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Triphan SMF, Bauman G, Konietzke P, Konietzke M, Wielpütz MO. Magnetic Resonance Imaging of Lung Perfusion. J Magn Reson Imaging 2024; 59:784-796. [PMID: 37466278 DOI: 10.1002/jmri.28912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
"Lung perfusion" in the context of imaging conventionally refers to the delivery of blood to the pulmonary capillary bed through the pulmonary arteries originating from the right ventricle required for oxygenation. The most important physiological mechanism in the context of imaging is the so-called hypoxic pulmonary vasoconstriction (HPV, also known as "Euler-Liljestrand-Reflex"), which couples lung perfusion to lung ventilation. In obstructive airway diseases such as asthma, chronic-obstructive pulmonary disease (COPD), cystic fibrosis (CF), and asthma, HPV downregulates pulmonary perfusion in order to redistribute blood flow to functional lung areas in order to conserve optimal oxygenation. Imaging of lung perfusion can be seen as a reflection of lung ventilation in obstructive airway diseases. Other conditions that primarily affect lung perfusion are pulmonary vascular diseases, pulmonary hypertension, or (chronic) pulmonary embolism, which also lead to inhomogeneity in pulmonary capillary blood distribution. Several magnetic resonance imaging (MRI) techniques either dependent on exogenous contrast materials, exploiting periodical lung signal variations with cardiac action, or relying on intrinsic lung voxel attributes have been demonstrated to visualize lung perfusion. Additional post-processing may add temporal information and provide quantitative information related to blood flow. The most widely used and robust technique, dynamic-contrast enhanced MRI, is available in clinical routine assessment of COPD, CF, and pulmonary vascular disease. Non-contrast techniques are important research tools currently requiring clinical validation and cross-correlation in the absence of a viable standard of reference. First data on many of these techniques in the context of observational studies assessing therapy effects have just become available. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Simon M F Triphan
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philip Konietzke
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Marilisa Konietzke
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
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Taso M, Aramendía-Vidaurreta V, Englund EK, Francis S, Franklin S, Madhuranthakam AJ, Martirosian P, Nayak KS, Qin Q, Shao X, Thomas DL, Zun Z, Fernández-Seara MA. Update on state-of-the-art for arterial spin labeling (ASL) human perfusion imaging outside of the brain. Magn Reson Med 2023; 89:1754-1776. [PMID: 36747380 DOI: 10.1002/mrm.29609] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
This review article provides an overview of developments for arterial spin labeling (ASL) perfusion imaging in the body (i.e., outside of the brain). It is part of a series of review/recommendation papers from the International Society for Magnetic Resonance in Medicine (ISMRM) Perfusion Study Group. In this review, we focus on specific challenges and developments tailored for ASL in a variety of body locations. After presenting common challenges, organ-specific reviews of challenges and developments are presented, including kidneys, lungs, heart (myocardium), placenta, eye (retina), liver, pancreas, and muscle, which are regions that have seen the most developments outside of the brain. Summaries and recommendations of acquisition parameters (when appropriate) are provided for each organ. We then explore the possibilities for wider adoption of body ASL based on large standardization efforts, as well as the potential opportunities based on recent advances in high/low-field systems and machine-learning. This review seeks to provide an overview of the current state-of-the-art of ASL for applications in the body, highlighting ongoing challenges and solutions that aim to enable more widespread use of the technique in clinical practice.
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Affiliation(s)
- Manuel Taso
- Division of MRI Research, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Erin K Englund
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Francis
- Sir Peter Mansfield Imaging Center, University of Nottingham, Nottingham, UK
| | - Suzanne Franklin
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Center for Image Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ananth J Madhuranthakam
- Department of Radiology, Advanced Imaging Research Center, and Biomedical Engineering, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Petros Martirosian
- Section on Experimental Radiology, Department of Radiology, University Hospital of Tuebingen, Tuebingen, Germany
| | - Krishna S Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Qin Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xingfeng Shao
- Laboratory of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Zungho Zun
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
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Othman AE, Liang C, Komma Y, Munz M, Kolb M, Rath D, Gückel B, Pohmann R, Nikolaou K, Schwartz M, Küstner T, Martirosian P, Seith F. Free-breathing Arterial Spin Labeling MRI for the Detection of Pulmonary Embolism. Radiology 2023; 307:e221998. [PMID: 36809218 DOI: 10.1148/radiol.221998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Arterial spin labeling (ASL) MRI can be used to assess organ perfusion but has yet to be implemented for perfusion evaluation of the lung. Purpose To evaluate pseudo-continuous ASL (PCASL) MRI for the detection of acute pulmonary embolism (PE) and its potential as an alternative to CT pulmonary angiography (CTPA). Materials and Methods Between November 2020 and November 2021, 97 patients (median age, 61 years; 48 women) with suspected PE were enrolled in this prospective study. PCASL MRI was performed within a 72-hour period following CTPA under free-breathing conditions and included three orthogonal planes. The pulmonary trunk was labeled during systole, and the image was acquired during diastole of the subsequent cardiac cycle. Additionally, multisection, coronal, balanced, steady-state free-precession imaging was carried out. Two radiologists blindly assessed overall image quality, artifacts, and diagnostic confidence (five-point Likert scale, 5 = best). Patients were categorized as positive or negative for PE, and a lobe-wise assessment in PCASL MRI and CTPA was conducted. Sensitivity and specificity were calculated on a patient level with the final clinical diagnosis serving as the reference standard. Interchangeability between MRI and CTPA was also tested with use of an individual equivalence index (IEI). Results PCASL MRI was performed successfully in all patients with high scores for image quality, artifact, and diagnostic confidence (κ ≥ .74). Of the 97 patients, 38 were positive for PE. PCASL MRI depicted PE correctly in 35 of 38 patients with three false-positive and three false-negative findings, resulting in a sensitivity of 35 of 38 patients (92% [95% CI: 79, 98]) and a specificity of 56 of 59 patients (95% [95% CI: 86, 99]). Interchangeability analysis revealed an IEI of 2.6% (95% CI: 1.2, 3.8). Conclusion Free-breathing pseudo-continuous arterial spin labeling MRI depicted abnormal lung perfusion caused by acute pulmonary embolism and may be useful as a contrast material-free alternative to CT pulmonary angiography for selected patients. German Clinical Trials Register no. DRKS00023599 © RSNA, 2023.
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Affiliation(s)
- Ahmed E Othman
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Cecilia Liang
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Yasmin Komma
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Max Munz
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Manuel Kolb
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Dominik Rath
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Brigitte Gückel
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Rolf Pohmann
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Konstantin Nikolaou
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Martin Schwartz
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Thomas Küstner
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Petros Martirosian
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
| | - Ferdinand Seith
- From the Department of Diagnostic and Interventional Radiology, University Department of Radiology (A.E.O., C.L., Y.K., M.M., M.K., B.G., K.N., T.K., F.S.), Department of Cardiology and Angiology (D.R.), Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Department of Radiology (M.S., P.M.), and Medical Image and Data Analysis (MIDAS.LAB), Department of Diagnostic and Interventional Radiology (T.K.), University Hospital Tübingen, Hoppe-Seyler-Str 3, 72076 Tübingen, Germany; Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany (A.E.O.); and High-Field MR Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany (R.P.)
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