Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis: MR Imaging of Airway Mucus Contrasts as a Tool for Diagnosis

Radiology. 2017 Oct;285(1):261-269. doi: 10.1148/radiol.2017162350. Epub 2017 May 22.


Purpose To assess the diagnostic accuracy of mucus contrast characterization by using magnetic resonance (MR) imaging to discriminate allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF). Materials and Methods The study was approved by the local Ethics Committee, and all patients or their parents gave written informed consent. One hundred ten consecutive patients with CF were screened between January 2014 and July 2015. All patients underwent a non-contrast material-enhanced MR protocol that included routine T1-weighted and T2-weighted sequences. The presence of mucus with both high T1 and low T2 signal intensities and the so-called inverted mucoid impaction signal (IMIS) sign was qualitatively and quantitatively assessed by two physicians who were blinded to all other data. The reference standard for a diagnosis of ABPA was the criteria of the Cystic Fibrosis Foundation Consensus Conference. ABPA status was followed up for 1 year. Reproducibility was assessed by using the κ test, correlation was assessed by using the Spearman coefficient, and diagnostic accuracy was assessed by calculating the sensitivity and specificity of IMIS. Results One hundred eight patients with CF were included (mean age, 20 years ± 11 [standard deviation]; range, 6-53 years): 18 patients with ABPA and 90 patients without ABPA. At the lobar level, inter- and intrareader reproducibility were very good (κ > 0.90). IMIS had 94% sensitivity (95% confidence interval [CI]: 73%, 99%) and 100% specificity (95% CI: 96%, 100%) for the diagnosis of ABPA. A complete resolution of IMIS was observed in patients with ABPA after 3 months of specific treatment that was significantly correlated with decrease in total immunoglobulin E level (ρ = 0.47; P = .04). Conclusion The IMIS sign was both specific and sensitive for the diagnosis of ABPA in CF. Allergic fungal inflammation appears to induce characteristic modifications of mucus contrasts that are assessable by using a noninvasive, contrast material-free, and radiation-free method. © RSNA, 2017 Online supplemental material is available for this article.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aspergillosis, Allergic Bronchopulmonary / complications*
  • Aspergillosis, Allergic Bronchopulmonary / diagnosis*
  • Aspergillosis, Allergic Bronchopulmonary / pathology
  • Child
  • Cystic Fibrosis / complications*
  • Cystic Fibrosis / diagnostic imaging
  • Cystic Fibrosis / pathology
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted / methods*
  • Lung / diagnostic imaging
  • Lung / pathology
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Mucus / diagnostic imaging*
  • Predictive Value of Tests
  • Prospective Studies
  • Radiography, Thoracic
  • Reproducibility of Results
  • Young Adult