MRI of the lungs using hyperpolarized noble gases

Hyperpolarized xenon in NMR and MRI

Hyperpolarized gases have found a steadily increasing range of applications in nuclear magnetic resonance (NMR) and NMR imaging (MRI). They can be regarded as a new class of MR contrast agent or as a way of greatly enhancing the temporal resolution of the measurement of processes relevant to areas as diverse as materials science and biomedicine. We concentrate on the properties and applications of hyperpolarized xenon. This review discusses the physics of producing hyperpolarization, the NMR-relevant properties of 129Xe, specific MRI methods for hyperpolarized gases, applications of xenon to biology and medicine, polarization transfer to other nuclear species and low-field imaging.

Magnetization tagging decay to measure long-range (3)He diffusion in healthy and emphysematous canine lungs

Spatial modulation (tagging) of the longitudinal magnetization allows diffusive displacements to be measured over times approximately as long as T(1) and over correspondingly long distances. Magnetization tagging is used here with hyperpolarized (3)He gas in canine lungs with unilateral elastase-induced emphysema. A new scheme for analyzing images subsequent to tagging determines the spatially-resolved fractional modulation and its decay rate, using a sliding window. The diffusivity so determined over seconds and centimeter lengths, D(sec), is smaller in all cases than the diffusivity measured over milliseconds and hundreds of microns, D(msec) (in healthy lungs, this ratio is about 0.1). While D(msec) is sensitive to lung microstructure on the alveolar level, D(sec) reflects airway connectivity and provides new information on lung structure. The results show substantial increases in D(sec) in the lungs of four dogs with clear evidence of emphysema. For these dogs, the fractional increase in long-range diffusivity D(sec) in the emphysematous lungs was greater than that in short-range diffusivity D(msec).

Developing integrative computational models of pulmonary structure

Integrative computational modeling of the pulmonary system aims to incorporate interactions between the lung's subsystems by means of a hierarchy of structural and functional models. This requires detailed imaging-based data, along with a wide range of functional information from experiments. Advances in computed tomography imaging technology ensure that high-resolution data are now readily available upon which the structure of these models can be based. We present methods for constructing anatomically realistic finite element models of interrelated pulmonary structures from such data. Segmented human lung lobe data are fit to high-order (cubic Hermite) volume elements. Meshes for the conducting airways and pulmonary arteries and veins are constructed within the lobe mesh, using a combination of fitting to imaging data and a bifurcating-distributive algorithm. The algorithm generates an airway-consistent mesh within a host volume, and this airway mesh is then used as a template for generating blood vessel models. The lung parenchyma is modeled as a space-filling three-dimensional (3D) Voronoi mesh, with generated geometry consistent with the alveolated airway structure. Pulmonary capillaries are generated over the alveolar model, as a 2D Voronoi mesh. These structural models have been compared extensively with morphometric data to verify that their geometry is representative of the pulmonary system. The models are designed to be integrative: they relate multiple structural systems within the same individual, and their use as computational meshes allows application of spatially distributed properties.

Recent advances in imaging the lungs of intact small animals

A new generation of imaging devices now make it possible to generate both structural and functional images for the study of lung biology in small animals, including common laboratory mouse and rat models. "Micro" X-ray computed tomography and positron emission tomography scanners, highly sensitive cooled charge coupled device cameras for bioluminescence and fluorescence imaging, high magnetic field magnetic resonance imaging scanners, and recent advances in ultrasound system technology can be used to study such diverse processes as ventilation, perfusion, pulmonary hypertension, lung inflammation, and gene transfer, among others. Images from more than one modality can also be fused, allowing structure-function and function-function relationships to be studied on a regional basis. These new instruments, part of an emerging suite of techniques collectively known as "molecular imaging," provide an enormous potential for elucidating lung biology in intact animal models and systems.

Investigating 3He diffusion NMR in the lungs using finite difference simulations and in vivo PGSE experiments

Finite difference simulations have been used to model (3)He gas diffusion in simulated lung tissue. The technique has the advantage that a wide range of structural models and diffusion-sensitizing gradient waveforms can be investigated, for which analytical methods would otherwise be virtually impossible. Results from simulations and in vivo pulsed-gradient-spin-echo (PGSE) experiments show that the apparent diffusion coefficient (ADC) is a function of diffusion time and gradient strength, and suggests diffusion is locally anisotropic. The simulations have been compared to recent work on an analytical model that characterizes lung tissue as a series of independent cylinders. The results presented may have clinical implications for (3)He ADC measurements in assessing lung diseases such as chronic-obstructive-pulmonary-disease.

MR imaging of lung parenchyma at 0.2 T: evaluation of imaging techniques, comparative study with chest radiography and interobserver analysis

The purpose of this study was to evaluate low-field MR imaging of the lung parenchyma in comparison with postero-anterior (PA) and lateral chest radiographs (CR). One hundred one prospectively randomized patients who had received routine CR were additionally examined with magnetic resonance imaging (MRI) at 0.2 T. Utilized sequences were: constructive interference in steady state (CISS), true fast imaging in steady state precession (True-FISP) and T1-weighted spin-echo (T1SE). Consensus reading of two observers was performed for CR. Three other observers analyzed hardcopies of the MRI examinations for each sequence independently. The individual results for the comparisons between the sequences and CR were calculated using kappa coefficients with their corresponding confidence intervals. Additionally, an interobserver analysis was performed. The proportions of agreement for the three sequences compared with CR were high, with 0.93 for CISS, 0.89 for True-FISP and 0.91 for T1SE. The kappa coefficients and the corresponding confidence intervals were 0.81 [0.68; 0.95] for CISS, 0.72 [0.57; 0.88] for True-FISP and 0.78 [0.65; 0.92] for T1SE. Concerning CISS, differences between MRI and CR were mainly related to advantages resulting from cross-sectional imaging. The smallest 95% lower confidence bound of the three kappa measures for comparing the MR readers with each other was 0.97, indicating a high interobserver agreement. Low-field MRI of the lung parenchyma using the CISS sequence is well comparable with chest radiography and demonstrates slight advantages resulting from the cross-sectional imaging technique.

Comparison of arterial spin labeling and first-pass dynamic contrast-enhanced MR imaging in the assessment of pulmonary perfusion in humans: The inflow spin-tracer saturation effect

The flow-sensitive alternating inversion recovery (FAIR) and the first-pass dynamic contrast-enhanced MR imaging (CE-MRI) techniques have both been shown to be effective in the assessment of human pulmonary perfusion. However, no comprehensive comparison of the measurements by these two methods has been reported. In this study, healthy adults were recruited, with FAIR and CE-MRI performed for an estimation of the relative pulmonary blood flow (rPBF). Regions of interest were encircled from the right and left lungs, with right-to-left rPBF ratios calculated. Results indicated that, on posterior coronal slices, the rPBF ratios obtained with the FAIR technique agreed well with CE-MRI measurements (mean difference = -0.02, intraclass correlation coefficient RI = 0.78, 95% confidence interval = [0.67, 0.86]). On middle coronal slices, however, FAIR showed a substantially lower rPBF by up to 43% in the right lung compared with CE-MRI (mean difference = -0.38, RI = 0.34, 95% confidence interval = [-0.09, 0.68]). The location-dependent discrepancy between measurements by FAIR and CE-MRI methods is attributed to tracer saturation effects of arterial inflow when the middle coronal slice contains the in-plane-oriented right pulmonary artery, whereas the left lung rPBF is less affected due to oblique orientation of the left pulmonary artery. Intrasequence comparison on additional subjects using FAIR at different slice orientations supported the above hypothesis. It is concluded that FAIR imaging for pulmonary perfusion in the coronal plane provides equivalent rPBF information with CE-MRI only in the absence of tracer saturation effects; hence, FAIR should be carefully exercised to avoid misleading interpretations.

Functional Analysis in Single-Lung Transplant Recipients

OBJECTIVE

To develop and evaluate a postprocessing tool to quantify ventilated split-lung volumes on the basis of (3)He-MRI and to apply it in patients after single-lung transplantation (SLTX). High-resolution CT (HRCT) was employed as a reference modality providing split air-filled lung volumes. Lung volumes derived from pulmonary function test results served as clinical parameters and were used as the "gold standard."

MATERIAL AND METHODS

Eight patients (mean age, 54 years) with emphysema and six patients (mean age, 58 years) with idiopathic pulmonary fibrosis. All patients were evaluated following SLTX. HRCT was performed during inspiration (slice thickness, 1 mm; increment, 10 mm). For correlation with (3)He-MRI, HRCT images were reconstructed in coronal orientation to match the same anatomic levels. Aerated lung was determined by threshold-based segmentation of CT. (3)He-MRI was performed on a 1.5-T scanner using a two-dimensional, fast low-angle shot sequence in coronal orientation covering the whole lung after inhalation of a 300-mL bolus of hyperpolarized (3)He gas followed by normal room air for the rest of the tidal volume. Lung segmentation on (3)He-MRI was done using different thresholds.

RESULTS

In emphysematous patients, (3)He-MRI showed excellent correlation (r = 0.9) with vital capacity, while CT correlated (r = 0.8) with total lung capacity. (3)He-MRI correlated well with CT (r > 0.8) for grafts and native fibrotic lungs. In emphysematous lungs, MRI showed a good correlation (r = 0.7) with the nonemphysematous lung volume from CT. Increasing thresholds in (3)He-MRI reveal differences between aerated and ventilated lung areas with a different distribution in emphysema and fibrosis.

CONCLUSIONS

(3)He-MRI is superior to CT in emphysema to demonstrate ventilated lung areas that participate in gas exchange. In fibrosis, (3)He-MRI and CT have a similar impact. The decrease pattern and the intraindividual ratio between ventilation of native and transplanted lungs will have to be investigated as a new surrogate for the ventilatory follow-up in patients undergoing SLTX.

Proton MRI of lung parenchyma reflects allergen-induced airway remodeling and endotoxin-aroused hyporesponsiveness: A step toward ventilation studies in spontaneously breathing rats

Proton signals from lung parenchyma were detected with the use of a gradient-echo sequence to noninvasively obtain information on pulmonary function in models of airway diseases in rats. Initial measurements carried out in artificially ventilated control rats revealed a highly significant negative correlation between the parenchymal signal and the partial pressure of oxygen (pO2) in the blood, for different amounts of oxygen administered. The magnitude of the signal intensity variations caused by changes in the oxygen concentration was larger than expected solely from the paramagnetic properties of molecular oxygen. Inhomogeneous line-broadening induced by lung inflation may explain the observed signal amplification. Experiments carried out in spontaneously breathing animals challenged with allergen or endotoxin revealed parenchymal signal changes that reflected the oxygenation status of the lungs and were consistent with airway remodeling or hyporesponsiveness. The results suggest that proton MRI of parenchymal tissue is a sensitive tool for probing the functional status of the lung in rat models of respiratory diseases. The method is complementary to the recently described noninvasive assessment by MRI of pulmonary inflammation in small rodents. Overall, these techniques provide invaluable information for profiling anti-inflammatory drugs in models of airway diseases.

MRI of helium-3 gas in healthy lungs: Posture related variations of alveolar size

PURPOSE

To probe the variation of alveolar size in healthy lung tissue as a function of posture using diffusion-weighted helium-3 hyperpolarized gas imaging.

MATERIALS AND METHODS

Measurements of the helium-3 apparent diffusion coefficient (ADC) were made on six healthy subjects. These were used to show the variation of alveolar size between the lowermost dependent regions of the lung compared to the uppermost regions of the lung in four postures: supine, prone, left-lateral decubitus, and right-lateral decubitus.

RESULTS

The distribution of acinar size in the lungs was found to be heterogeneous, and influenced by lung orientation. In nearly all postures, the ADC was significantly higher in the non-dependent uppermost regions of the lung compared to the dependent lowermost regions of the lung; the greatest variation was found in the left-lateral decubitus position. The difference in ADC between uppermost and lowermost regions was on average 0.012 cm(2)second(-1), which represents 20% of the average ADC value for the whole lung. A systematic decrease in ADC from the apex of the lung to the base was also found, which corresponds to an inherent gradient in alveolar size.

CONCLUSION

The posture dependent variations in ADC were attributed to compression of the parenchyma under its own weight and the mass of the heart.

MRI for the diagnosis of pulmonary embolism

Pulmonary embolism (PE) is one of the most frequently encountered clinical emergencies. The diagnosis often involves multiple diagnostic tests, which need to be carried out rapidly to assist in the safe management of the patient. Recent strides in computed tomography (CT) have made big improvements in patient management and efficiency of diagnostic imaging. This review article describes the developments in magnetic resonance (MR) techniques for the diagnosis of acute PE. Techniques include MR angiography (MRA) and thrombus imaging for direct clot visualization, perfusion MR, and combined perfusion-ventilation MR. As will be demonstrated, some of these techniques are now entering the clinical arena, and it is anticipated that MR imaging (MRI) will have an increasing role in the initial diagnosis and follow-up of patients with acute PE.

Assessment and compensation of susceptibility artifacts in gradient echo MRI of hyperpolarized 3He gas

The effects of macroscopic background field gradients upon 2D gradient echo images of inhaled (3)He in the human lung were investigated at 1.5 T. Effective compensation of in-slice signal loss in (3)He gradient echo images was then demonstrated using a multiple acquisition interleaved single gradient echo sequence. This method restores signal dephasing through a combination of separate images acquired with different slice refocusing gradients. In vivo imaging of volunteers with the sequence shows substantial restoration of signal at the lung periphery and close to blood vessels. The technique presented may be useful when using (3)He MRI for volumetric measurements of lung ventilation and in studies using (3)He combined with intravenous contrast as a means of assessing lung ventilation/perfusion (V/Q).

Hyperpolarized 13C MR angiography using trueFISP

A (13)C-enriched water-soluble compound (bis-1,1-(hydroxymethyl)-1-(13)C-cyclopropane-D(8)), with a (13)C-concentration of approximately 200 mM, was hyperpolarized to approximately 15% using dynamic nuclear polarization, and then used as a contrast medium (CM) for contrast-enhanced magnetic resonance angiography (CE-MRA). The long relaxation times (in vitro: T(1) approximately 82 s, T(2) approximately 18 s; in vivo: T(1) approximately 38 s, T(2) approximately 1.3 s) are ideal for steady-state free precession (SSFP) imaging with a true fast imaging and steady precession (trueFISP) pulse sequence. It was shown both theoretically and experimentally that the optimal flip angle was 180 degrees. CE-MRA was performed in four anesthetized live rats after intravenous injection of 3 ml CM. The angiograms covered the thoracic/abdominal region in two of the animals, and the head-neck region in the other two. Fifteen consecutive images were acquired in each experiment, with a flip-back pulse at the end of each image acquisition. In the angiograms, the vena cava (SNR approximately 240), aorta, renal arteries, carotid arteries (SNR approximately 75), jugular veins, and several other vessels were visible. The SNR in the cardiac region was 500. Magnetization was preserved from one image acquisition to the next using the flip-back technique (SNR(cardiac) approximately 10 in the 15th image).

Contrast-enhanced magnetic resonance angiography: development and optimization of techniques for paramagnetic and hyperpolarized contrast media

Contrast-enhanced magnetic resonance angiography (CE-MRA) is a diagnostic method for imaging of vascular structures based on nuclear magnetic resonance. Vascular enhancement is achieved by injection of a contrast medium (CM). Studies were performed using two different types of CM: conventional paramagnetic CM, and a new type of CM based on hyperpolarized (HP) nuclei. The effects of varying CM concentration with time during image acquisition were studied by means of computer simulations using two different models. It was shown that a rapid concentration variation during encoding of the central parts of k-space could result in signal loss and severe image artifacts. The results were confirmed qualitatively with phantom experiments. A postprocessing method was developed to address problems with simultaneous enhancement of arteries and veins in CE-MRA of the lower extremities. The method was based on the difference in flow-induced phase in the two vessel types. Evaluation of the method was performed with flow phantom measurements and with CE-MRA in two volunteers using standard pulse sequences. The flow-induced phase in the vessels of interest was sufficient to distinguish arteries from veins in the superior-inferior direction. Using this method, the venous enhancement could be extinguished. The possibility of using HP nuclei as CM for CE-MRA was evaluated. Signal expressions for a flow of HP CM imaged with a gradient echo sequence were derived. These signal expressions were confirmed in phantom experiments using HP 129Xe dissolved in ethanol. Studies were also performed with a new CM based on HP 13C. The CM had very long relaxation times (T1, in vivo/T2, in vivo approximately 38/1.3 s). The long relaxation times were utilized in imaging with a fully balanced steady-state free precession pulse sequence (trueFISP), where the optimal flip angle was found to be 180 degrees. CE-MRA with the 13C-based CM in rats resulted in images with high vascular SNR (approximately 500). CE-MRA is a useful clinical tool for diagnosing vascular disease. With the development of new contrast media, based on hyperpolarized nuclei for example, there is a potential for further improvement in the signal levels that can be achieved, enabling a standard of imaging of vessels that is not possible today.

Dynamic radial projection MRI of inhaled hyperpolarized 3He gas

A radial projection sliding-window sequence has been developed for imaging the rapid flow of (3)He gas in human lungs. The short echo time (TE) of the radial sequence lends itself to fast repetition times, and thus allows a rapid update in the image when it is reconstructed with a sliding window. Oversampling in the radial direction combined with angular undersampling can further reduce the time needed to acquire a complete image data set, without significantly compromising spatial resolution. Controlled flow phantom experiments using hyperpolarized (3)He gas exemplify the temporal resolution of the method. In vivo studies on three healthy volunteers, one patient with chronic obstructive pulmonary disease (COPD), and one patient with hemiparalysis of the right diaphragm demonstrate that it is possible to accurately resolve the passage of gas down the trachea and bronchi and into the peripheral lung.

Fast measurement of relaxation times by steady-state free precession of 129Xe in carrier agents for hyperpolarized noble gases

Hyperpolarized gases ((129)Xe and (3)He) are being used increasingly in both MRI and NMR spectroscopy studies. However, it has been shown that carrier agents are required to preserve the long relaxation times of gases in biological fluids. Optimized gas transport can be achieved through controlled T(1) and T(2) measurements of (129)Xe gas at equilibrium, using the steady-state free precession method (SSFP). The accuracy of the method was proven with the use of CuSO(4)-doped water samples and xenon dissolved in chloroform. The following T(1) and T(2) values were measured for xenon dissolved in a 30% intralipid emulsion: T(1) = 29 +/- 3 s; T(2) = 1.0 +/- 0.1 s. The values obtained in the intralipid emulsion contrast significantly with those obtained in conventional gas NMR experiments, in which it is commonly assumed that T(1) = T(2). This highlights the importance of obtaining accurate relaxation time measurements for medical applications of hyperpolarized gases.

Hyperpolarized helium-3 gas magnetic resonance imaging of the lung

3He magnetic resonance imaging (MRI) is capable of producing new and regional information on normal and abnormal lung ventilation. The basis of 3He MRI involves "optical pumping" to hyperpolarize the 3He nuclei by photon angular momentum transfer. The hyperpolarized gas is administered via inhalation. 3He is an inert, nontoxic noble gas and absorbed in less than 0.1%. Imaging consists of a four-step protocol. 1) Gas density 3He MRI with high spatial resolution displays the distribution of a 3He bolus in a 10-second breath-hold. An almost homogeneous distribution is regarded as normal. Patients with lung diseases show multiple ventilation defects. 3He MRI has been shown to be more sensitive than proton MRI, computed tomography, nuclear medicine or pulmonary function testing for detection of ventilation defects. 2) Dynamic imaging 3He MRI with high temporal resolution shows the dynamic distribution of ventilation during continuous breathing after inhalation of a single breath of 3He gas. Homogeneous and fast distribution is regarded as normal, whereas patients show irregular and delayed patterns with redistribution and air trapping. 3) Diffusion-weighted 3He MRI provides a new measure for pulmonary microstructure because the apparent diffusion coefficient (ADC) reflects lung structure. Normal ADC values are less than 0.25 cm2/s and are increased in fibrosis and emphysema (0.3-0.9 cm2/s). 4) Oxygen-sensitive 3He MRI allows for regional and temporal analysis of intrapulmonary Pao2, which reflects regional pulmonary perfusion, ventilation-perfusion ratio, and oxygen uptake. In patients, an inhomogeneous Po2 distribution indicates alterations of ventilation-perfusion matching. Based on increased experience, 3He MRI can be regarded as a highly promising tool for functional analysis of ventilation. The clinical significance of the increase in sensitivity and sensitivity associated with 3He MRI is yet to be determined.

Applications of controlled-flow laser-polarized xenon gas to porous and granular media study

We report initial NMR studies of continuous flow laser-polarized xenon gas, both in unrestricted tubing, and in a model porous media. The study uses Pulsed Gradient Spin Echo-based techniques in the gas-phase, with the aim of obtaining more sophisticated information than just translational self-diffusion coefficients. Pulsed Gradient Echo studies of continuous flow laser-polarized xenon gas in unrestricted tubing indicate clear diffraction minima resulting from a wide distribution of velocities in the flow field. The maximum velocity experienced in the flow can be calculated from this minimum, and is seen to agree with the information from the complete velocity spectrum, or motion propagator, as well as previously published images. The susceptibility of gas flows to parameters such as gas mixture content, and hence viscosity, are observed in experiments aimed at identifying clear structural features from echo attenuation plots of gas flow in porous media. Gas-phase NMR scattering, or position correlation flow-diffraction, previously clearly seen in the echo attenuation data from laser-polarized xenon flowing through a 2 mm glass bead pack is not so clear in experiments using a different gas mixture. A propagator analysis shows most gas in the sample remains close to static, while a small portion moves through a presumably near-unimpeded path at high velocities.

Elucidation of structure-function relationships in the lung: contributions from hyperpolarized 3helium MRI

Magnetic resonance imaging (MRI) using hyperpolarized 3helium (He) gas as the source of signal provides new physiological insights into the structure-function relationships of the lung. Traditionally, lung morphology has been visualized by chest radiography and computed tomography, whereas lung function was assessed by using nuclear medicine. As all these techniques rely on ionizing radiation, MRI has some inherent advantages. 3He MRI is based on 'optical pumping' of the 3He gas which increases the nuclear spin polarization by four to five orders of magnitude translating into a massive gain in signal. Hyperpolarized 3He gas is administered as an inhaled 'contrast agent' and allows for selective visualization of airways and airspaces. Straightforward gas density images demonstrate the homogeneity of ventilation with high spatial resolution. In patients with lung diseases 3He MRI has shown a high sensitivity to depict ventilation defects. As 3He has some more exciting properties, a comprehensive four-step functional imaging protocol has been established. The dynamic distribution of ventilation during continuous breathing can be visualized after inhalation of a single breath of 3He gas using magnetic resonance (MR) sequences with high temporal resolution. Diffusion weighted 3He MRI provides a new measure for pulmonary microstructure because the degree of restriction of the Brownian motion of the 3He atoms reflects lung structure. Since the decay of 3He hyperpolarization is dependent on the ambient oxygen concentration, regional and temporal analysis of intrapulmonary pO2 becomes feasible. Thus, pulmonary perfusion, ventilation /perfusion ratio and oxygen uptake can be indirectly assessed. Further research will determine the significance of the functional information with regard to physiology and patient management.