Voxel-Wise Comparison of Co-Registered Quantitative CT and Hyperpolarised Gas Diffusion-Weighted MRI Measurements in IPF.

The patterns of idiopathic pulmonary fibrosis (IPF) lung disease that directly correspond to elevated hyperpolarised gas diffusion-weighted (DW) MRI metrics are currently unknown. This study aims to develop a spatial co-registration framework for a voxel-wise comparison of hyperpolarised gas DW-MRI and CALIPER quantitative CT patterns. Sixteen IPF patients underwent 3 He DW-MRI and CT at baseline, and eleven patients had a 1-year follow-up DW-MRI. Six healthy volunteers underwent 129 Xe DW-MRI at baseline only. Moreover, 3 He DW-MRI was indirectly co-registered to CT via spatially aligned 3 He ventilation and structural 1 H MRI. A voxel-wise comparison of the overlapping 3 He apparent diffusion coefficient (ADC) and mean acinar dimension (LmD ) maps with CALIPER CT patterns was performed at baseline and after 1 year. The abnormal lung percentage classified with the LmD value, based on a healthy volunteer 129 Xe LmD , and CALIPER was compared with a Bland-Altman analysis. The largest DW-MRI metrics were found in the regions classified as honeycombing, and longitudinal DW-MRI changes were observed in the baseline-classified reticular changes and ground-glass opacities regions. A mean bias of -15.3% (95% interval -56.8% to 26.2%) towards CALIPER was observed for the abnormal lung percentage. This suggests DW-MRI may detect microstructural changes in areas of the lung that are determined visibly and quantitatively normal by CT.