MRI scoring of pleural findings in cystic fibrosis does not require intravenous contrast media.

objectivesCystic fibrosis (CF) leads to severe lung disease requiring regular monitoring. The morpho-functional chest MRI score enables reproducible semi-quantitative assessment of CF-related pulmonary and pleural changes, but the optimal sequences for pleural evaluation and the need for intravenous contrast media remain uncertain. This study aims to investigate the usability and agreement of different unenhanced and contrast-enhanced MRI sequences in assessing CF-related pleural findings using a blinded multi-reader study design. MATERIALS AND

methodsThis study included 75 people with CF (pwCF), who underwent morpho-functional chest MRI comprising contrast-enhanced and unenhanced sequences. Three 3D gradient echo T1-weighted sequences (unenhanced with (T1UEFS) and without fat saturation (T1UE), contrast-enhanced with fat saturation (T1CEFS)) and a high-resolution T2-weighted sequence with fat saturation (T2FS) were evaluated by two blinded independent readers applying the chest MRI scoring system for each individual lung lobe and the entire pleura (lobar/total pleural findings score). In case of deviations, a thoracic radiologist adjudicated. Statistical analyses included Spearman's correlation, Kruskal-Wallis test, and intraclass correlation coefficients.

resultsInterreader agreement was consistently good for all sequences and for all pulmonary lobes. While all unenhanced MRI sequences showed strong correlation with T1CEFS regarding the total pleural findings score, T1UEFS showed the highest agreement. T2FS tended to overestimate, and T1UE tended to underestimate lobar and total pleural findings scores.

conclusionsContrast-enhanced T1-weighted imaging is standard for assessing CF-related pleural inflammation and thickening. Our findings show that contrast agent-free fat-saturated T1-weighted sequences provide equivalent diagnostic value, indicating contrast media are not required for pleural assessment in pwCF. KEY POINTS: Question It is unclear which MRI sequence is best for assessing signs of pleurisy in pwCF and whether intravenous contrast media is required. Findings Pleural inflammation and thickening can be diagnosed just as precisely with an unenhanced fat-saturated T1-weighted sequence as with a contrast-enhanced T1-weighted sequence. Clinical relevance The assessment of pleural findings in MRI is not dependent on the use of intravenous contrast media. For pwCF, this paves the way for future routine MRI monitoring without contrast agents, thereby streamlining imaging protocols and reducing patient burden.