Imaging pulmonary blood flow and perfusion using phase-sensitive selective inversion recovery

Pulmonary Functional Imaging: Part 1-State-of-the-Art Technical and Physiologic Underpinnings

Over the past few decades, pulmonary imaging technologies have advanced from chest radiography and nuclear medicine methods to high-spatial-resolution or low-dose chest CT and MRI. It is currently possible to identify and measure pulmonary pathologic changes before these are obvious even to patients or depicted on conventional morphologic images. Here, key technological advances are described, including multiparametric CT image processing methods, inhaled hyperpolarized and fluorinated gas MRI, and four-dimensional free-breathing CT and MRI methods to measure regional ventilation, perfusion, gas exchange, and biomechanics. The basic anatomic and physiologic underpinnings of these pulmonary functional imaging techniques are explained. In addition, advances in image analysis and computational and artificial intelligence (machine learning) methods pertinent to functional lung imaging are discussed. The clinical applications of pulmonary functional imaging, including both the opportunities and challenges for clinical translation and deployment, will be discussed in part 2 of this review. Given the technical advances in these sophisticated imaging methods and the wealth of information they can provide, it is anticipated that pulmonary functional imaging will be increasingly used in the care of patients with lung disease. © RSNA, 2021 Online supplemental material is available for this article.

The effect of lung deformation on the spatial distribution of pulmonary blood flow

KEY POINTS

Pulmonary perfusion measurement using magnetic resonance imaging combined with deformable image registration enabled us to quantify the change in the spatial distribution of pulmonary perfusion at different lung volumes. The current study elucidated the effects of tidal volume lung inflation [functional residual capacity (FRC) + 500 ml and FRC + 1 litre] on the change in pulmonary perfusion distribution. Changes in hydrostatic pressure distribution as well as transmural pressure distribution due to the change in lung height with tidal volume inflation are probably bigger contributors to the redistribution of pulmonary perfusion than the changes in pulmonary vasculature resistance caused by lung tissue stretch.

ABSTRACT

Tidal volume lung inflation results in structural changes in the pulmonary circulation, potentially affecting pulmonary perfusion. We hypothesized that perfusion is recruited to regions receiving the greatest deformation from a tidal breath, thus ensuring ventilation-perfusion matching. Density-normalized perfusion (DNP) magnetic resonance imaging data were obtained in healthy subjects (n = 7) in the right lung at functional residual capacity (FRC), FRC+500 ml, and FRC+1.0 l. Using deformable image registration, the displacement of a sagittal lung slice acquired at FRC to the larger volumes was calculated. Registered DNP images were normalized by the mean to estimate perfusion redistribution (nDNP). Data were evaluated across gravitational regions (dependent, middle, non-dependent) and by lobes (upper, RUL; middle, RML; lower, RLL). Lung inflation did not alter mean DNP within the slice (P = 0.10). The greatest expansion was seen in the dependent region (P < 0.0001: dependent vs non-dependent, P < 0.0001: dependent vs middle) and RLL (P = 0.0015: RLL vs RUL, P < 0.0001: RLL vs RML). Neither nDNP recruitment to RLL [+500 ml = -0.047(0.145), +1 litre = 0.018(0.096)] nor to dependent lung [+500 ml = -0.058(0.126), +1 litre = -0.023(0.106)] were found. Instead, redistribution was seen in decreased nDNP in the non-dependent [+500 ml = -0.075(0.152), +1 litre = -0.137(0.167)) and increased nDNP in the gravitational middle lung [+500 ml = 0.098(0.058), +1 litre = 0.093(0.081)] (P = 0.01). However, there was no significant lobar redistribution (P < 0.89). Contrary to our hypothesis, based on the comparison between gravitational and lobar perfusion data, perfusion was not redistributed to the regions of the most inflation. This suggests that either changes in hydrostatic pressure or transmural pressure distribution in the gravitational direction are implicated in the redistribution of perfusion away from the non-dependent lung.

PERFIDI FILTERS VALIDATION: FROM NUCLEAR MAGNETIC RESONANCE RELAXOMETRY TO MAGNETIC RESONANCE IMAGING

In order to well distinguish different tissues of the human body by magnetic resonance imaging (MRI), it is of great importance to find procedures to improve the image contrast. In particular, a valuable feature is to image only specific parts of organs and/or tissues while ignoring all the others. Dedicated MRI sequences able to filter the 1 H nuclei signals based on the different longitudinal relaxation times (T1) of the tissues have been developed. Standard signal selection/attenuation sequences, such as the Short Time Inversion Recovery and Multiple Inversion Recovery, have the effect to zero the signal for a discrete number of T1 values. Parametrically Enabled Relaxation Filters with Double and multiple Inversion (PERFIDI) sequences act on a range of T1 values and behave as an electronic band-pass or high-pass or low-pass filters. PERFIDI filters are therefore primarily focused on the components that pass through, rather than on those that are blocked. These filters have been developed and tested by nuclear magnetic resonance relaxometry. Here, these sequences have been validated for MRI on phantom samples to mimic T1 distributions present in tissues. Preliminary applications show that PERFIDI filters can effectively work on a range of T1 values to give well contrasted images.

[Improved visualization of long-axis black-blood imaging of the carotid arteries using phase sensitive inversion recovery combined with 3D IR-T₁TFE]

The purpose of this study was to improve the visualization of long-axis black-blood imaging of the carotid arteries. We experimented on phantom and in-vivo study of 3 dimension (3D) inversion recovery T(1) turbo field echo combined with phase sensitive inversion recovery (PSIR-3D IR-T(1)TFE) at 3.0 Tesla. As a result, the contrast has been improved by calculated images of PSIR-3D IR-T(1)TFE set to inversion time (TI) 350 ms that is shorter than null point of blood. This displays that the contrast between blood and tissues can be improved when the longitudinal magnetization of blood is a negative. Therefore, the visualization of long-axis black-blood imaging of the carotid arteries has been improved by the calculated images of PSIR-3D IR-T(1)TFE set to TI that is shorter than null point of blood.

Improved identification of intracortical lesions in multiple sclerosis with phase-sensitive inversion recovery in combination with fast double inversion recovery MR imaging

BACKGROUND AND PURPOSE

Accurate detection and classification of purely intracortical lesions in multiple sclerosis (MS) are important in understanding their role in disease progression and impact on the clinical manifestations of the disease. However, detection of these lesions with conventional MR imaging remains a challenge. Although double inversion recovery (DIR) has been shown to improve the sensitivity of the detection of cortical lesions, this sequence has low signal-to-noise ratio (SNR), poor delineation of lesion borders, and is prone to image artifacts. We demonstrate that intracortical lesions can be identified and classified with greater confidence by the combination of DIR with phase-sensitive inversion recovery (PSIR) images.

MATERIALS AND METHODS

A total of 16 subjects with MS were included in this study. DIR, PSIR, and fluid-attenuated inversion recovery (FLAIR) images were acquired and inspected by 3 experts, with identification of lesions by consensus. PSIR and DIR images were jointly used to classify lesions as purely intracortical, mixed gray-white matter, and juxtacortical. The difference in the number of lesions detected in each category was compared between combined PSIR and DIR and conventional FLAIR.

RESULTS

PSIR consistently allowed a clearer classification and delineation of lesions. Combined PSIR and DIR images showed a 337% improvement in the total number of lesions detected compared with FLAIR alone. Detection of intracortical lesions was improved by 417% compared with FLAIR. Detection of mixed gray-white matter and juxtacortical lesions was improved by 396% and 130%, respectively, compared with FLAIR.

CONCLUSION

Reliable detection and classification of intracortical lesions in MS are greatly improved by combined use of PSIR and DIR.

Quantification of regional pulmonary blood flow using ASL-FAIRER

Pulsed arterial spin labeling (ASL) techniques have been theoretically and experimentally validated for cerebral blood flow (CBF) quantification. In this study ASL-FAIRER was used to measure regional pulmonary blood flow (rPBF) in seven healthy subjects. Two general ASL strategies were investigated: 1) a single-subtraction approach using one tag-control pair acquisition at an inversion time (TI) matched to the RR-interval, and 2) a multiple-subtraction approach using tag-control pairs acquired at various TIs. The mean rPBF averaged 1.70 +/- 0.38 ml/min/ml when measured with the multiple-subtraction approach, and was approximately 2% less when measured with the single-subtraction method (1.66 +/- 0.24 ml/min/ml). Assuming an average lung density of 0.33 g/ml, this translates into a regional perfusion of approximately 5.5 ml/g/min, which is comparable to other measures of pulmonary perfusion. As with other ASL applications, a key problem with quantitative interpretation of the results is the physical gap between the tagging region and imaged slice. Because of the high pulsatility of PBF, ASL acquisition and data analysis differ significantly between the lung and the brain. The advantages and drawbacks of the single- vs. multiple-subtraction approaches are considered within a theoretical framework tailored to PBF.

Pulmonary Embolism: Comprehensive Evaluation with MR Ventilation and Perfusion Scanning with Hyperpolarized Helium-3, Arterial Spin Tagging, and Contrast-enhanced MRA

PURPOSE

Development of a comprehensive magnetic resonance (MR) examination consisting of MR angiography (MRA) and MR ventilation and perfusion (MR V/Q) scan for the detection of pulmonary emboli (PE) and assessment of the technique in a rabbit model.

MATERIALS AND METHODS

Reversible PE was induced by inflating a non-detachable silicon balloon in the left pulmonary artery of five New Zealand White rabbits. MR V/Q scans were obtained prior to, during, and after balloon deflation. MRA was performed during balloon inflation. MR ventilation imaging was performed after the inhalation of hyperpolarized helium-3. MR perfusion imaging was performed with Flow-sensitive Alternating Inversion Recovery with an Extra Radiofrequency pulse technique (FAIRER). High-resolution contrast-enhanced MR pulmonary angiography was used to confirm the occlusion of the pulmonary artery. All imaging was performed on a 1.5-T whole body scanner with broadband capabilities.

RESULTS

High-resolution ventilation images of the lungs were obtained. No ventilation defects were detected before, during, or after resolution of simulated PE. FAIRER imaging allowed visualization of pulmonary perfusion. No perfusion defects were detected prior to balloon inflation. During balloon inflation (PE), there was decreased perfusion in the left lower lobe. After reversal of the PE, there was improved perfusion to the left lower lobe. In analogy to nuclear medicine techniques, acute PE produced a mismatched defect in the MR V/Q scan. MRA verified the occlusive filling defect in the left pulmonary artery.

CONCLUSION

High-resolution MRA and MR V/Q imaging of the lung is feasible and allows comprehensive assessment of pulmonary embolism in one imaging session.

Multislice and multicoil phase-sensitive inversion-recovery imaging

Phase-sensitive inversion-recovery (PSIR) imaging may provide enhanced T(1) contrast. However, clinical implementation of PSIR imaging is hindered because image reconstruction with this method often lacks robustness and requires manual intervention, particularly for data acquired in multiple slices and with phased-array coils. In this paper, a new algorithm suitable for automatic PSIR image reconstruction of multislice and multicoil data is presented. This algorithm phase corrects by region-growing, employing both the magnitude and the phase information of image pixels. Specifically, phase gradients of the original complex image are first calculated and then used to determine the sequence of the region-growing. The signal direction relating to the phase error for each pixel is then determined during the region-growing using both the magnitude and the phase of the previously determined pixels that are located within a boxcar neighborhood of the pixel. Finally, the intrinsic intercoil and interslice correlation is exploited to ensure consistency in the global polarity of all of the PSIR images. The results are demonstrated with in vivo human brain images acquired at 3 Tesla with an eight-channel phased-array coil.

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.