Abstract
ObjectivesTo compare the diagnostic value of ultrashort echo time (UTE) magnetic resonance imaging (MRI) for the lung versus the gold standard computed tomography (CT) and two T1-weighted MRI sequences in children.MethodsTwenty-three patients with proven oncologic disease (14 male, 9 female; mean age 9.0 + / − 5.4 years) received 35 low-dose CT and MRI examinations of the lung. The MRI protocol (1.5-T) included the following post-contrast sequences: two-dimensional (2D) incoherent gradient echo (GRE; acquisition with breath-hold), 3D volume interpolated GRE (breath-hold), and 3D high-resolution radial UTE sequences (performed during free-breathing). Images were evaluated by considering image quality as well as distinct diagnosis of pulmonary nodules and parenchymal areal opacities with consideration of sizes and characterisations.ResultsThe UTE technique showed significantly higher overall image quality, better sharpness, and fewer artefacts than both other sequences. On CT, 110 pulmonary nodules with a mean diameter of 4.9 + / − 2.9 mm were detected. UTE imaging resulted in a significantly higher detection rate compared to both other sequences (p < 0.01): 76.4% (84 of 110 nodules) for UTE versus 60.9% (67 of 110) for incoherent GRE and 62.7% (69 of 110) for volume interpolated GRE sequences. The detection of parenchymal areal opacities by the UTE technique was also significantly higher with a rate of 93.3% (42 of 45 opacities) versus 77.8% (35 of 45) for 2D GRE and 80.0% (36 of 45) for 3D GRE sequences (p < 0.05).ConclusionThe UTE technique for lung MRI is favourable in children with generally high diagnostic performance compared to standard T1-weighted sequences as well as CT.Key Points• Due to the possible acquisition during free-breathing of the patients, the UTE MRI sequence for the lung is favourable in children.• The UTE technique reaches higher overall image quality, better sharpness, and lower artefacts, but not higher contrast compared to standard post-contrast T1-weighted sequences.• In comparison to the gold standard chest CT, the detection rate of small pulmonary nodules small nodules ≤ 4 mm and subtle parenchymal areal opacities is higher with the UTE imaging than standard T1-weighted sequences.
Highlights
Magnetic resonance imaging (MRI) of the lung is increasingly established in children and adolescents [1,2,3,4,5,6,7]
The image quality parameters of the ultrashort echo time (UTE) sequence are higher compared to both gradient echo (GRE) sequences, except for the contrast
The ultrashort echo time of the UTE sequence leads to substantial signal gain in the lung parenchyma [27, 42]
Summary
Magnetic resonance imaging (MRI) of the lung is increasingly established in children and adolescents [1,2,3,4,5,6,7]. Paediatric primary lung tumours are rare with the majority of pulmonary malignancies being of metastatic origin [2, 4, 8, 9]. The detection of subtle pulmonary pathologies, tiny nodules, by lung MRI is still challenging [10,11,12,13]. Even small pulmonary nodules can be malignant in children with proven malignancies, as many paediatric tumours can develop metastases in the lungs [4, 17]
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