Comparison of chest computed tomography and 3-T magnetic resonance imaging results in patients with common variable immunodeficiency

Abstract

Background

Patients with common variable immunodeficiency (CVID) have an increased incidence of pulmonary infections and require frequent follow-up computed tomography (CT) scans.

Purpose

To evaluate the diagnostic performance of 3-T magnetic resonance imaging (MRI) in patients with CVID.

Material and Methods

In this prospective study, 3-T MRI was performed in 20 patients with CVID. The patients were imaged with CT and MRI scans on the same day. The MRI protocol included a T2-weighted HASTE sequence (TR=1400 ms, TE=95 ms, slice thickness (ST)=3 mm), T2-weighted BLADE sequence (TR=5379 ms, TE=100 ms, ST=3 mm), and 3D VIBE sequence (TR=3.9 ms, TE=1.32 ms, ST=3 mm). Mediastinal and parenchymal changes were compared. A modified Bhalla scoring system was used in the evaluation of CT and MRI scans.

Results

A total of 17 (85%) patients had parenchymal abnormalities identified by CT or MRI. Similar findings were detected with CT and MRI in the assessment of the severity of bronchiectasis (P=0.083), bronchial wall thickening (P=0.157), and mucus plugging (P=0.250). Consolidations were detected with both modalities in all patients. There was excellent concordance between the two modalities in the evaluation of nodules >5 mm (nodule size 5–10 mm, P=0.317; nodule size >10 mm, P=1). However, MRI failed to detect most of the small nodules (<5 mm).

Conclusion

3-T MRI detected mediastinal and parenchymal alterations in patients with CVID and provided findings that correlated well with CT. Despite a few limitations, MRI is a well-suited radiation-free technique for patients requiring longitudinal imaging.

Keywords

Magnetic resonance imaging computed tomography immunodeficiency lung

Introduction

Primary antibody deficiencies (PADs) are a group of immune diseases characterized by impaired or absent immunoglobulin responses associated with complex polygenic disorders. Common variable immunodeficiency (CVID) is the most common symptomatic subgroup of these immunodeficiency syndromes diagnosed in adulthood (1). The low levels of immunoglobulin in these patients make them vulnerable targets for infections.

Upper and lower respiratory tract infections are the most important clinical problem detected during follow-up, resulting in permanent lung diseases. Immunoglobulin replacement therapy (IgRT) is the main treatment modality accepted to reduce the incidence and outcome of these infections. Airway disease is the most frequent radiologic pulmonary abnormality and manifests as bronchiectasis, bronchial wall thickening, mucoid impaction, and atelectasis (2–,4). The multicenter European Chest CT study reported the radiologic evidence of some form of bronchial pathology in 80% of patients with CVID (4). There is also an increased prevalence of interstitial lung diseases (granulomatous lung disease and pulmonary lymphocytic infiltration) and lymphoma leading to increased morbidity and mortality in these patients (2,3). GLILD disease (granulomatous-lymphocytic interstitial disease) is a distinct clinico-radio-pathological interstitial disease that occurs in patients with CVID. On computed tomography (CT), it is characterized by lung nodules and consolidations located in lower lung lobes associated with areas of ground-glass opacities and septal lines. The pulmonary manifestations may wax and wane. Lymphadenopathy and splenomegaly are common extrapulmonary findings (3,4).

Prevention and early diagnosis of these lung diseases are important for the development of appropriate treatment strategies. Today, CT is the gold standard method used in the diagnosis of lung diseases and is preferred in the follow-up of these patients (4). However, radiosensitivity is a matter of concern in patients with CVID. Repeated CT examinations resulting in accumulated radiation exposure may lead to malignancies such as lymphoma in patients with immunosuppression (5 –7). Since there is no consensus on a safe level of radiation exposure, there is a need to avoid repeated CT scans.

Although magnetic resonance imaging (MRI) is a radiation-free method, low proton density of the lung and MRI artifacts have long been an important obstacle in lung imaging (8). However, with the latest technological developments, MRI started to become a feasible alternative method by providing morphological and functional data (9,10). Currently, in clinical scenarios such as cystic fibrosis, MRI started to be considered as a first-choice modality in the assessment of lung changes (9). Similarly, in the pediatric patient group, it is used as an alternative option to CT in the diagnosis of pneumonia and tumors (10).

The basic imaging protocol in MRI of the lung includes a precontrast fast breath-hold T1-weighted (T1W) and T2-weighted (T2W) sequences to detect lung infiltrations and nodules. Respiratory triggered T2W turbo spin echo sequences are well established sequences in lung MRI, especially in pediatric patients. T1W gradient echo sequences with ultrashort echo time appear as new imaging options (9,10).

However, to the best of our knowledge, there are no studies in the literature on the use of 3-T MRI in patients with CVID. The aim of the present study was to evaluate the diagnostic performance of 3-T chest MRI and to investigate the correlation between imaging findings of CT and MRI.

Material and Methods

Patient population

This prospective study was performed between March and July 2021 and was approved by the institutional review board (No. 20-12T26). Written informed consent was obtained from patients. A total of 20 patients (9 men, 11 women) with a clinical diagnosis of CVID were included in the study.

The diagnosis of CVID was based on the diagnostic criteria of the European Society for Immunodeficiencies. Primary immunodeficiency was considered in the presence of recurrent infections (viral, bacterial, and parasitic), autoimmune diseases, atypical lymphoproliferation, and/or malignancy. In case of clinical suspicion, primary immunodeficiency is suspected in cases where the median value of at least two groups of immunoglobulin levels (IgG plus IgA and/or IgM) is below 2 standard deviations (SD) of the normal value for age, and in cases where there is a concomitant deficiency in antibody response to the vaccine and/or isohemagglutinin response. These cases were evaluated flow cytometrically. If lymphocyte flow cytometric analysis shows a decrease in class-switching B cells and memory B cells, and normal/impaired T cell responses, the diagnosis of primary humoral immunodeficiency is strongly considered. In the presence of all these findings, a diagnosis of CVID was made for cases >4 years in which monogenic germline mutations were not detected and secondary causes leading to hypogammaglobulinemia were excluded (11 –13).

To provide an updated view of the spectrum of illness at the time of presentation, imaging studies were performed. MRI and CT scans were performed on the same day.

CT protocol

All CT images were obtained on a 64-detector single tube dual-energy CT (DECT) scanner with rapid kVp switching (Discovery CT 750 HD; GE Healthcare, WI, USA) without any contrast medium, at the end of inspiration. The scans were acquired from lung apex to base. The following parameters were used: tube current setting = 150–200 mA; voltage = 120 kV; collimation = 0.6 mm; and gantry rotation time = 0.33 s). To review the images, a standard lung window (window level = 600, window width = 1500) and mediastinal window (window level = 30, window width = 350) were used. The dose length product (DLP) of the CT scans was recorded.

MRI protocol

MRI of the chest was performed on a 3-T MR scanner (Verio; Siemens, Erlangen, Germany). Contrast material was not administered during the scan. A combination of spine coil and body coil was used to cover the chest. The following MRI sequences were used: (i) a two-dimensional (2D) half-Fourier single-shot turbo spin-echo (HASTE) sequence (TR = 1400 ms, TE = 95 ms, slice thickness = 3 mm) in the axial and coronal planes; (ii) respiratory triggered T2W BLADE sequence (TR = 5379 ms, TE = 100 ms, slice thickness = 3 mm) acquired in the axial plane; and (iii) fast three-dimensional (3D) gradient-echo T1W volumetric interpolated breath-hold examination (VIBE) sequence (TR = 3.9 ms, TE = 1.32 ms, slice thickness = 3 mm) in the axial plane.

Image evaluation

CT and MRI scans were reviewed separately by two radiologists blinded to clinical data of the patients. The MRI and CT scans were scored according to the modified Bhalla scoring system (14). Readers evaluated each examination in random order and reached an agreement on the controversial lesions. To eliminate the recall bias effect, CT images were reviewed four weeks after the MRI scans. Interrater variations for scoring the radiologic findings were evaluated. The syllabus of the Fleischner Society was used for radiological terminology.

Five radiologic findings regarding bronchial pathologies were assessed as follows: (i) severity of bronchiectasis (score 0 = none, 1 = mild, 2 = moderate, 3 = severe); (ii) extent of bronchiectasis (number of segments affected: score 0 = none, 1 = 1–5 segments, 2 = 6–9 segments, 3 = >9 segments) (iii) generation of the bronchial division involved (score 0 = none, 1 = up to 4th generation, 2 = up to 5th generation, 3 = up to 6th generation); (iv) presence of peribronchial thickening (score 0 = none, 1 = mild, 2 = moderate, 3 = severe); and (v) extent of mucus plugging (score 1 = 1–5 segments, 2 = 6–9 segments, 3 = >9 segments).

Four parenchymal pathologies were evaluated as follows: (i) consolidation (score 0 = none, 1 = subsegmental, 2 = segmental-lobar); (ii) abscess (absent = 0, present = 1); (iii) presence of bullae and emphysema (absent = 0, present = 1); and (iv) ground-glass opacities (score 0 = none, 1 = subsegmental, 2 = segmental-lobar).

An extra category was used to assess lung nodules: the number of nodules (score 0 = no nodules detected; 1 = <5 nodules detected; 2 = >5 nodules detected). The size of the nodules were calculated with the following formula: nodule diameter × number of segments affected (none = 0, nodule diameter <5 mm = 1, nodule diameter 5–10 mm = 2; nodule diameter >10 mm = 3). Nodules >30 mm were considered as consolidation.

Associated findings such as pleural-pericardial effusion, mediastinal and axillary lymphadenomegaly, and the presence of splenomegaly were also evaluated using both modalities. The mediastinal or axillary lymph nodes were considered enlarged if the short-axis diameter was >10 mm. A splenic width >10.5 cm or a craniocaudal diameter >14.5 cm was considered as splenomegaly.

Statistical analysis

The statistical analysis was performed using SPSS Statistics for Windows version 25.0 (IBM Corp., Armonk, NY, USA). Descriptive data were presented as mean ± SD or range. The Wilcoxon test was used to compare differences in the numerical data between methods. The comparison of categorical variables between groups was performed using the McNemar test for nominal data and by the marginal homogeneity test for ordinal data. A P value <0.05 was taken as the threshold for statistical significance. Interrater variations were evaluated using Cohen's kappa statistics.

Results

Patient characteristics

A total of 20 patients (9 men, 11 women; mean age = 41.15 ± 3.3 years; age range = 22–66 years) were included in the study. All patients had a clinical diagnosis of CVID. The median age at onset of symptoms was 15.75 ± 2.7 years. The median age at the time of diagnosis was 28.95 ± 3.1 years (age range = 3–59 years). All patients were under follow-up with IgRT. Two patients in the study group had a diagnosis of marginal zone lymphoma. The clinical and immunologic data of the patients at the time of study are listed in the Supplemental material (Table 1).

Table 1.

Clinical and immunological data of patients.

Patient No.	Age (years)	Sex	Age at onset of symptoms (years)	Age at diagnosis (years)	Ig A level (mg/dL)	Ig G level (mg/dL)	Ig M level (mg/dL)	Dose of IVIG (g/month)	Presence of malignancy
1	45	F	13	26	<27	620	<18	40	(-)
2	31	M	13	13	<27	629	<18	50	Marginal zone lymphoma
3	63	M	55	59	<27	<142	<18	40	Marginal zone lymphoma
4	31	F	12	28	<25	<139	<18	40	(-)
5	32	M	5	9	<27	197	19	40	(-)
6	56	F	12	44	<27	905	19	40	(-)
7	24	F	21	22	49	496	257	40	(-)
8	27	F	11	21	<26	477	94	50	(-)
9	27	M	7	14	<27	288	59	45	(-)
10	31	M	1	28	29	1370	51	50	(-)
11	66	F	20	46	62	406	58	40	(-)
12	64	F	20	40	<27	1300	93	50	(-)
13	48	F	29	39	<24	<300	<18	50	(-)
14	59	M	22	25	<27	540	<18	40	(-)
15	56	F	20	46	28	233	21	60	(-)
16	41	M	18	28	<50	<300	1047	40	(-)
17	22	M	1	3	<25	610	<18	40	(-)
18	42	M	1	38	<27	<142	19	50	(-)
19	30	F	13	26	52	1250	35	50	(-)
20	28	F	23	24	<25	<300	<18	50	(-)

IVIG, intravenous immunoglobulin.

Agreement between CT and MRI

Parenchymal and bronchial changes in these patients were compared using a scoring system. Bronchiectasis was the most common bronchial change recorded in CT and MRI examinations (n = 10, 50%). A total of 17 (85%) patients had parenchymal abnormalities identified by CT or MRI scan. The most common parenchymal changes were nodules (n = 17, 85%) and consolidations (n = 7, 35%). Consolidations were detected with both modalities in all patients. However, in four patients the nodules present on CT scans were not identified on MRI scans. Three patients had no lung abnormalities on their CT and MRI scans. The comparison of CT and MRI findings of bronchial and parenchymal findings is listed in the Supplemental material (Tables 2 and 3).

Table 2.

CT and MRI scores of bronchial abnormalities.

Patient	Presence of peribronchial thickening		Extent of bronchiectasis		Severity of bronchiectasis		The extent of mucus plugging		Generation of the bronchial division involved
Patient	CT	MRI	CT	MRI	CT	MRI	CT	MRI	CT	MRI
1	0	0	0	0	0	0	0	0	0	0
2	0	0	1	1	1	1	0	0	3	3
3	0	0	0	0	0	0	0	0	0	0
4	2	2	1	1	2	2	0	0	3	3
5	2	1	3	3	2	1	1	0	3	2
6	0	0	0	0	0	0	0	0	0	0
7	0	0	0	0	0	0	0	0	0	0
8	0	0	0	0	0	0	0	0	0	0
9	0	0	0	0	0	0	0	0	0	0
10	2	2	2	2	3	3	1	1	3	2
11	0	0	0	0	0	0	0	0	0	0
12	1	1	2	2	1	1	0	0	3	3
13	3	3	3	3	3	2	1	0	2	2
14	1	1	1	1	3	3	1	1	2	2
15	0	0	0	0	0	0	0	0	0	0
16	1	1	1	1	1	1	0	0	1	1
17	1	0	1	0	1	0	0	0	1	0
18	1	1	1	1	1	1	1	0	1	1
19	0	0	0	0	0	0	0	0	0	0
20	0	0	0	0	0	0	0	0	0	0

CT, computed tomography; MRI, magnetic resonance imaging.

Table 3.

CT and MRI scores of parenchymal abnormalities.

Patient	Consolidation		Presence of abscess		Presence of bullae and emphysema		No. of nodules		Nodule diameter <5 mm		Nodule diameter 5–10 mm		Nodule diameter >10 mm		Ground-glass opacities
Patient	CT	MRI	CT	MRI	CT	MRI	CT	MRI	BT	MRI	CT	MRI	CT	MRI	CT	MRI
1	0	0	0	0	0	0	1	1	0	0	1	1	0	0	0	0
2	2	2	0	0	0	0	2	2	0	0	5	4	4	4	1	0
3	0	0	0	0	0	0	1	1	0	0	1	1	0	0	0	0
4	0	0	0	0	0	0	1	1	0	0	1	1	0	0	2	1
5	1	1	0	0	0	0	0	0	0	0	0	0	0	0	0	0
6	0	0	0	0	0	0	1	1	0	0	1	1	0	0	0	0
7	0	0	0	0	0	0	1	0	1	0	0	0	0	0	0	0
8	1	1	0	0	0	0	0	0	0	0	0	0	0	0	2	0
9	0	0	0	0	0	0	1	0	1	0	0	0	0	0	0	0
10	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
11	1	1	0	0	0	0	1	0	1	0	0	0	0	0	0	0
12	0	0	0	0	0	0	1	0	1	0	0	0	0	0	0	0
13	2	2	0	0	0	0	0	0	0	0	0	0	0	0	0	0
14	0	0	0	0	0	0	1	1	0	0	0	0	1	1	1	0
15	0	0	0	0	0	0	1	1	3	3	0	0	0	0	0	0
16	2	2	0	0	0	0	2	1	3	0	0	0	0	0	0	0
17	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
18	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0	0
19	0	0	0	0	0	0	1	1	3	3	0	0	0	0	0	0
20	1	1	0	0	0	0	2	2	5	3	0	0	0	0	1	0

CT, computed tomography; MRI, magnetic resonance imaging.

In 15% of patients, the scores regarding the severity of bronchiectasis, peripheral bronchial changes, and the extent of mucus plugging were rated lower on MRI scans. However, significant differences between the two tests in scoring bronchiectasis severity (P = 0.083), bronchial wall thickening (P = 0.157), an extension of bronchiectasis (P = 0.317), and mucus plugging (P = 0.250) were not detected (Table 4 and Fig. 1).

Fig. 1.

Bar graphs showing the comparison of CT and MRI scores of patients with CVID. The number of patients with bronchial involvement score (severity, extent of bronchiectasis and mucus plugging, bronchial generation involved, peribronchial thickening) and ground-glass opacities detected on CT/MRI scans are shown as bars. CT, computed tomography; CVID, common variable immunodeficiency; MRI, magnetic resonance imaging.

Table 4.

Comparison of CT and MRI findings.

	P value		P value		P value
Bronchial parameters		Parenchymal parameters		Other parameters
Severity of bronchiectasis	0.083	Consolidation	1	Splenomegaly	1
Presence of peribronchial thickening	0.157	Emphysema/bullae	1	Mediastinal lymphadenopathy	1
Extent of bronchiectasis	0.317	Abscess	1	Axillary lymphadenopathy	1
Bronchial generation involved	0.083	Ground-glass opacities	0.034	Pericardial effusion	1
The extent of mucus plugging	0.250	No. of nodules	0.025	Pleural effusion	1
		Nodule diameter <5 mm	0.024
		Nodule diameter 5–10 mm	0.317
		Nodule diameter >10 mm	1

CT, computed tomography; MRI, magnetic resonance imaging.

Emphysema, bullae, and abscesses were not present in the study population. Nodules were evaluated according to their number and size. There was a significant difference between the two tests in determining the number of nodules (P = 0.025). Similarly, a significant difference between the two examinations in the scoring of nodules <5 mm was present (P = 0.024). MRI failed to detect most of the nodules measuring <5 mm. However, there was excellent concordance between the two modalities in the evaluation of nodules >5 mm (Table 4 and Figs. 2 –5).

Fig. 2.

Bar and pie graphs showing the comparison of CT and MRI scores of patients with CVID. The number of patients with consolidation and lung nodules detected on CT/MRI scans are shown as bar graphs. The pie graphs show the percentage of lung nodules detected on both scans regarding their size. CT, computed tomography; CVID, common variable immunodeficiency; MRI, magnetic resonance imaging.

Fig. 3.

A 31-year-old male patient. (a) CT image showing a peripheral area of consolidation (black arrow) at the right upper lobe. (b) High signal intensity is present on the T2-weighted sequence (BLADE) at the same lung segment (white arrow). CT, computed tomography; MRI, magnetic resonance imaging.

Fig. 4.

A 60-year-old female patient. (a) CT image shows bronchiectasis in both lower lobes (long arrow) and associated atelectasis (short arrow) is present in the right middle lobe. (b) MRI scan (HASTE sequence) shows the same findings. CT, computed tomography; MRI, magnetic resonance imaging.

Fig. 5.

A 28-year-old female patient. (a) CT image showing the peripheral lung nodule (arrow). (b, c) MRI scans show a peripheral subpleural nodule located at the right lower lobe detected on BLADE and VIBE sequences (arrows). CT, computed tomography; MRI, magnetic resonance imaging.

In the study population, seven patients had splenectomy and four patients had splenomegaly.

Mediastinal lymphadenomegaly was present in four patients and accompanying axillary lymphadenomegalies were also observed in one of them. In one of the patients with mediastinal lymphadenomegalies, there was a pathologically confirmed diagnosis of the lymphoproliferative disease. Two patients had pleural effusion and one had pericardial effusion confirmed by both modalities. Perfect agreement was present between CT and MRI studies for the detection of lymphadenomegalies, splenomegaly, and pleural-pericardial effusions (Table 4 and Fig. 6).

Fig. 6.

A 24-year-old female patient. (a) CT image shows subcarinal and bilateral hilar lymphadenomegalies (arrow). (b) Enlarged lymph nodes are detected on MRI scan (BLADE sequence) (arrow). CT, computed tomography; MRI, magnetic resonance imaging.

Interrater variations for scoring the radiologic findings were evaluated. The Cohen's kappa coefficient of interrater reliability was 0.805, suggesting strong agreement.

The mean dose length product of CT scans was 237.16 ± 12 mGy*cm. The total scan time for CT was 2 ± 1 min. The total MRI examination scan time was 17.2 ± 3 min.

Discussion

Infections, granulomatous and autoimmune diseases, and cancers constitute the spectrum of diseases associated with CVID. Respiratory tract infections are the major clinical problem during the follow-up of patients with immunodeficiency. Chronic lung disease was detected in 34.2% of patients with CVID at the initial diagnosis and this percentage has raised to 46.4% during follow-up, as reported in an Italian multicenter study (2). As a consequence of chronic lung diseases, bronchiectasis is detected in more than half of the patients (15,16). Similarly, in a previous study, we also reported the most frequent CT findings as bronchiectasis and lymphadenopathies, peribronchial cuffing, ground-glass abnormality, and nodules in our patients (3).

Since CT examination of the chest is the current gold standard, it is preferred in the long-term follow-up of lung diseases in patients with CVID leading to increased radiation exposure in this radiosensitive patient group. As a radiation-free method, MRI has gained importance in the evaluation of parenchyma in several diseases (9,10,17). This applies particularly to certain patient groups that require repetitive examinations. The patients with cystic fibrosis or patients with immunosuppression requiring assessment of parenchymal infiltrations are examples of these (10,17,18). There are a limited number of studies performed to investigate the role of MRI in the evaluation of CVID (19,20). These studies have been performed on 1.5-T scanners. 3-T MRI has increased the signal-to-noise ratio and resolution due to higher magnetic field strength. The increased spatial resolution leads to an improvement in lesion detection. However, susceptibility artifact is a drawback in high field strength (21). Initial studies of lung MRI on 3-T scanners have reported the feasibility of parenchymal evaluation (17,22). Attenberger et al. evaluated the diagnostic accuracy of 3-T MRI for the assessment of pneumonia in neutropenic patients and reported they could detect infectious nodules and consolidations with sufficient diagnostic accuracy (17).

3-T MRI scanners are increasingly being installed worldwide. Some centers have only 3-T MRI devices and perform chest imaging with these devices; knowledge of 3-T MRI techniques of the lungs and findings may be advantageous in such cases. Our study results are the first to report the results of 3-T MR examinations to evaluate the lung alterations in patients with CVID. The results of the present study show that 3-T MRI is promising as an alternative imaging choice to CT for the imaging of this patient group.

Initially, Serra et al. first evaluated lung MRI as an alternative to CT in patients with CVID. They reported a substantial correlation between CT and MRI for moderate to severe degrees of bronchial and parenchymal changes. They noted a low concordance for lower scores of bronchial abnormalities (19). Similarly, Arslan et al. demonstrated comparable results for scoring bronchial and parenchymal abnormalities for both modalities (20). However, they reported limitations in the assessment of peripheral airway abnormalities.

Both studies used a T2W BLADE sequence for MR parenchyma evaluation and mentioned limitations of visualization of lung nodules <1 cm. The value of MRI for the detection of pulmonary nodules has showed a great potential over the past year. MR sequences, such as 3D gradient recalled echo VIBE and 3D ultra-short echo-time (UTE) sequences, have been described for the evaluation of lung nodules (21,23).

In the present study, we used BLADE and 3D VIBE sequences for parenchymal analysis. The detection of nodules <5 mm was limited in our study, this was because of the presence of calcification in most of these nodules. In non-calcified small nodules (<5 mm), the susceptibility difference at the interface of lung parenchyma and nodule or slice thickness might be the reason for this limitation. The results of our study indicate that the VIBE sequence on 3-T MRI can be used to detect nodules as small as 5 mm. This result is consistent with other studies in the literature using this sequence (17,21). However, further studies are needed to clarify this issue.

As mentioned in previous studies, MRI performance was similar to that of CT at the scoring of bronchial parenchymal abnormalities. In assessment of ground-glass opacities, CT was less sensitive than MRI in this study. Both modalities showed similar success in the detection of parenchymal and bronchial changes, such as the presence, extension, and severity of bronchiectasis, mucus plugging, and consolidations.

Non-Hodgkin lymphoma is the most frequent malignancy in CVID and is detected in 2%–8% of patients (24). The follow-up of lymph nodes is important in the diagnosis of CVID-related lymphoproliferative diseases. In our study, the detection rate of lymphadenomegalies with both modalities was similar. Lymphadenomegalies were present in four of our patients and one of these patients had a confirmed diagnosis of lymphoma.

Several CT scoring systems are well established in qualitative assessment of parenchymal changes of cystic fibrosis (14). There are several suggested dedicated scoring systems for MRI using both morphological and functional assessments in patients with cystic fibrosis (25,26). However, in the literature, there are few studies using dedicated CT scoring methods in the follow-up of patients with CVID (27). In these scoring methods, reticular changes, ground-glass areas, nodules, and lymphadenopathies are also evaluated, different from the Bhalla scoring used for cystic fibrosis. Although the clinical significance of these scoring systems defined for CVID is still under investigation, most of those CT parameters used in these scoring methods were included and evaluated in our study.

Finally, the radiation dose of our CT scans was in the range of 3–3.5 mSv. MRI is valuable as a radiation-free alternative for these patients. Recently, technical advances, such as UTE imaging, have been reported in the imaging of lung changes (28,29). Considering the newly developed MRI sequences and developments in MRI technology, it is predicted that lung MRI examinations will provide faster and more accurate information in the future (9,10).

The present study has some limitations. One is the relatively small number of patients involved in the study. However, the incidence of CVID is low in the general population. The initial results of this 3-T study are promising and can also be used in the evaluation of lung parenchyma in other diseases associated with immunosuppression. Another limitation is that we did not include new sequences such as UTE and functional imaging sequences such as perfusion studies. Our study did not evaluate UTE sequences as the technique is currently not commercially available worldwide.

In conclusion, there is a substantial correlation between CT and 3-T MRI in the detection of pulmonary parenchymal and bronchial changes in patients with CVID. However, the evaluation of ground-glass opacities and small nodules (<5 mm) is limited. With the current 3-T MRI findings, MRI is promising as a radiation-free alternative, but the validation of findings with larger studies is required.

Supplemental Material

sj-docx-1-acr-10.1177_02841851221144249 - Supplemental material for Comparison of chest computed tomography and 3-T magnetic resonance imaging results in patients with common variable immunodeficiency

Supplemental material, sj-docx-1-acr-10.1177_02841851221144249 for Comparison of chest computed tomography and 3-T magnetic resonance imaging results in patients with common variable immunodeficiency by Selen Bayraktaroğlu, Akın Çinkooğlu, Ceyda Tunakan Dalgıç, Gülhan Boğatekin, Funda Elmas Uysal and Ömür Ardeniz in Acta Radiologica

Footnotes

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the authorship, research, and publication of this article: This work was supported by a grant (project no. TGA-2021-22601), provided by Ege University.

ORCID iD

Selen Bayraktaroğlu

References

Wood

. Primary antibody deficiency syndromes. Curr Opin Hematol 2010;17:356–361.

Quinti

Soresina

Spadaro

, et al. Italian primary immunodeficiency network. Long-term follow-up and outcome of a large cohort of patients with common variable immunodeficiency. J Clin Immunol 2007;27:308–316.

Ardeniz

Basoglu

Günsar

, et al. Clinical and immunological analysis of 23 adult patients with cvariablerieble immune deficiency. J Investig Allergol Clin Immunol 2010;20:222–236.

Schütz

Alecsandru

Grimbacher

, et al. Chest CT in antibody deficiency group. Imaging of bronchial pathology in antibody deficiency: data from the European chest CT group. J Clin Immunol 2019;39:45–54.

Aghamohammadi

Moin

Kouhi

, et al. Chromosomal radiosensitivity in patients with common variable immunodeficiency. Immunobiology 2008;213:447–454.

Vorechovský

Scott

Haeney

, et al. Chromosomal radiosensitivity in common variable immune deficiency. Mutat Res 1993;290:255–264.

Gangemi

Allegra

Musolino

. Lymphoproliferative disease and cancer among patients with common variable immunodeficiency. Leuk Res 2015;39:389–396.

Puderbach

Hintze

Ley

, et al. MR imaging of the chest: a practical approach at 1.5 T. Eur J Radiol 2007;64:345–355.

Biederer

Mirsadraee

Beer

, et al. MRI of the lung (3/3)-current applications and future perspectives. Insights Imaging 2012;3:373–386.

10.

Hirsch

Sorge

Vogel-Claussen

, et al. The current status and further prospects for lung magnetic resonance imaging in pediatric radiology. Pediatr Radiol 2020;50:734–749.

11.

Bousfiha

Jeddane

Picard

, et al. Human inborn errors of immunity: 2019 update of the IUIS phenotypical classification. J Clin Immunol 2020;40:66–81.

12.

Ameratunga

Woon

Gillis

, et al. New diagnostic criteria for common variable immune deficiency (CVID), which may assist with decisions to treat with intravenous or subcutaneous immunoglobulin. Clin Exp Immunol 2013;174:203–211.

13.

Ameratunga

Longhurst

Steele

, et al. Comparison of diagnostic criteria for common Variable immunodeficiency disorders (CVID) in the New Zealand CVID cohort study. Clin Rev Allergy Immunol 2021;61:236–244.

14.

Bhalla

Turcios

Aponte

, et al. Cystic fibrosis: scoring system with thin-section CT. Radiology 1991;179:783–788.

15.

Martínez García

de Rojas

Nauffal Manzur

, et al. Respiratory disorders in common variable immunodeficiency. Respir Med 2001;95:191–195.

16.

Hermaszewski

Webster

. Primary hypogammaglobulinemia: a survey of clinical manifestations and complications. Q J Med 1993;86:31–42.

17.

Attenberger

Morelli

Henzler

, et al. 3 Tesla proton MRI for the diagnosis of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia: initial results in comparison to HRCT. Eur J Radiol 2014;83:e61–e66.

18.

Eibel

Herzog

Dietrich

, , et al. Pulmonary abnormalities in immunocompromised patients: comparative detection with parallel acquisition MR imaging and thin-section helical CT. Radiology 2006;241:880–891.

19.

Serra

Milito

Mitrevski

, et al. Lung MRI as a possible alternative to CT scan for patients with primary immune deficiencies and increased radiosensitivity. Chest 2011;140: 581–1589.

20.

Arslan

Poyraz

Ucar

, et al. Magnetic resonance imaging may be a valuable radiation-free technique for lung pathologies in patients with primary immunodeficiency. J Clin Immunol 2016;36:66–72.

21.

Fink

Puderbach

Biederer

, et al. Lung MRI at 1.5 and 3 tesla: observer preference study and lesion contrast using five different pulse sequences. Invest Radiol 2007;42:377–383.

22.

Sodhi

Sharma

Lee

, et al. Diagnostic utility of 3T lung MRI in children with interstitial lung disease: a prospective pilot study. Acad Radiol 2018;25:380–386.

23.

Bonert

Schneider

Solyanik

, et al. Diagnostic accuracy of magnetic resonance imaging for the detection of pulmonary nodules simulated in a dedicated porcine chest phantom. PLoS One 2020;15:e0244382.

24.

Bang

Richards

Olson

, et al. Pulmonary manifestations of common variable immunodeficiency. J Thorac Imaging 2018;33:377–383.

25.

Puderbach

Eichinger

Haeselbarth

, et al. Assessment of morphological MRI for pulmonary changes in cystic fibrosis (CF) patients: comparison to thin-section CT and chest x-ray. Invest Radiol 2007;42:715–725.

26.

Eichinger

Optazaite

Kopp-Schneider

, et al. Morphologic and functional scoring of cystic fibrosis lung disease using MRI. Eur J Radiol 2012;81:1321–1329.

27.

Meerburg

Hartmann

IJC

Goldacker

, et al. Analysis of granulomatous lymphocytic interstitial lung disease using two scoring systems for computed tomography scans-A retrospective cohort study. Front Immunol 2020;30:589148.

28.

Roach

Crémillieux

Fleck

, et al. Ultrashort echo-time magnetic resonance imaging is a sensitive method for the evaluation of early cystic fibrosis lung disease. Ann Am Thorac Soc 2016;13:1923–1931.

29.

Gräfe

Anders

Prenzel

, et al.

Pediatric MR lung imaging with 3D ultrashort-TE in free breathing: are we past the conventional T2 sequence?

Pediatr Pulmonol 2021;56:3899–3907.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB