sequence we used those alterations found in our patiens are very likely to be oedema. We found the amount of oedema was not strictly related to the stage of the ILD. In our group six patients with moderate to severe oedema alterations were basically stable at the six months follow-up. Three patients had a slight remission of the oedema while tree had a subtle worsening. Among the three of the last group two had a real worsening of the stage of the ILD in the following HRCT scans.
Conclusion: Our preliminary results suggest that the presence and the evolution of oedema in the MRI scan could relate the potential likelihood of worsening of ILD. We definitely need more patients and a longer follow-up. The study is still in progress.
Limitations: No limitations were identified.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: D. Cetiner¹, P. Leutz-Schmidt¹, M. Stahl², O. Sommerburg¹, C. P. Heußel¹, H-U. Kauczor¹, M. A. Mall², M. O. Wielpütz³, L. Wucherpfennig¹; ¹Heidelberg/DE, ²Berlin/DE, ³Greifswald/DE
Purpose: Bronchial arterial dilatation (BAD) is known to be associated with pulmonary hemorrhage and is highly prevalent in patients with chronic muco-obstructive lung diseases such as cystic fibrosis. However, studies on the prevalence of BAD in patients with primary ciliary dyskinesia (PCD) and their association with lung disease severity are lacking. Thus, the aim of our study is to evaluate BAD onset and its association with disease severity in patients from two different centers with PCD by magnetic resonance imaging (MRI).
Methods or Background: 68 patients with PCD (mean age at baseline 17.3±14.4 yr) performed annual standardized MRI including dynamic contrast-enhanced (DCE) MRI or angiography, contributing to a total of 155 examinations. The presence of BAD was assessed visually by two readers in consensus. Disease severity was assessed using the validated chest MRI score and spirometry (percent predicted forced expiratory volume in 1s [ppFEV1]).
Results or Findings: At baseline, at least one BAD was present in 30 patients (44.1%), with most patients having one or two BAD (53.3% and 26.6%, respectively). The number of BAD correlated strongly with patient age (r=0.641, p<0.001). The mean MRI global score was significantly higher in patients with BAD at baseline compared to patients without BAD (26.3±6.7 vs. 19±8.1, p=0.002), while ppFEV1 did not show differences (76.2±20.8% vs. 73.1±18.5%, p=0.57). During follow-up, four patients developed a BAD for the first time (5.8%) and three patients (4.4%) developed an additional BAD. BAD development was neither associated with changes in the MRI score, nor in ppFEV1 (p>0.99 and p=0.87).
Conclusion: Our study demonstrates a high prevalence of BAD in children and adults with PCD and an association between prevalence of BAD markers of greater disease severity.
Limitations: Not all patients received angiography additional to DCE-MRI.
Funding for this study: This study was supported by grants from the German Federal Ministry of Education and Research (BMBF) (82DZL004A1, 82DZL009C1 and 01GL2401A) and the German Research Foundation (CRC 1449 – project 431232613). MS is participant of the BIH-Charité Clinician Scientist Program funded by the Charité – Universitätsmedizin Berlin and the BIH. LW is participant of the Career Development Programm funded by the University of Heidelberg. Funders had no involvement in the collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the article for publication.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethic commitee approval number: S-509/2019, S-184/2025, EA2/003/21
University Hospital Heidelberg

Author Block: M. Kumar¹, K. K. Ratre², A. Rai², A. Agrawal², V. Kumar²; ¹Raipur, Chhatisgarh/IN, ²Raipur/IN
Purpose: To identify characteristic imaging features of atypical thoracic hydatid disease on multimodality imaging
To emphasize the importance of imaging in guiding clinical management and surgical planning in complicated hydatid disease.
Methods or Background: 6 patients with confirmed thoracic hydatid disease were retrospectively evaluated using CXR, ultrasound, CECT and MRI. Findings were correlated with clinical and surgical outcomes.
Results or Findings: 1.Extrapleural hydatid

CXR demonstrated homogeneous radiodense lesion in the left upper zone which on CT appeared solid non-enhancing. MRI revealed a multilocular cystic lesion with internal T2 hypointense membranes located outside the pleural cavity with cervical extension and compressing the left brachial plexus.

2.Endobronchial and pleural rupture of pulmonary hydatid cyst with air and fluid in pleural space.


3.Pleural hydatidosis secondary to ruptured pulmonary hydatid

CECT revealed multiple cystic lesions in the lung parenchyma bilaterally with left sided effusion & one of them showing rupture into the left pleural space. Multilocular lesion was seen in the left pleural cavity with pleural thickening, internal membranes and hydatid sand.

4.Primary pleural hydatid

Chest CT reveals presence of moderate sized pleural effusion and a large lesion inseparable from the collapsed right lower lobe. Ultrasound showed a multilocular cystic lesion outside the lung.

5.Calcification within pulmonary hydatid cysts.

CECT revealed solitary/ multiple lesions with calcification in the wall or membranes.
Conclusion: Pleural hydatid cysts may be primary or secondary to rupture of pulmonary cysts.
Ultrasound is superior to CT in characterisation of pleural lesions/disease.
Extrapleural hydatid disease can mimic chest wall or pleural tumors.
Calcification represents chronicity.
MRI is reserved for unusual cases like extrapleural or mediastinal lesions.
Identifying pleural rupture is paramount as it needs emergency chest tube placement or planned surgical decortication in refractory cases.
Limitations: Less number of cases
Funding for this study: None recived.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: G. Piccinni, A. Palmisano, D. Serra, E. Bruno, A. Esposito; Milano/IT
Purpose: Evaluate the performance of a single breath-hold accelerated 3D-T1-FFE 3T MRI sequence for the screening of lung nodules using Photon-Counting Detector CT as the reference standard.
Methods or Background: This single-center prospective study enrolled 97 healthy adults who underwent Photon-Counting Detector CT scans after pulmonary nodules were detected by 3T whole-body magnetic resonance imaging (3D-T1-FFE with AI and breath-hold) between June 2024 and June 2025. All nodules were evaluated in terms of size and composition and sensitivity of MRI in comparision to PCD-CT in nodule detection capability was calculated. Intermodality agreement was assessed with the Prevalence-Adjusted Bias-Adjusted Kappa and Lin’s Concordance Correlation Coefficient.
Results or Findings: Using CT as the reference standard, MRI achieved a specificity of 97.0% (95% CI: 84.7–99.5) and a positive predictive value of 98.7% (95% CI: 93.1–99.8), indicating that nearly all nodules detected by MRI were true positives. Stratifying lesions by size (<4 mm vs. ≥4 mm), MRI showed a sensitivity of 60.8% (95% CI: 49.7–70.8), specificity of 89.7% (95% CI: 76.4–95.9), PPV of 92.3% (95% CI: 81.8–97.0), NPV of 53.0% (95% CI: 41.2–64.6), and an overall accuracy of 70.3% (95% CI: 61.6–77.8) compared with CT . Stratifying by composition, MRI demonstrated excellent ability to identify solid nodules with a sensitivity of 86.3% (95% CI: 76.6–92.4), specificity of 100% (95% CI: 92.1–100), PPV of 100% (95% CI: 94.3–100), NPV of 81.8% (95% CI: 69.7–89.8), and an accuracy of 91.5% (95% CI: 85.1–95.3), indicating that MRI has an excellent accuracy for detection of solid nodule, whereas false negatives occur in calcific lesions.
Conclusion: A single breath-hold accelerated 3D-T1-FFE MRI scan is a fast valuable tool for solid lung nodule screening with an excellent agreement with CT.
Limitations: Small patient sample.
Funding for this study: No.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the local Ethic Commitee (AIMOMICS-BANK CET 233-2024), and written informed consent was obtained.

Author Block: Y. Ozawa, T. Ueda, M. Nomura, T. Yoshikawa, D. Takenaka, Y. Ohno; Toyoake/JP
Purpose: Zonally magnified oblique multi-slice DWI (Zoom DWI) enables a smaller field of view than conventional DWI (cDWI), reducing aliasing and echo planar imaging distortion. However, Zoom DWI’s impact on image quality and apparent diffusion coefficient (ADC) measurements in mediastinal lesions remains unexplored. This study compared Zoom DWI with cDWI in terms of image quality and ADC assessment.
Methods or Background: Thirty patients with mediastinal lesions underwent STIR, Zoom DWI, and cDWI on a 3T MR system. Tumor long- and short-axis diameters (LA and SA) were measured on STIR and each DWI for distortion evaluation. ADC values and signal-to-noise ratios (SNR) of tumor and muscle were obtained from ROI analyses. Two radiologists assessed image quality, artifacts, and diagnostic confidence. Spearman’s correlation and Bland-Altman analysis evaluated diameter agreement, while paired t-tests or Wilcoxon tests compared quantitative and qualitative indices.
Results or Findings: On correlation between STIR and each DWI, Zoom DWI (LA and SA: r=0.99, p<0.0001) showed significant and better correlations than cDWI (LA: r=0.98, p<0.0001; SA: r=0.97, p<0.0001). The limits of agreement (mean, SD) of Zoom DWI (LA: -0.8, 3.4 mm, SA: -0.3, 1.6 mm) were smaller than those of cDWI (LA: -4.1, 4.4 mm, SA: -2.6, 2.2 mm). ADC values of tumor on Zoom DWI was significantly higher than that of cDWI (p< 0.01). Zoom DWI showed significantly better qualitative image quality indices than cDWI (p<0.01).
Conclusion: Zoom DWI has the potential to reduce image distortion and enhance image quality, as well as influence tumor ADC measurements, compared with conventional DWI.
Limitations: First, relatively small number of the cases. Second, explore of further clinical Utility for diagnosis of mediastinal lesions is needed.
Funding for this study: No funding was provided for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Institutional Review Board HM24-283

Author Block: W. Yang, Q. Feng, X. Chen, X. Xin; Nanjing/CN
Purpose: This study aimed to evaluate the predictive value of spectral CT-derived histogram features for progression-free survival (PFS) in patients with advanced NSCLC undergoing immunotherapy.
Methods or Background: This retrospective study included 43 patients who underwent baseline spectral contrast-enhanced CT prior to immunotherapy and a first follow-up scan at three months, with progression-free survival (PFS) recorded. Spectral image series-including conventional images, 40/70 keV virtual monoenergetic images (VMI), iodine density, effective atomic number, electron density, and water/iodine-based maps-were reconstructed in arterial and venous phases. Lesions were segmented on VMI-40 keV images for extraction of histogram features. Significant predictors were selected using univariate and variance inflation factor analyses, followed by Cox proportional hazards regression. Patients were stratified into high- and low-risk groups based on Cox-derived risk scores (median cutoff). Kaplan–Meier (KM) analysis compared PFS between groups, and model performance was evaluated by concordance index (C-index).
Results or Findings: At follow-up, 12 patients (26.1%) remained progression-free, while 34 (73.9%) progressed (PFS range: 1.7–25 months, mean 9.05 ± 5.61). Three baseline features yielded a Cox model with a C-index of 0.72. Ten follow-up features achieved the same C-index. KM analysis showed significant PFS differences between high- and low-risk groups (log-rank p < 0.01). Median 12-month survival was markedly shorter in high-risk groups compared with low-risk groups.
Conclusion: Histogram features derived from spectral CT at baseline or early follow-up are significant predictors of immunotherapy response and PFS in advanced NSCLC, offering potential for early risk stratification.
Limitations: Sample size is small.
Funding for this study: Not applicable.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the Institutional Ethics Committee. The requirement for informed consent was waived due to the retrospective nature of the analysis.

Author Block: Y. Ozawa¹, T. Ueda¹, M. Nomura¹, T. Yoshikawa¹, D. Takenaka¹, M. Endo², Y. Ohno¹; ¹Toyoake/JP, ²Shizuoka/JP
Purpose: To directly compare the quantitative capabilities of regional perfusion and pulmonary functional change assessment among electrocardiogram (ECG-) and photoplethysmography (PPG-) phase-resolved functional lung (PREFUL) MRIs and dynamic contrast-enhanced (CE-) perfusion MRI in thoracic oncologic patients.
Methods or Background: 17 thoracic oncologic patients prospectively underwent ECG- and PPG-gated PREFUL MRI, dynamic CE-perfusion MRI and pulmonary function test. Then, quantitatively assessed ECG- and PPG-gated perfusion-weighted (PW-) MRI and perfusion map from dynamic CE-perfusion MRI were generated. On each method, regional perfusions were determined by ROI measurements, and overall perfusion was determined as average value of ROI measurements. Then, Pearson’s correlations were performed to determine relationship among all regional perfusions. On comparison of regional perfusion among ECG- and PPG-gated PW-MRI and quantitative perfusion maps, Tukey’s HSD test was performed. To assess pulmonary functional loss on each MRI method, each overall perfusion was correlated with %VC and %FEV1 by Pearson’s correlation.
Results or Findings: Correlation of regional perfusion between ECG- and PPG-gated PW-MRIs was determined as significant and good (r=0.79, p<0.0001). However, correlations between ECG- or PPG-gated PW-MRIs and quantitative perfusion map were assessed as significant and fair (ECG: r=0.4, p<0.0001; PPG: r=0.36, p<0.0001). ECG- and PPG-gated PW-MRI demonstrated significantly higher perfusion than quantitative perfusion map (p<0.0001). Moreover, ECG-and PPG-gated PW-MRIs and quantitative perfusion map had significant and moderate correlations with them (%VC: 0.59Conclusion: When compared to others, PPG-gated PREFUL MRI had almost similar potential for quantitatively assessed regional perfusion and pulmonary functional change assessments in thoracic oncologic patients.
Limitations: Limited study population
Funding for this study: This study was financially and technically supported by Canon Medical Systems. This study was also financially supported by Grants-in-Aid for Scientific Research from the Japanese Ministry of Education, Culture, Sports, Science and Technology.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by the institutional review board of Fujita Health University Hospital (HM24-303).