Table 1.
10 patients with mild COPD (GOLD stages I & II) and 10 patients with severe COPD (GOLD stages III & IV) were enrolled into the study.
Table 2.
MRI protocol and sequence parameters.
Table 3.
Weighted kappa of test vs. retest (consensus of n = 3 readers), displayed for category subscores and for the global score.
Fig 1.
Examples of of typical findings.
(A) Saber sheath trachea in a 69 year old patient diagnosed with GOLD stage IV (“tracheal disease”-score = 1). (B) Complete destruction of the middle lobe due to severe bronchiectasis in a 59 year old patient with GOLD stage II (lobar score for “bronchial disease” = 2). (C) Small airway disease (arrowhead) in the right lower lobe of a 50 year old patient with GOLD stage I (lobar score for the category “small airway disease” = 1). (D) Bronchial carcinoma ≥ 1.0 cm in the right lower lobe adjacent to the bronchovascular bundle of a 79 year old patient with GOLD stage IV (lobar score for the category “nodules” = 2).
Fig 2.
Discrepancy of parenchymal structure and function in mild COPD.
57 year old male patient suffering from mild COPD (GOLD stage I). VIBE (A), post-contrast VIBE (B), as well as HASTE (C) did not show significant parenchymal alterations. However, functional MRI with 4D first pass perfusion revealed scattered minor defects (arrowheads) across the lung on subtracted images (D) and therefore was rated with a perfusion score of 1 for each lobe.
Fig 3.
Pulmonary emphysema with concomitant perfusion deficit.
Grossly circumscribed structural defect (arrowheads) located in the periphery of the right upper lobe of a 50 year old male patient with GOLD stage I, as displayed on VIBE (A), post-contrast VIBE (B), and HASTE (C). A corresponding, but slightly larger defect (arrowheads) is visible on subtraction images of MR perfusion datasets (D). With regard to the category subscore “parenchymal defects”, the lobe was rated with a score of 1, and with regard to the perfusion score, it was rated with a 2. Additionally, one recognizes a small pleural effusion in the right oblique fissure which is also visible in Fig 4B.
Table 4.
Number of patients with COPD-relevant MRI findings in MRI1 and MRI2 ordered by categories.
2 individuals rejected contrast media at each examination.
Fig 4.
Respiratory mechanics in mild and advanced COPD.
Snapshots from dynamic TrueFISP in coronal orientation showing respiratory mechanics in a 50 year old male patient with GOLD stage I (A, B) and a 77 year old male patient with GOLD stage III (C, D). Diaphragmatic function of the patient with mild COPD appeared normal, as shown in inspiration (A) and expiration (B). Note a small pleural effusion in the right oblique fissure as secondary finding (arrowhead). The patient with GOLD stage III showed bilateral phrenic flattening and signs of whipsaw-motion in inspiration (C) and expiration (D). Phrenic motion amplitude was bilaterally restricted, with hardly recognizable motion on the left side (category subscore for respiratory mechanics right = 1; left = 2). Note an emphysemal bulla in the left upper lobe as additional finding.
Table 5.
Number of abnormal lung lobes or thoracic compartments as observed on MRI1 or MRI2, ordered by category and by score point (0, 1, or 2 points) for n = 19 patients (n = 114 lobes).
Note that the total number of lung lobes for the category perfusion is reduced by 2 patients (12 lobes) who rejected contrast media at each examination.