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Eur Respir J. 2019 Feb 28. pii: 1702020. doi: 10.1183/13993003.02020-2017. [Epub ahead of print]

Quantitative multivolume proton-MRI in patients with cystic fibrosis lung disease: comparison with clinical indicators.

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Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Radiologia Pediatrica, Milano, Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, U.O.C. Direzione Professioni Sanitarie, Milano, Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Centro Fibrosi Cistica, Milano, Italy.



The present cross-sectional study aims to verify the relationship between quantitative multivolume magnetic resonance imaging (MRI) and clinical indicators of ventilatory abnormalities in cystic fibrosis (CF) lung disease.


28 patients (10-27 years) with CF lung disease performed non-enhanced chest MRI, spirometry and multiple breath washout (MBW). Images acquired at end-inspiration and end-expiration were registered by optical flow to estimate expiratory-inspiratory proton density change (Δ1H-MRI) as a measure of regional ventilation. MR images were also evaluated using a CF-specific scoring system.


Biomarkers of CF ventilation impairment were defined from Δ1H-MRI: Δ1H-MRI median, Δ1H-MRI quartile coefficient of variation (QCV) and percent low-ventilation volume (%LVV). Imaging biomarkers correlate to all the clinical measures of ventilation abnormalities, with the strongest correlation between Δ1H-MRI median and forced expiratory volume in one second (FEV1) (r2=0.44, p<0.001), Δ1H-MRI QCV and lung clearance index (LCI) (r2=0.51, p<0.001) and %LVV and LCI (r2=0.66, p<0.001). Correlations were also found between imaging biomarkers of ventilation and morphological scoring.


The study showed a significant correlation between quantitative multivolume-MRI and clinical indicators of CF lung disease. MRI, as a non-ionizing imaging technique, may be particularly attractive in CF care for longitudinal evaluation, providing a new imaging biomarker to detect early ventilator abnormalities.

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