A combined 1H perfusion/3He ventilation NMR study in rat lungs

Synchronous acquisition of hyperpolarised 3He and 1H MR images of the lungs - maximising mutual anatomical and functional information

The development of hybrid medical imaging scanners has allowed imaging with different detection modalities at the same time, providing different anatomical and functional information within the same physiological time course with the patient in the same position. Until now, the acquisition of proton MRI of lung anatomy and hyperpolarised gas MRI of lung function required separate breath-hold examinations, meaning that the images were not spatially registered or temporally synchronised. We demonstrate the spatially registered concurrent acquisition of lung images from two different nuclei in vivo. The temporal and spatial registration of these images is demonstrated by a high degree of mutual consistency that is impossible to achieve in separate scans and breath holds.

Ultra-short echo time (UTE) MR imaging of the lung: comparison between normal and emphysematous lungs in mutant mice

PURPOSE

To investigate the utility of ultra-short echo time (UTE) sequence as pulmonary MRI to detect non-uniform disruption of lung architecture that is typical of emphysema.

MATERIALS AND METHODS

MRI of the lungs was conducted with a three-dimensional UTE sequence in transgenic mice with severe emphysema and their wild-type littermates in a 3 Tesla clinical MR system. Measurements of the signal intensity (SI) and transverse relaxation time (T2*) of the lung parenchyma were performed with various echo times (TEs) ranging from 100 micros to 2 ms.

RESULTS

Much higher SI of the lung parenchyma was observed at an UTE of 100 micros compared with longer TEs. The emphysematous lungs had reduced SIs and T2* than the controls, in particular at end-expiratory phase. The results suggested that both SI and T2* in lung parenchyma measured with the method represent fractional volume of lung tissue.

CONCLUSION

The UTE imaging provided MR signal from the lung parenchyma. Moreover, the UTE sequence was sensitive to emphysematous changes and may provide a direct assessment of lung parenchyma. UTE imaging has the potential to assist detection of localized pathological destruction of lung tissue architecture in emphysema.

Ventilation/perfusion imaging in a rat model of airway obstruction

The global increase in asthma, chronic obstructive pulmonary disease, and other pulmonary diseases has stimulated interest in preclinical rat models of pulmonary disease. Imaging methods for study of these models is particularly appealing since the results can be readily translated to the clinical setting. Comprehensive understanding of lung function can be achieved by performing registered pulmonary ventilation and perfusion imaging studies in the same animal. While ventilation imaging has been addressed for small animals, quantitative pulmonary perfusion imaging has not been feasible until recently, with our proposed technique for quantitative perfusion imaging using multiple contrast-agent injections and a view-sharing radial imaging technique. Here, we combine the method with registered ventilation imaging using hyperpolarized (3)He in an airway obstruction rodent model. To our knowledge, this is the first comprehensive quantitative assessment of lung function in small animals at high spatial resolution. Standard deviation of the log (V/Q) is used as a quantitative biomarker to differentiate heterogeneity between the control and treatment group. The estimated value of the biomarker lies within the normal range of values reported in the literature. The biomarker that was extracted using the imaging technique described in this work showed statistically significant differences between the control rats and those with airway obstruction.

Quantitative blood flow measurements in the small animal cardiopulmonary system using digital subtraction angiography

PURPOSE

The use of preclinical rodent models of disease continues to grow because these models help elucidate pathogenic mechanisms and provide robust test beds for drug development. Among the major anatomic and physiologic indicators of disease progression and genetic or drug modification of responses are measurements of blood vessel caliber and flow. Moreover, cardiopulmonary blood flow is a critical indicator of gas exchange. Current methods of measuring cardiopulmonary blood flow suffer from some or all of the following limitations--they produce relative values, are limited to global measurements, do not provide vasculature visualization, are not able to measure acute changes, are invasive, or require euthanasia.

METHODS

In this study, high-spatial and high-temporal resolution x-ray digital subtraction angiography (DSA) was used to obtain vasculature visualization, quantitative blood flow in absolute metrics (ml/min instead of arbitrary units or velocity), and relative blood volume dynamics from discrete regions of interest on a pixel-by-pixel basis (100 x 100 microm2).

RESULTS

A series of calibrations linked the DSA flow measurements to standard physiological measurement using thermodilution and Fick's method for cardiac output (CO), which in eight anesthetized Fischer-344 rats was found to be 37.0 +/- 5.1 ml/min. Phantom experiments were conducted to calibrate the radiographic density to vessel thickness, allowing a link of DSA cardiac output measurements to cardiopulmonary blood flow measurements in discrete regions of interest. The scaling factor linking relative DSA cardiac output measurements to the Fick's absolute measurements was found to be 18.90 x CODSA = COFick.

CONCLUSIONS

This calibrated DSA approach allows repeated simultaneous visualization of vasculature and measurement of blood flow dynamics on a regional level in the living rat.

Hyperpolarized 129Xe phase-selective imaging of mouse lung at 9.4T using a continuous-flow hyperpolarizing system

The use of hyperpolarized (HP) 129Xe magnetic resonance (MR) imaging to regionally evaluate gas diffusion and perfusion processes as well as ventilation in the lung has been expected. In this study, we used a continuous-flow hyperpolarizing (CF-HP) system to acquire gas- and dissolved-phase 129Xe images from mouse lung, employing standard gradient echo sequence equipped with chemical shift selective excitation and 90 degrees flip angle. The character of non-recoverable HP magnetization enabled the use of a phase (frequency)-selective 90 degrees pulse for direct visualization of only a given-phase 129Xe magnetization replenished into the slice during repetition time (TR). We combined gas- and dissolved-phase 129Xe images to map the ratio of dissolved- to gas-phase 129Xe replenished into the slice during TR (Mdissolved/Mgas) and found it to be approximately 0.05 to 0.08 in the peripheral regions of mouse lungs. This result suggested that replenishment of dissolved-phase 129Xe magnetization by gas diffusion and pulmonary perfusion would be faster than that of gas-phase by ventilation. The use of a CF-HP system that allows the application of relatively long TR to HP 129Xe imaging using a phase-selective 90 degrees pulse would be useful in evaluating gas transport mechanisms in the lung.

Pulmonary perfusion imaging in the rodent lung using dynamic contrast-enhanced MRI

With the development of various models of pulmonary disease, there is tremendous interest in quantitative regional assessment of pulmonary function. While ventilation imaging has been addressed to a certain extent, perfusion imaging for small animals has not kept pace. In humans and large animals perfusion can be assessed using dynamic contrast-enhanced (DCE) MRI with a single bolus injection of a gadolinium (Gd)-based contrast agent. But the method developed for the clinic cannot be translated directly to image the rodent due to the combined requirements of higher spatial and temporal resolution. This work describes a novel image acquisition technique staggered over multiple, repeatable bolus injections of contrast agent using an automated microinjector, synchronized with image acquisition to achieve dynamic first-pass contrast enhancement in the rat lung. This allows dynamic first-pass imaging that can be used to quantify pulmonary perfusion. Further improvements are made in the spatial and temporal resolution by combining the multiple injection acquisition method with Interleaved Radial Imaging and "Sliding window-keyhole" reconstruction (IRIS). The results demonstrate a simultaneous increase in spatial resolution (<200 mum) and temporal resolution (<200 ms) over previous methods, with a limited loss in signal-to-noise-ratio.

Functional imaging: CT and MRI

Numerous imaging techniques permit evaluation of regional pulmonary function. Contrast-enhanced CT methods now allow assessment of vasculature and lung perfusion. Techniques using spirometric controlled multi-detector row CT allow for quantification of presence and distribution of parenchymal and airway pathology; xenon gas can be employed to assess regional ventilation of the lungs, and rapid bolus injections of iodinated contrast agent can provide a quantitative measure of regional parenchymal perfusion. Advances in MRI of the lung include gadolinium-enhanced perfusion imaging and hyperpolarized gas imaging, which allow functional assessment, including ventilation/perfusion, microscopic air space measurements, and gas flow and transport dynamics.

3He MRI in mouse models of asthma

In the study of asthma, a vital role is played by mouse models, because knockout or transgenic methods can be used to alter disease pathways and identify therapeutic targets that affect lung function. Assessment of lung function in rodents by available methods is insensitive because these techniques lack regional specificity. A more sensitive method for evaluating lung function in human asthma patients uses hyperpolarized (HP) (3)He MRI before and after bronchoconstriction induced by methacholine (MCh). We now report the ability to perform such (3)He imaging of MCh response in mice, where voxels must be approximately 3000 times smaller than in humans and (3)He diffusion becomes an impediment to resolving the airways. We show three-dimensional (3D) images that reveal airway structure down to the fifth branching and visualize ventilation at a resolution of 125 x 125 x 1000 microm(3). Images of ovalbumin (OVA)-sensitized mice acquired after MCh show both airway closure and ventilation loss. To also observe the MCh response in naive mice, we developed a non-slice-selective 2D protocol with 187 x 187 microm(2) resolution that was fast enough to record the MCh response and recovery with 12-s temporal resolution. The extension of (3)He MRI to mouse models should make it a valuable translational tool in asthma research.

Basics concepts and clinical applications of oxygen-enhanced MR imaging

Oxygen-enhanced MR imaging is a new technique, and its physiological significance has not yet been fully elucidated. This review article covers (1) the theory of oxygen enhancement and its relationship with respiratory physiology; (2) design for oxygen-enhanced MR imaging sequencing; (3) a basic study of oxygen-enhanced MR imaging in animal models and humans; (4) a clinical study of oxygen-enhanced MR imaging; and (5) a comparison of advantages and disadvantages of this technique with those of hyperpolarized noble gas MR ventilation imaging. Oxygen-enhanced MR imaging provides not only the ventilation-related, but also respiration-related information. Oxygen-enhanced MR imaging has the potential to replace nuclear medicine studies for the identification of regional pulmonary function, and many investigators are now attempting to adapt this technique for routine clinical studies. We believe that further basic studies as well as clinical applications of this new technique will define the real significance of oxygen-enhanced MR imaging for the future of pulmonary functional imaging and its usefulness for diagnostic radiology and pulmonary medicine.

Lung MRI for experimental drug research

Current techniques to evaluate the efficacy of potential treatments for airways diseases in preclinical models are generally invasive and terminal. In the past few years, the flexibility of magnetic resonance imaging (MRI) to obtain anatomical and functional information of the lung has been explored with the scope of developing a non-invasive approach for the routine testing of drugs in models of airways diseases in small rodents. With MRI, the disease progression can be followed in the same animal. Thus, a significant reduction in the number of animals used for experimentation is achieved, as well as minimal interference with their well-being and physiological status. In addition, under certain circumstances the duration of the observation period after disease onset can be shortened since the technique is able to detect changes before these are reflected in parameters of inflammation determined using invasive procedures. The objective of this article is to briefly address MRI techniques that are being used in experimental lung research, with special emphasis on applications. Following an introduction on proton techniques and MRI of hyperpolarized gases, the attention is shifted to the MRI analysis of several aspects of lung disease models, including inflammation, ventilation, emphysema, fibrosis and sensory nerve activation. The next subject concerns the use of MRI in pharmacological studies within the context of experimental lung research. A final discussion points towards advantages and limitations of MRI in this area.

Functional lung imaging using hyperpolarized gas MRI

The noninvasive assessment of lung function using imaging is increasingly of interest for the study of lung diseases, including chronic obstructive pulmonary disease (COPD) and asthma. Hyperpolarized gas MRI (HP MRI) has demonstrated the ability to detect changes in ventilation, perfusion, and lung microstructure that appear to be associated with both normal lung development and disease progression. The physical characteristics of HP gases and their application to MRI are presented with an emphasis on current applications. Clinical investigations using HP MRI to study asthma, COPD, cystic fibrosis, pediatric chronic lung disease, and lung transplant are reviewed. Recent advances in polarization, pulse sequence development for imaging with Xe-129, and prototype low magnetic field systems dedicated to lung imaging are highlighted as areas of future development for this rapidly evolving technology.

Quantitative measurements of regional lung ventilation using helium-3 MRI in a methacholine-induced bronchoconstriction model

PURPOSE

To demonstrate ventilation changes in an animal model of methacholine-induced bronchoconstriction using hyperpolarized (HP) helium-3 (He-3) MRI.

MATERIALS AND METHODS

Bronchoconstriction was induced in 11 healthy rats using an intravenous injection of methacholine. The He-3 was laser-polarized using a custom-built system. MRI studies were performed on a 2-Tesla bore magnet. Coronal dynamic ventilation images were obtained using a single inhalation of the laser-polarized He-3 gas before and after methacholine injection. Ventilation image series were processed on a pixel-by-pixel basis to generate three regional ventilation parameters: gas flow rate, filling time, and maximum gas volume. Student's paired t-test was used for analysis.

RESULTS

Ventilation image series with a temporal resolution of 5 msec were obtained before and after methacholine challenge. Quantitative regional gas dynamic information demonstrated statistically significant differences between the baseline and constricted states. Following methacholine injection, the mean flow values were significantly lower for the right lung (RL) (P = 0.006) and left lung (LL) (P = 0.024), while the mean filling time was found to be greater (RL: P = 0.08, LL: P = 0.021). Gas volume values at maximum inspiration were found to be significantly lower after methacholine (RL: P = 0.002; LL: P = 0.036).

CONCLUSION

He-3 MRI demonstrated and quantified regional ventilation changes in bronchoconstriction conditions in rats.

Feasibility of combining MR perfusion, angiography, and 3He ventilation imaging for evaluation of lung function in a porcine model

RATIONALE AND OBJECTIVE

To assess the feasibility of combining magnetic resonance (MR) perfusion, angiography, and 3He ventilation imaging for the evaluation of lung function in a porcine model.

MATERIALS AND METHODS

Fourteen consecutive porcine models with externally delivered pulmonary emboli and/or airway occlusions were examined with MR perfusion, angiography, and 3He ventilation imaging. Ultrafast gradient-echo sequences were used for 3D perfusion and angiographic imaging, in conjunction with the use of contrast-agent injections. 2D multiple-section 3He imaging was performed subsequently via the inhalation of hyperpolarized 3He gas. The diagnostic accuracy of MR angiography for detecting pulmonary emboli was determined by two reviewers. The diagnostic confidence for different combinations of MR techniques was rated on the basis of a 5-point grading scale (5 = definite).

RESULTS

The sensitivity, specificity, and accuracy of MR angiography for detecting pulmonary emboli were approximately 85.7%, 90.5%, and 88.1%, respectively. The interobserver agreement was very strong (k = 0.82). There was a clear tendency for confidence to increase when first perfusion and then ventilation imaging were added to the angiographic image (Wilcoxon signed ranks test, P = 0.03).

CONCLUSION

The combination of the three methods of MR perfusion, angiography, and 3H ventilation imaging may provide complementary information on abnormal lung anatomy and function.

Assessment of regional lung function impairment in airway obstruction and pulmonary embolic dogs with combined noncontrast electrocardiogram-gated perfusion and gadolinium diethylenetriaminepentaacetic acid aerosol magnetic resonance images

PURPOSE

To define regional function impairment in airway obstruction (AO) and pulmonary embolic (PE) dogs with a combination study of noncontrast electrocardiogram (ECG)-gated perfusion and gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) aerosol magnetic resonance (MR) images.

METHODS

After acquisition of multiphase fast-spin-echo (FSE) MR images during cardiac cycles in 14 AO dogs and 19 PE dogs, ECG-gated perfusion-weighted (PW) images were obtained by subtraction between two-phase images of the minimum lung signal intensity (SI) during systole and maximum SI during diastole. Each dog subsequently inhaled Gd-DTPA aerosol for 20 minutes, and subtracted Gd-DTPA aerosol images were obtained from precontrast and maximally enhanced images. ECG-gated PW images were compared with intravenous Gd-DTPA-enhanced pulmonary arterial perfusion phase (PAPP) images.

RESULTS

ECG-gated PW images were consistent with Gd-DTPA-enhanced PAPP images in all dogs, with significant correlations in the affected-to-unaffected lung perfusion ratios (P < 0.005). Gd-DTPA aerosol images showed sufficient and uniform enhancement in the unaffected lungs. In all the AO areas, these combined images showed the matched perfusion and aerosol deposition defects. These images showed perfusion defects without aerosol deposition defects in the relatively small embolized areas, but showed the matched defects in the widely embolized areas probably due to hypoxic bronchial constriction.

CONCLUSION

The combination MR studies may be acceptable for noninvasively defining regionally impaired lung function in AO and PE.

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.

Automatic tuning and matching of a small multifrequency saddle coil at 4.7 T

A new circuit design for automatically tuning and matching a saddle coil for small animal imaging is presented. This design allows working at (1)H, (19)F, and (3)He resonance frequencies in a 4.7 T spectrometer. It is based on a balanced circuit with commercial variable capacity diodes controlled by a computer using digital potentiometers. The change between two different frequencies can be accurately performed in a few seconds. System Q is compared, between 140-210 MHz, to the same coil tuned and matched with high Q variable capacitors. Differences lower than 5% were found with a loaded coil. The proposed design has initially been evaluated in (19)F and (1)H NMR images acquired with a five-tube phantom. An application is also shown for the acquisition of (3)He, (19)F, and (1)H lung images in a control rat.

Characterization of diffusing capacity and perfusion of the rat lung in a lipopolysaccaride disease model using hyperpolarized 129Xe

The ability to quantify pulmonary diffusing capacity and perfusion using dynamic hyperpolarized (129)Xe NMR spectroscopy is demonstrated. A model of alveolar gas exchange was developed, which, in conjunction with (129)Xe NMR, enables quantification of average alveolar wall thickness, pulmonary perfusion, capillary diffusion length, and mean transit time. The technique was employed to compare a group of naïve rats (n = 10) with a group of rats with acute inflammatory lung injury (n = 10), caused by instillation of lipopolysaccaride (LPS). The measured structural and perfusion-related parameters were in agreement with reported values from studies using non-NMR methods. Significant differences between the groups were found in total diffusion length (control 8.5 +/- 0.5 microm, LPS 9.9 +/- 0.6 microm, P < 0.001), in capillary diffusion length (control 2.9 +/- 0.4 microm, LPS 3.9 +/- 1.0 microm, P < 0.05), and in pulmonary hematocrit (control 0.55 +/- 0.06, LPS 0.43 +/- 0.08, P < 0.01), whereas no differences were observed in alveolar wall thickness, pulmonary perfusion, and mean transit time. These results demonstrate the ability of the method to distinguish two main aspects of lung function, namely, diffusing capacity and pulmonary perfusion.

Ventilation-synchronous magnetic resonance microscopy of pulmonary structure and ventilation in mice

Increasing use of transgenic animal models for pulmonary disease has raised the need for methods to assess pulmonary structure and function in a physiologically stable mouse. We report here an integrated protocol using magnetic resonance microscopy with gadolinium (Gd)-labeled starburst dendrimer (G6-1B4M-Gd, MW = 192 +/- 1 kDa, R(h) = 5.50 +/- 0.04 nm) and hyperpolarized (3)helium ((3)He) gas to acquire images that demonstrate pulmonary vasculature and ventilated airways in live mice (n = 9). Registered three-dimensional images of (1)H and (3)He were acquired during breath-hold at 2.0 T using radial acquisition (total acquisition time of 38 and 25 min, respectively). The macromolecular Gd-labeled dendrimer (a half-life of approximately 80 min) increased the signal-to-noise by 81 +/- 30% in the left ventricle, 43 +/- 22% in the lung periphery, and -4 +/- 5% in the chest wall, thus increasing the contrast of these structures relative to the less vascular surrounding tissues. A constant-flow ventilator was developed for the mouse to deliver varied gas mixtures of O(2) and N(2) (or (3)He) during imaging. To avoid hypoxemia, instrumental dead space was minimized and corrections were made to tidal volume lost due to gas compression. The stability of the physiologic support was assessed by the lack of spontaneous breathing and maintenance of a constant heart rate. We were able to stabilize the mouse for >8 hr using ventilation of 105 breath/min and approximately 0.2 mL/breath. The feasibility of acquiring both pulmonary vasculature and ventilated airways was demonstrated in the mouse lung with in-plane spatial resolution of 70 x 70 microm(2) and slice thickness of 800 microm.

Assessment of lung perfusion impairment in patients with pulmonary artery-occlusive and chronic obstructive pulmonary diseases with noncontrast electrocardiogram-gated fast-spin-echo perfusion MR imaging

PURPOSE

To evaluate the ability of noncontrast electrocardiogram (ECG)-gated fast-spin-echo (FSE) perfusion MR images for defining regional lung perfusion impairment, as compared with technetium (Tc)-99m macroaggregated albumin (MAA) single-photon emission computed tomography (SPECT) images.

MATERIALS AND METHODS

After acquisition of ECG-gated multiphase FSE MR images during cardiac cycles at selected lung levels in nine healthy volunteers, 11 patients with pulmonary artery-occlusive diseases, and 15 patients with chronic obstructive pulmonary diseases (COPD), the subtracted perfusion-weighted (PW) MR images were obtained from the two-phase images of the minimum lung signal intensity (SI) during systole and the maximum SI during diastole, and were compared with SPECT images.

RESULTS

ECG-gated PW images showed uniform but posture-dependent perfusion gradient in normal lungs and visualized the various sizes of perfusion defects in affected lungs. These defect sites were nearly consistent with those on SPECT images, with a significant correlation for the affected-to-unaffected perfusion contrast (r = 0.753; P < 0.0001). These MR images revealed that the pulmonary arterial blood flow in the affected areas of COPD was relatively preserved as compared with pulmonary artery-occlusive diseases, and also showed significant decrease in blood flow, even in the areas with homogeneous perfusion on SPECT images in patients with focal pulmonary emphysema.

CONCLUSION

This noninvasive MR technique allows qualitative and quantitative assessment of lung perfusion, and may better characterize regional perfusion impairment in pulmonary artery-occlusive diseases and COPD.

Molecular imaging using hyperpolarized13C

MRI provides unsurpassed soft tissue contrast, but the inherent low sensitivity of this modality has limited the clinical use to imaging of water protons. With hyperpolarization techniques, the signal from a given number of nuclear spins can be raised more than 100 000 times. The strong signal enhancement enables imaging of nuclei other than protons, e.g. (13)C and (15)N, and their molecular distribution in vivo can be visualized in a clinically relevant time window. This article reviews different hyperpolarization techniques and some of the many application areas. As an example, experiments are presented where hyperpolarized (13)C nuclei have been injected into rabbits, followed by rapid (13)C MRI with high spatial resolution (scan time <1 s and 1.0 mm in-plane resolution). The high degree of polarization thus enabled mapping of the molecular distribution within various organs, a few seconds after injection. The hyperpolarized (13)C MRI technique allows a selective identification of the molecules that give rise to the MR signal, offering direct molecular imaging.

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.

An evaluation of pulmonary atelectasis and its re-expansion

RATIONALE AND OBJECTIVES

Atelectasis, the collapse of small airways, is a significant clinical problem. We use hyperpolarized (HP) 3He magnetic resonance imaging (MRI), or HP 3He MRI, to describe atelectasis in the normal Yorkshire pig, the pig with atelectasis, and the pig with re-expansion of atelectasis. We compare HP 3He MRI findings with depictions of atelectasis by proton MRI.

MATERIALS AND METHODS

During end-expiration in the anesthetized and paralyzed Yorkshire pig (n = 6), HP 3He gas produced by the optical pumping spin-exchange method, was delivered via an endotracheal tube. For two separate groups, atelectasis was either induced by Fogarty-catheter occlusion balloon inflation (n = 3), or lateral chest wall administration of sodium hydroxide (NaOH) (n = 3). MRI was performed at time zero, at 5, 9, 13, 15, and 19 minutes after atelectasis production, 30 minutes after balloon deflation, and 10 and 30 minutes after recruitment of atelectatic areas with increased tidal volumes and added positive end-expiratory pressure. High-resolution, cross-sectional MR images were procured, and comparison was made with the traditional proton MRI.

RESULTS

Atelectatic areas by HP 3He MRI were easily distinguishable in both subject groups, and correlated with those located by proton MR. HP 3He MR images showed absence of ventilation, whereas proton MR images depicted dense, white areas. Re-expansion of atelectasis was well delineated by HP 3He MRI.

CONCLUSION

HP 3He MRI may overcome many of the shortcomings of other well-established radiographic methods. HP 3He MRI is a novel, informative method for describing atelectasis and its re-expansion.

Dynamic3He imaging for quantification of regional lung ventilation parameters

Dynamic ventilation imaging using laser-polarized (3)He has a promising potential for elucidating the physiology and physiopathology of the lungs. In this study, a methodological approach is proposed for the assessment and quantification of local ventilation parameters. High-temporal-resolution coronal ventilation image series were obtained with a projection-reconstruction (PR) sequence combined with the sliding-window technique. After image series were processed, parametric pixel-by-pixel maps of the gas arrival time, filling time constant, inflation rate, and gas volume were generated. The acquisition technique and the signal processing procedure, which are referred to collectively as sliding pulmonary imaging for respiratory overview (SPIRO), were tested in vivo in healthy rat lungs using a contrast media injector for controlled (3)He flow and volume injection in the animal lungs. The same protocol was applied to broncho-constriction animal models using intravenous injection of methacholine solution. Inflation rate values measured in the lungs were found to decrease with increasing doses of injected methacholine solution. This study demonstrates that it is possible to obtain quantitative regional gas dynamic information using the SPIRO technique in a single polarized gas inspiration.

Clinical oxygen-enhanced magnetic resonance imaging of the lung

SUMMARY

Oxygen-enhanced magnetic resonance (MR) ventilation imaging is a new technique, and the full extent of its physiologic significance has not been elucidated. This review article includes (1) theory of oxygen enhancement; (2) respiratory physiology; (3) oxygen-enhanced MR imaging (MRI) sequence design; (4) basic study of oxygen-enhanced MRI in animal models and humans; (5) clinical study of oxygen-enhanced MRI; and (6) merits and demerits of the technique in comparison with hyperpolarized noble gas MR ventilation imaging. Oxygen-enhanced MRI provides not only ventilation-related information but also respiration-related information. Although application of oxygen-enhanced MR ventilation imaging to patients with pulmonary diseases has been limited, oxygen-enhanced MRI offers the possibility of demonstrating regional pulmonary function and substituting for nuclear medicine ventilation-perfusion study, when combined with MR perfusion imaging. We believe that further basic studies and clinical applications of this new technique will define the real significance of oxygen-enhanced MR ventilation imaging in the future of pulmonary functional imaging and its usefulness for diagnostic radiology.

Recent advances in magnetic resonance perfusion imaging of the lung

Magnetic resonance imaging has been relatively underused for clinical application in the lung; however, developments in magnetic resonance perfusion imaging using contrast agents and spin labeling techniques have shown significant potential for clinical application in lung perfusion. This article reviews the recent publications on magnetic resonance pulmonary perfusion.

Operating characteristics of hyperpolarized 3He and arterial spin tagging in MR imaging of ventilation and perfusion in healthy subjects

RATIONALE AND OBJECTIVES

The authors tested the feasibility of a magnetic resonance (MR) imaging method combining the use of hyperpolarized helium 3 (3He) for ventilation imaging and an arterial spin-tagging sequence for perfusion imaging in six healthy human subjects.

MATERIALS AND METHODS

High-resolution sagittal images depicting 3He distribution were acquired after the subjects' inhalation of 500 mL of laser-hyperpolarized 3He produced by spin-exchange optical pumping. Perfusion MR imaging was performed with a steady-state arterial spin-tagging sequence that enabled the acquisition of three-dimensional images of pulmonary perfusion without the need for subject breath holding.

RESULTS

The 3He ventilation images display, with high signal intensity and detailed anatomic localization, the airspace of the lung parenchyma. The signal intensity on the perfusion images decreased by 23.2% with the use of arterial spin tagging. Ventilation and perfusion were matched, as is expected in healthy subjects.

CONCLUSION

This method may have important applications in the assessment of lung function, enabling the calculation of regional ventilation-perfusion ratios. It may also aid in the selection of candidates for lung volume-reduction surgery.

Ventilation-perfusion ratio of signal intensity in human lung using oxygen-enhanced and arterial spin labeling techniques

This study investigates the distribution of ventilation-perfusion (V/Q) signal intensity (SI) ratios using oxygen-enhanced and arterial spin labeling (ASL) techniques in the lungs of 10 healthy volunteers. Ventilation and perfusion images were simultaneously acquired using the flow-sensitive alternating inversion recovery (FAIR) method as volunteers alternately inhaled room air and 100% oxygen. Images of the T(1) distribution were calculated for five volunteers for both selective (T(1f)) and nonselective (T(1)) inversion. The average T(1) was 1360 ms +/- 116 ms, and the average T(1f) was 1012 ms +/- 112 ms, yielding a difference that is statistically significant (P < 0.002). Excluding large pulmonary vessels, the average V/Q SI ratios were 0.355 +/- 0.073 for the left lung and 0.371 +/- 0.093 for the right lung, which are in agreement with the theoretical V/Q SI ratio. Plots of the V/Q SI ratio are similar to the logarithmic normal distribution obtained by multiple inert gas elimination techniques, with a range of ratios matching ventilation and perfusion. This MRI V/Q technique is completely noninvasive and does not involve ionized radiation. A limitation of this method is the nonsimultaneous acquisition of perfusion and ventilation data, with oxygen administered only for the ventilation data.

CT and MR in pulmonary embolism: A changing role for nuclear medicine in diagnostic strategy

The goal of this article is to summarize current data on computed tomography (CT) and magnetic resonance (MR) in the diagnosis of acute pulmonary embolism (PE) in relation to the radionuclide ventilation perfusion scan. It is important for the nuclear medicine, CT, and MR communities to develop a shared approach to this disorder. Triage using chest radiographs appears to be a practical method for enhancing both nuclear medicine and CT/MR performance. The realization that there is no clinically available gold standard for the diagnosis of PE suggests that the imaging community should replace impractical and idealistic discussions with more realistic outcome-oriented approaches. A simplified one-step evaluation of the pulmonary arteries and the lower extremity veins for deep venous thrombus can provide a comprehensive examination for PE. CT is currently a more practical diagnostic tool, whereas MR offers a scientific probe for pulmonary physiology including the regional mapping of ventilation-perfusion relationships. Nuclear medicine, CT, and MR thus form an imaging triad for the diagnosis of acute PE.

MRI of the lungs using hyperpolarized noble gases

The nuclear spin polarization of the noble gas isotopes (3)He and (129)Xe can be increased using optical pumping methods by four to five orders of magnitude. This extraordinary gain in polarization translates directly into a gain in signal strength for MRI. The new technology of hyperpolarized (HP) gas MRI holds enormous potential for enhancing sensitivity and contrast in pulmonary imaging. This review outlines the physics underlying the optical pumping process, imaging strategies coping with the nonequilibrium polarization, and effects of the alveolar microstructure on relaxation and diffusion of the noble gases. It presents recent progress in HP gas MRI and applications ranging from MR microscopy of airspaces to imaging pulmonary function in patients and suggests potential directions for future developments.

Dynamic oxygen-enhanced MRI reflects diffusing capacity of the lung

The purpose of this study was to demonstrate the feasibility of dynamic oxygen-enhanced MRI in a clinical setting. We hypothesized that dynamic oxygen enhancement can reflect the regional diffusing capacity of the lung. Ten patients with pulmonary emphysema and seven healthy volunteers were examined with a respiratory-synchronized inversion recovery single-shot turbo spin-echo sequence (TR = 3200-5000 ms, TE = 16 ms, TI = 720 ms, ETS = 4 ms) following 100% oxygen inhalation, using a 1.5 T whole-body scanner. Maximum mean relative enhancement ratios calculated by averaging six defined regions of interest (ROIs) in both lungs were statistically compared between healthy volunteers and patients, and were correlated with diffusing lung capacity (%DL(CO)). In patients with pulmonary emphysema, maximum mean relative enhancement ratios were significantly decreased compared to those in healthy volunteers (P = 0.0008). Maximum mean relative enhancement ratio had excellent correlation with % DL(C0) (r(2) = 0.83). Dynamic oxygen-enhanced MRI may reflect the diffusing capacity of the lung; therefore, imaging of oxygen enhancement with MRI may provide maps of the diffusing capacity.

Regional lung functional impairment in acute airway obstruction and pulmonary embolic dog models assessed with gadolinium-based aerosol ventilation and perfusion magnetic resonance imaging

RATIONALE AND OBJECTIVES

Gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA)-based aerosol ventilation and perfusion magnetic resonance (MR) images were used to define regional functional impairment in acute airway obstruction (AO) and pulmonary embolic (PE) dog models.

METHODS

The aerosol study was performed in 10 anesthetized normal dogs in a supine position during 20-minute spontaneous inhalation of an aerosol of 100- or 200-mmol-Gd/L Gd-DTPA solute produced by an ultrasonic nebulizer in an open-circuit delivery system, combined with a dynamic perfusion study after a 3-second intravenous bolus injection of a 0.1 mmol/kg dose of Gd-DTPA. These MR studies were also performed in the same 10 dogs approximately 30 minutes after obstructing the segmental (n = 6) or lobar (n = 4) bronchus with a balloon catheter, and in another six dogs after segmental (n = 6) and lobar (n = 4) pulmonary arterial embolization with enbucrilate. Regional lung enhancement was assessed on time-signal intensity (SI)-curves and ventilation- and perfusion-weighted images produced by a subtraction technique.

RESULTS

The normal lungs were gradually and gravity-dependently enhanced with time after Gd-DTPA aerosol inhalation regardless of the respiratory SI changes, except for three animals with the fastest breathing rate. The averaged maximal relative lung SI increase against the baseline in the successful animals was significantly greater in the slowly and deeply breathing animals than in the fast and shallow breathing animals, regardless of the difference in Gd-concentration (100 mmol Gd/L: 153.3% +/- 69.7% vs. 54.2% +/- 23%; P < 0.001; and 200 mmol Gd/L: 189.7% +/- 68.0% vs. 75.6% +/- 42.2%; P < 0.0001, respectively). There was an additional enhancement of 382% +/- 101 in the ventral lung and 722% +/- 160 in the dorsal lung on the pulmonary arterial phase perfusion image even in the slowly and deeply breathing animals who inhaled 200-mmol-Gd/L aerosol, and the enhancement effect was significantly greater compared with that with the aerosol (P < 0.0001). The ventilation- and perfusion-weighted images clearly defined the regionally matched perfusion-ventilation deficits in all the AO models, and the regionally mismatched perfusion-ventilation in all the PE models.

CONCLUSION

Gd-based aerosol can provide efficient lung enhancement in spontaneously and adequately breathing animals, using a relatively noninvasive aerosol delivery system. The combined use of Gd-based perfusion MR imaging may be acceptable for defining regionally impaired function associated with acute AO and PE.

Nuclear magnetic resonance of laser-polarized noble gases in molecules, materials, and organisms

The sensitivity of conventional nuclear magnetic resonance (NMR) techniques is fundamentally limited by the ordinarily low spin polarization achievable in even the strongest NMR magnets. However, by transferring angular momentum from laser light to electronic and nuclear spins, optical pumping methods can increase the nuclear spin polarization of noble gases by several orders of magnitude, thereby greatly enhancing their NMR sensitivity. This review describes the principles and magnetic resonance applications of laser-polarized noble gases. The enormous sensitivity enhancement afforded by optical pumping can be exploited to permit a variety of novel NMR experiments across numerous disciplines. Many such experiments are reviewed, including the void-space imaging of organisms and materials, NMR and MRI of living tissues, probing structure and dynamics of molecules in solution and on surfaces, NMR sensitivity enhancement via polarization transfer, and low-field NMR and MRI.

Combined MR proton lung perfusion/angiography and helium ventilation: potential for detecting pulmonary emboli and ventilation defects

Three-dimensional (3D) perfusion imaging allows the assessment of pulmonary blood flow in parenchyma and main pulmonary arteries simultaneously. MRI using laser-polarized (3)He gas clearly shows the ventilation distribution with high signal-to-noise ratio (SNR). In this report, the feasibility of combined lung MR angiography, perfusion, and ventilation imaging is demonstrated in a porcine model. Ultrafast gradient-echo sequences have been used for 3D perfusion and angiographic imaging, in conjunction with the use of contrast agent injections. 2D multiple-section (3)He imaging was performed subsequently by inhalation of 450 ml of hyperpolarized (3)He gas. The MR techniques were examined in a series of porcine models with externally delivered pulmonary emboli and/or airway occlusions. With emboli, perfusion deficits without ventilation defects were observed; airway occlusion resulted in matched deficits in perfusion and ventilation. High-resolution MR angiography can unambiguously reveal the location and size of the blood emboli. The combination of the three imaging methods may provide complementary information on abnormal lung anatomy and function.

MR ventilation-perfusion imaging of human lung using oxygen-enhanced and arterial spin labeling techniques

Magnetic resonance ventilation-perfusion (V/Q) imaging has been demonstrated using oxygen and arterial spin labeling techniques. Inhaled oxygen is used as a paramagnetic contrast agent in ventilation imaging using a multiple inversion recovery (MIR) approach. Pulmonary perfusion imaging is conducted using a flow-sensitive alternating inversion recovery with an extra radiofrequency pulse (FAIRER) technique. A half Fourier single-short turbo spin echo (HASTE) sequence is used for data acquisition in both techniques. V/Q imaging was performed in ten of the twenty volunteers, while either ventilation or perfusion was imaged in the other ten. This V/Q imaging scheme is completely noninvasive, does not involve ionized radiation, and shows promising potential for clinical use in the diagnosis of lung diseases such as pulmonary embolism.

MR perfusion imaging using encapsulated laser-polarized 3He

In this work, the use of a new carrier agent for intravascular laser-polarized 3He imaging is reported. Lipid-based helium microbubbles were investigated. Their average diameter of 3 microm, which is smaller than that of the capillaries, makes it possible to conduct in vivo studies. The NMR relaxation parameters T1, T2, and T2* of a microbubble suspension were measured as 90 s, 300 ms, and 4.5 ms, respectively, and in vivo images of encapsulated 3He with signal-to-noise ratios (SNRs) larger than 30 were acquired. Dynamic cardiac images and vascular images of encapsulated 3He were obtained in rats using intravenous injections of microbubble suspensions. Excellent preservation of 3He polarization through the lung capillaries and heart cavities was observed. The first images of 3He microbubble distributions in the lungs were obtained. Additionally, the potential of this technique for lung perfusion assessment was validated through an experimental embolism model with the visualization of perfusion defects.

Challenges in small animal noninvasive imaging

The current status and challenges of small animal non-invasive imaging is briefly reviewed. The advantages of non-invasive studies on living animals versus post-mortem studies are evaluated. An argument is advanced that even in post-mortem situations, non-invasive imaging may play an important role in efficiently characterizing small animal phenotypes as well as pathology. Issues of data interpretation under anesthetized conditions in live animal studies are also reviewed. The five imaging technologies covered include CT, PET, ultrasound, MRI and optical imaging. The structural and physiological information content of these different modalities is reviewed along with the ability of these techniques to scale down for use in small mammals such as mice and rats. In general, it was found that most of these technologies scale favorably to the study of small mammals, generally providing more physiological information than when used on the larger human scale. This suggests that these types of small mammal imaging capabilities will play a very significant role in the full utilization of these important animal models in biomedical research.

Oxygen-enhanced MR ventilation imaging of the lung: preliminary clinical experience in 25 subjects

OBJECTIVE

The purpose of this study was to show the feasibility of oxygen-enhanced MR ventilation imaging in a clinical setting with correlation to standard pulmonary function tests, high-resolution CT, and (81m)Kr ventilation scintigraphy.

SUBJECTS AND METHODS

Seven healthy volunteers, 10 lung cancer patients, and eight lung cancer patients with pulmonary emphysema were studied. A respiratory synchronized inversion-recovery single-shot turbo-spin-echo sequence (TE, 16; inversion time, 720 msec; interecho spacing, 4 msec) was used for data acquisition. The following paradigm of oxygen inhalation was used: 21% oxygen (room air), 100% oxygen, 21% oxygen. MR imaging data including maximum mean relative enhancement ratio and mean slope of relative enhancement were correlated with forced expiratory volume in 1 sec, diffusing lung capacity, high-resolution CT emphysema score, and mean distribution ratio of (81m)Kr ventilation scintigraphy.

RESULTS

Oxygen-enhanced MR ventilation images were obtained in all subjects. Maximum mean relative enhancement ratio and mean slope of relative enhancement of lung cancer patients were significantly decreased compared with those of the healthy volunteers (p < 0.0001, p < 0.0001). The mean slope of relative enhancement in lung cancer patients with pulmonary emphysema was significantly lower than that of lung cancer patients without pulmonary emphysema (p < 0.0001). Maximum mean relative enhancement ratio (r(2) = 0.81) was excellently correlated with diffusing lung capacity. Mean slope of relative enhancement (r(2) = 0.74) was strongly correlated with forced expiratory volume in 1 sec. Maximum mean relative enhancement had good correlation with the high-resolution CT emphysema score (r(2) = 0.38). The maximum mean relative enhancement had a strong correlation with the distribution ratio (r(2) = 0.77).

CONCLUSION

Oxygen-enhanced MR ventilation imaging in human subjects showed regional changes in ventilation, thus reflecting regional lung function.

Oxygen-enhanced magnetic resonance ventilation imaging of lung

The oxygen-enhanced magnetic resonance (MR) ventilation imaging is a new technique, and the full extent of its physiological significance has not been elucidated. This review article includes background on (1) respiratory physiology; (2) mechanism and optimization of oxygen-enhanced MR imaging technique; (3) recent applications in animal and human models; and (4) merits and demerits of the technique in comparison with hyperpolarized noble gas MR ventilation imaging. Application of oxygen-enhanced MR ventilation imaging to patients with pulmonary diseases has been very limited. However, we believe that further basic studies, as well as clinical applications of this new technique will define the real significance of oxygen-enhanced MR ventilation imaging in the future of pulmonary functional imaging and its usefulness for diagnostic radiology.

Vascular and perfusion imaging using encapsulated laser-polarized helium

In this work, the use of hyperpolarized (HP) 3He for in vivo intravascular imaging on animal is reported. To overcome the problem of the low solubility of helium in blood, we propose an approach based on helium encapsulation in lipid-based carrier agents. The mean diameter of the 3He microbubbles, measured equal to 3.0+/-0.2 microm, makes it possible to conduct in vivo studies. In vitro spectroscopy yielded a longitudinal relaxation time T(1) equal to 90 s and an apparent transverse relaxation time T(2)(*) of 4.5 ms. Angiographic imaging (venous and cardiac cavity visualization), as well as lung perfusion imaging, were demonstrated in rats using intravenous injections of microbubble suspensions. Suitable signal and spatial resolution were achieved. The potential of this technique for lung perfusion assessment was assessed using an experimental animal embolism model. Lung perfusion defects and recovery towards a normal perfusion state were visualized. This study was completed with the demonstration of a new ventilation-perfusion lung exploration method based entirely on HP 3He.

Registered (1)H and (3)He magnetic resonance microscopy of the lung

Using in vivo magnetic resonance microscopy, registered (1)H and hyperpolarized (3)He images of the rat lung were obtained with a resolution of 0.098 x 0.098 x 0.469 mm (4.5 x 10(-3) mm(3)). The requisite stability and SNR was achieved through an integration of scan-synchronous ventilation, dual-frequency RF coils, anisotropic projection encoding, and variable RF excitation. The total acquisition time was 21 min for the (3)He images and 64 min for the (1)H image. Airways down to the 6th and 7th orders are clearly visible. Magn Reson Med 45:365-370, 2001.

Laser-polarized (3)He as a probe for dynamic regional measurements of lung perfusion and ventilation using magnetic resonance imaging

Magnetic resonance imaging (MRI) using laser-polarized noble gases, such as (129)Xe and (3)He, allows unparalleled noninvasive information on gas distribution in lung airways and distal spaces. In addition to pulmonary ventilation, lung perfusion assessment is crucial for proper diagnosis of pathological conditions, such as pulmonary embolism. Magnetic resonance perfusion imaging usually can be performed using techniques based on the detection of water protons in tissues. However, lung proton imaging is extremely difficult due to the low proton density and the magnetically inhomogeneous structure of the lung parenchyma. Here we show that laser-polarized (3)He can be used as a noninvasive probe to image, in a single MRI experiment, not only the ventilation but also the perfusion state of the lungs. Blood volume maps of the lungs were generated based on the (3)He signal depletion during the first pass of a superparamagnetic contrast agent bolus. The combined and simultaneous lung ventilation and perfusion assessments are demonstrated in normal rat lungs and are applied to an experimental animal model of pulmonary embolism. Magn Reson Med 44:1-4, 2000.

Dynamic imaging of hyperpolarized (3)He distribution in rat lungs using interleaved-spiral scans

The use of spiral scan techniques is investigated for (3)He lung imaging on small animals. Dynamic series of up to 40 high temporal resolution (3)He ventilation images are obtained using a single bolus of gas. General properties of the spiral technique are discussed and compared to those of standard imaging techniques in relation to the specific case of rare gas imaging. To improve temporal resolution of the image series, the efficiency of a sliding window technique, combining data from two consecutive spiral images, is demonstrated. An example of the typical global (3)He signal variation during the (3)He breathing of the animal is shown. Pixel-by-pixel measurements of the (3)He signal derivative during the gas inspiration are performed. A corresponding lung map of the magnetization per time unit entering the lung during gas inflow is presented.

Low-temperature polarized helium-3 for MRI applications

The first 3He nuclear magnetic resonance (NMR) experiments using low-temperature prepolarization are presented. 3He cells were polarized at 4.2 K and 4.7 T, transported to another magnet, heated to room temperature, and used for NMR experiments at 2.35 T. Cells with and without a rubidium coating were tested. In both cases, the NMR signal was greater than 100 times the thermal equilibrium signal. No evidence of a rubidium coating effect on the longitudinal relaxation time T1 of 3He (500 mbar) at 4.2 K could be demonstrated. NMR gradient-echo images of the cells were acquired.