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Original Research |

Lung MRI as a Possible Alternative to CT Scan for Patients With Primary Immune Deficiencies and Increased RadiosensitivityMRI for Lung Evaluation in Immunodeficiencies

Goffredo Serra, MD; Cinzia Milito, MD; Milica Mitrevski, MD; Guido Granata, MD; Helene Martini, MD; Anna Maria Pesce, MD; Ifigenia Sfika, MD; Livia Bonanni, MD; Carlo Catalano, MD; Francesco Fraioli, MD; Isabella Quinti, MD, PhD
Author and Funding Information

From the Department of Radiological Sciences (Drs Serra, Catalano, and Fraioli) and the Department of Molecular Medicine (Drs Milito, Mitrevski, Granata, Martini, Pesce, Sfika, Bonanni, and Quinti), Sapienza University of Rome, Rome, Italy.

Correspondence to: Isabella Quinti, MD, PhD, Department of Molecular Medicine, Sapienza University of Rome, Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy; e-mail: isabella.quinti@uniroma1.it

The CVID diagnosis was based on the European Society for Immunodeficiencies/Pan-American Group for Immunodeficiency definition.15 Trough IgG is IgG level prior to the next replacement dose. CVID = common variable immunodeficiency; F = female; M = male; MEF25 = mid expiratory flow 25%.

Data are presented as No. (%). See Table 1 legend for expansion of abbreviation.

Morphologic MRI and CT scan studies scored in a random order by two independent observers in consensus, adopting a validated CT scan scoring system for lung alterations (Bhalla scoring system).17

Morphologic MRI and CT scan studies scored in a random order by two independent observers in consensus, adopting a validated CT scan scoring system for lung alterations (Bhalla scoring system).17 The extra category represented by nodules (number and dimension) has been added to the scoring system.

Funding/Support: This work was supported by the European Commission [Grant HEALTH-F2-2008-201549].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: This work was supported by the European Commission [Grant HEALTH-F2-2008-201549].

Funding/Support: This work was supported by the European Commission [Grant HEALTH-F2-2008-201549].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1581-1589. doi:10.1378/chest.10-3147
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Background:  Patients with common variable immunodeficiency (CVID) suffer from respiratory infections leading over time to permanent lung damage. Increased radiosensitivity has been described, and clinicians should consider a risk-benefit assessment when ordering a CT scan, in that the exact level of “safe” radiation exposure is unknown.

Methods:  Twenty-one patients with CVID were evaluated with chest CT scan, MRI, and pulmonary function tests on the same day. MRI protocol included a T2-weighted rotating blade-like k-space covering sequence (time repetition, 2,000; echo train = 27; field of view, 400 mm; flip angle, 150; slice thickness, 5 mm) on axial and coronal planes. The bronchial and parenchymal abnormalities were compared with those identified by CT scan applying a modified Bhalla scoring system to assess bronchiectasis, bronchial wall thickening, number of bronchial generations involved, mucous plugging, consolidations, emphysema, bullae, and nodules.

Results:  CT scan and MRI findings were comparable for moderate to severe degrees of bronchial and parenchymal alterations. A low concordance was found between MRI and CT scan for lower scores of bronchial abnormalities. CT scan allowed a better identification of peripheral airways abnormalities.

Conclusions:  Lung alterations in patients with higher radiation sensitivity, such as patients with CVID, might be evaluated by MRI, a radiation-free technique alternative to CT scan.

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