Thoracic MRI as a tool in diagnosis and follow up in CVID patients
Research type
Research Study
Full title
Evaluation of Thoracic MRI as a Replacement for Thoracic HRCT in the Diagnosis and Assessment of Disease Progression in Common Variable Immune Deficiency
IRAS ID
216300
Contact name
Joseph Jacob
Contact email
Sponsor organisation
Royal Free Hospital London NHS Foundation Trust
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Patients with common variable immune deficiency disorders (CVID) have genetic abnormalities of their immune system, predisposing patients to autoimmune disease and recurrent infections. A subset of these patients are also at increased risk of developing pulmonary lymphoma.
Early identification of CVID patients with lung disease is important to improve quality of life and reduce mortality. Current recommendations are therefore for CT scan monitoring of asymptomatic patients every 5 years and annual pulmonary function tests. However, recurrent infections occur with a higher frequency than this, roughly 2.5 per year, which often necessitates more frequent CT imaging. Furthermore, given the increased risk of the development of lymphoma, numerous follow-up CT examinations are not uncommon.
Background radiation is estimated at 2msV per year, while every CT Chest administers approximately 6msV which equates to three times yearly radiation exposure with a single encounter.The cumulative effects of ionising radiation from CT imaging on a young radiosensitive population are considerable and there are concerns that CVID innately predisposes patients to increased radiosensitivity, further adding to this risk. The ability to image more frequently without additional radiation exposure would be a major clinical development.
Our study aims to evaluate MR imaging of the lungs as a potential alternative to CT scanning follow up in patients with CVID. The Royal Free Hospital is a tertiary referral centre for immunodeficiency and has the largest CVID population in the country. We will recruit 20-30 patients from this group to have an additional MRI scan alongside their routine follow up CT imaging and will evaluate both imaging methodologies using published scoring systems and we will correlate imaging findings with functional indices. We also propose to evaluate diffusion MR sequences as a method by which to risk stratify pulmonary nodules or foci of consolidation for lymphoma risk.
REC name
East of England - Cambridge Central Research Ethics Committee
REC reference
16/EE/0477
Date of REC Opinion
2 Nov 2016
REC opinion
Further Information Favourable Opinion