Lung MRI in the Management of Idiopathic Pulmonary Fibrosis (PIC'IRM)

University Hospital of Bordeaux

Status: Completed

Conditions: Idiopathic Pulmonary Fibrosis

Treatments: Other: Thoracic HRCT (standard reference); Device: MRI

Study type: Interventional

Funder types: Other

Identifiers

NCT03078426

CHUBX2015/31

Details and patient eligibility

About

High resolution computed tomography (HRCT) plays a major role in the management of idiopathic pulmonary fibrosis (IPF) by identifying characteristic lesions of usual interstitial pneumonia (UIP). Though HRCT is the standard reference to describe pulmonary structural alterations using a non invasive technique, it is nonetheless a radiating exam which provides limited functional information regarding inflammation. In this trial, the investigators aimed to evaluate whether MRI (Magnetic Resonance Imaging) using ultra-short echotime could be an alternative to HRCT in the assessment of the four morphological criteria required to define an UIP pattern. The investigators also planned to study the clinical value of the additional informations derived from MRI such as contrasts and lung perfusion using functional MRI.

Full description

High resolution computed tomography (HRCT) is an essential component in the diagnostic pathway of idiopathic pulmonary fibrosis (IPF). With the appropriate clinical setting, the presence of an usual interstitial pneumonia (UIP) pattern on HRCT is sufficient to diagnose IPF. Four morphological criteria are required: (1) Subpleural, basal predominance, (2) Reticular abnormality, (3) Honeycombing with or without traction bronchiectasis, (4) Absence of features inconsistent with UIP pattern. However, HRCT is a radiating technique and only give data about structural alterations. Recent advances in three-dimensional ultra-short echo time (3D-UTE) imaging have shown promising results in improving lung MR (Magnetic Resonance) imaging quality. Since HRCT is the standard reference in IPF, the investigators aimed to evaluate whether thoracic MRI could be an alternative to HRCT in the assessment of the four radiologic criteria required for the diagnosis of IPF. Moreover, thoracic MRI could give new functional data, expected to relate to lung inflammation.

In order to study the diagnostic's accuracy of MRI for each radiological criteria defining UIP pattern, the investigators will compare HRCT and thoracic MRI of patients with IPF to HRCT and thoracic MRI of patients with other lung diseases that do not have all the UIP criteria.

Study procedure will be gadolinium-enhanced PETRA (pointwise encoding time reduction with radial acquisition) MR sequencing compared to unenhanced HRCT within 15 days. No follow-up is needed.

Enrollment: 60 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients > 18 years old followed in Bordeaux University Hospital

• Patients with a definite diagnosis of IPF :

  • Based on a "certain" UIP pattern at HRCT without histopathology
  • Based on a "possible" UIP pattern at HRCT with histopathology given by surgical lung biopsy.

• Patients with a diagnosis of fibrosing sarcoidosis after multidisciplinary discussion

• Patients with a diagnosis of acute or sub-acute hypersensitivity pneumonitis after multidisciplinary discussion

• Patients diagnosed with organizing pneumonia after multidisciplinary discussion

• Patients with a diagnosis of isolated pleural plaques after multidisciplinary discussion

• Patient able to withstand supine position for more than 30 minutes

• Patient affiliated to a social security system

• Patients who gave their written informed consent

Exclusion criteria

• Subject detained by judicial or administrative decision.
• Major protected by law.
• Subject not affiliated to a social security care
• Subject in period of relative exclusion in relation to another protocol.
• Patients with specific contraindication to undergoing MRI: iron material, a heart pacemaker, claustrophobia, gadolinium hypersensitivity, renal impairment with glomerular filtration rate less than 30 mL/min, pregnant or nursing woman.

Trial design

Primary purpose: Diagnostic

Allocation: Non-Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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60 participants in 4 patient groups

Group 1 : UIP pattern

Experimental group

Description:

18 patients with UIP pattern at HRCT and IPF as a definite diagnosis.

Treatment:

Device: MRI

Other: Thoracic HRCT (standard reference)

Group 2 : possible UIP pattern

Experimental group

Description:

7 patients with " possible " UIP pattern at HRCT with histopathology given by surgical lung biopsy making the diagnosis of IPF.

Treatment:

Device: MRI

Other: Thoracic HRCT (standard reference)

Group 3 : diagnosis of fibrosing sarcoidosis

Experimental group

Description:

15 patients with the diagnosis of fibrosing sarcoidosis after multidisciplinary discussion.

Treatment:

Device: MRI

Other: Thoracic HRCT (standard reference)

Group 4 : lung diseases without reticulations

Experimental group

Description:

20 patients with lung diseases without reticulations (acute or sub-acute hypersensitivity pneumonitis, organizing pneumonia, isolated pleural plaques) .

Treatment:

Device: MRI

Other: Thoracic HRCT (standard reference)