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Master Thesis

Évaluation de la perfusion de premier passage pulmonaire en IRM chez des patients atteints de fibrose pulmonaire idiopathique : étude pilote

Abstract : Background: idiopathic pulmonary fibrosis (IPF) is the most frequent pulmonary interstitial and fibrosing disease in the elderly, with a poor prognosis. Recently, structural alterations of the lung vasculature have been pointed out in the peripheral lung of IPF patients, although their functional modifications remains unknown. Imaging tools enabling to assess the dynamics of the lung small vessels involvement in IPF are needed. Purpose: the main endpoint was to demonstrate that the feasibility of quantifying the lung first-pass peripheral perfusion in IPF and to correlate it to severity indexes. Secondary endpoint was to compare both first-pass and late perfusion between IPF and controls. Methods: the retrospective pilot study was held between February 2017 and December 2018. All participants had to perform thoracic-MRI at 1.5 T, chest-CT and pulmonary function tests (PFT). Both first-pass and late perfusions were assessed after gadolinium chelate injection, with calculation of the normalized peripheral pulmonary blood flow (PBF) and T1-weighted late enhancement (ΔT1w), respectively. IPF severity was assessed using the Composite Physiological Index (CPI) and Transfer Lung Carbon Monoxide (TLCO) at PFT. Correlations were assessed using Spearman’s test, comparisons using Mann-Whitney test, and reproducibility using intraclass correlation coefficients (ICC). Results: 15 FPI and 17 controls were included. PBF significantly correlated to CPI (rho=0.56; p=0.03) and TLCO% (rho=-0.58; p=0.02). Both PBF and ΔT1w were significantly higher in IPF than in controls (p<0.05). The reproducibility of assessment was very good (ICC=0.93). Conclusion: this pilot study showed that dynamic quantification of first-pass peripheral lung perfusion is feasible, reproducible and correlate to the severity of IPF. MRI may allow to speed up researches enabling to better understand the functional vascular involvement of IPF and to quantitatively follow-up the process in longitudinal studies.
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https://dumas.ccsd.cnrs.fr/dumas-03012355
Contributor : Médecine Ub <>
Submitted on : Wednesday, November 18, 2020 - 3:04:23 PM
Last modification on : Saturday, December 19, 2020 - 3:12:50 AM

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Benjamin Langlet. Évaluation de la perfusion de premier passage pulmonaire en IRM chez des patients atteints de fibrose pulmonaire idiopathique : étude pilote. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03012355⟩

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