title: Diffusion weighted imaging in cystic fibrosis disease: beyond morphological imaging.
abstract: OBJECTIVE
  To explore the feasibility of diffusion-weighted imaging (DWI) to assess inflammatory lung changes in patients with Cystic Fibrosis (CF) METHODS: CF patients referred for their annual check-up had spirometry, chest-CT and MRI on the same day. MRI was performed in a 1.5 T scanner with BLADE and EPI-DWI sequences (b = 0-600 s/mm2). End-inspiratory and end-expiratory scans were acquired in multi-row scanners. DWI was scored with an established semi-quantitative scoring system. DWI score was correlated to CT sub-scores for bronchiectasis (CF-CTBE), mucus (CF-CTmucus), total score (CF-CTtotal-score), FEV1, and BMI. T-test was used to assess differences between patients with and without DWI-hotspots.
  
  
  RESULTS
  Thirty-three CF patients were enrolled (mean 21 years, range 6-51, 19 female). 4 % (SD 2.6, range 1.5-12.9) of total CF-CT alterations presented DWI-hotspots. DWI-hotspots coincided with mucus plugging (60 %), consolidation (30 %) and bronchiectasis (10 %). DWItotal-scorecorrelated (all p < 0.0001) positively to CF-CTBE(r = 0.757), CF-CTmucus(r = 0.759) and CF-CTtotal-score(r = 0.79); and negatively to FEV1(r = 0.688). FEV1was significantly higher (p < 0.0001) in patients without DWI-hotspots.
  
  
  CONCLUSIONS
  DWI-hotspots strongly correlated with radiological and clinical parameters of lung disease severity. Future validation studies are needed to establish the exact nature of DWI-hotspots in CF patients.
  
  
  CONCLUSIONS
  • DWI hotspots only partly overlapped structural abnormalities on morphological imaging • DWI strongly correlated with radiological and clinical indicators of CF-disease severity • Patients with more DWI hotspots had lower lung function values • Mucus score best predicted the presence of DWI-hotspots with restricted diffusion.
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.|Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands.|Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Ciet
authors.affiliation: Department of Radiology, University of Rome "Sapienza", Rome, Italy.
authors.forename: Goffredo
authors.initials: G
authors.lastname: Serra
authors.affiliation: Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Eleni Rosalina
authors.initials: ER
authors.lastname: Andrinopoulou
authors.affiliation: Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bertolo
authors.affiliation: Department of Pediatrics, Ca' Foncello Hospital, Treviso, Italy.
authors.forename: Mirco
authors.initials: M
authors.lastname: Ros
authors.affiliation: Department of Radiology, University of Rome "Sapienza", Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.affiliation: Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi., Largo Brambilla 3, Florence, 50134, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Colagrande
authors.affiliation: Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.|Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands.
authors.forename: Harm A W M
authors.initials: HA
authors.lastname: Tiddens
authors.affiliation: Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy. gmorana@ulss.tv.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morana
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013147:Spirometry; D055815:Young Adult
keywords: Cystic fibrosis; Diffusion magnetic resonance imaging; Disease exacerbation; Magnetic resonance imaging; Pulmonary inflammation