Objectives High-resolution computed tomography (HRCT) plays a key role in the diagnosis of interstitial lung diseases (ILD). Lung MRI with ultrashort echo time (UTE-MRI) is a promising alternative, yet its accuracy in identifying usual interstitial pneumonia (UIP) patterns, a key feature of idiopathic pulmonary fibrosis (IPF) management, remains unknown. This study aimed to evaluate UTE-MRI’s diagnostic accuracy for UIP hallmarks compared to HRCT. Material and methods A monocentric prospective study was conducted between 2017 and 2020. All patients underwent HRCT (reference test) and UTE-MRI (index test). Diagnostic accuracy was assessed for the main UIP hallmarks, i.e., honeycombing, reticulation with or without bronchiolectasis, subpleural and basal distribution and the absence of abnormalities suggestive of an alternative diagnosis. A comprehensive evaluation of UIP and non-UIP patterns was also conducted. Results Sixty patients were included (median age = 64 years; 46 males), with (n = 25) and without IPF (n = 35). UTE-MRI demonstrated high (sensitivity/specificity) for honeycombing (86.9%/91.9%), reticulation with bronchiolectasis (88.0%/91.4%) or without bronchiolectasis (83.9%/89.7%), subpleural and basal distribution (88.0%/97.1%) and absence of alternative diagnoses (81.2%/77.8%), respectively. It accurately discriminated patients with UIP patterns versus alternative diagnoses with 100% (89.7; 100) sensitivity and 100% (86.7; 100) specificity. Intra- and inter-reader reproducibility was very good (κ ≥ 0.80). Conclusion UTE-MRI can diagnose the main structural hallmarks of IPF with high sensitivity and specificity, and was found to be comparable to CT for discriminating patients with UIP patterns among other fibrosing or non-fibrosing ILDs. Future research should explore morpho-functional combinations for monitoring IPF progression. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> The diagnostic accuracy of UTE-MRI to diagnose the usual interstitial pneumonia (UIP) patterns is currently unknown. <Emphasis Type="BoldItalic">Findings</Emphasis> UTE-MRI demonstrated high (sensitivity/specificity) for honeycombing (86.9%/91.9%), reticulation with (88.0%/91.4%) or without bronchiolectasis (83.9%/89.7%), and accurately discriminated patients with UIP patterns versus alternative diagnoses. <Emphasis Type="BoldItalic">Clinical relevant statement</Emphasis> UTE-MRI can diagnose the main structural hallmarks of IPF with high sensitivity and specificity, and was found to be comparable to CT for discriminating patients with UIP patterns among other fibrosing or non-fibrosing ILDs. Graphical Abstract

Diagnostic accuracy of ultrashort echo times-MRI in patients with and without idiopathic pulmonary fibrosis

期刊论文
发表日期：

2025年10月26日

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Gaël Dournes,
Ilyes Benlala,
Hugues Bégueret,
Chantal Raherison-Semjen,
Léo Grassion,
François Laurent,
Julie Macey,
Pan Su,
Rodolphe Thiébaut,
Julien Asselineau,
Elodie Blanchard

摘要

Objectives

High-resolution computed tomography (HRCT) plays a key role in the diagnosis of interstitial lung diseases (ILD). Lung MRI with ultrashort echo time (UTE-MRI) is a promising alternative, yet its accuracy in identifying usual interstitial pneumonia (UIP) patterns, a key feature of idiopathic pulmonary fibrosis (IPF) management, remains unknown. This study aimed to evaluate UTE-MRI’s diagnostic accuracy for UIP hallmarks compared to HRCT.

Material and methods

A monocentric prospective study was conducted between 2017 and 2020. All patients underwent HRCT (reference test) and UTE-MRI (index test). Diagnostic accuracy was assessed for the main UIP hallmarks, i.e., honeycombing, reticulation with or without bronchiolectasis, subpleural and basal distribution and the absence of abnormalities suggestive of an alternative diagnosis. A comprehensive evaluation of UIP and non-UIP patterns was also conducted.

Results

Sixty patients were included (median age = 64 years; 46 males), with (n = 25) and without IPF (n = 35). UTE-MRI demonstrated high (sensitivity/specificity) for honeycombing (86.9%/91.9%), reticulation with bronchiolectasis (88.0%/91.4%) or without bronchiolectasis (83.9%/89.7%), subpleural and basal distribution (88.0%/97.1%) and absence of alternative diagnoses (81.2%/77.8%), respectively. It accurately discriminated patients with UIP patterns versus alternative diagnoses with 100% (89.7; 100) sensitivity and 100% (86.7; 100) specificity. Intra- and inter-reader reproducibility was very good (κ ≥ 0.80).

Conclusion

UTE-MRI can diagnose the main structural hallmarks of IPF with high sensitivity and specificity, and was found to be comparable to CT for discriminating patients with UIP patterns among other fibrosing or non-fibrosing ILDs. Future research should explore morpho-functional combinations for monitoring IPF progression.

Key Points

Question The diagnostic accuracy of UTE-MRI to diagnose the usual interstitial pneumonia (UIP) patterns is currently unknown.

Findings UTE-MRI demonstrated high (sensitivity/specificity) for honeycombing (86.9%/91.9%), reticulation with (88.0%/91.4%) or without bronchiolectasis (83.9%/89.7%), and accurately discriminated patients with UIP patterns versus alternative diagnoses.

Clinical relevant statement UTE-MRI can diagnose the main structural hallmarks of IPF with high sensitivity and specificity, and was found to be comparable to CT for discriminating patients with UIP patterns among other fibrosing or non-fibrosing ILDs.

Graphical Abstract