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Neder JA, Santyr G, Zanette B, Kirby M, Pourafkari M, James MD, Vincent SG, Ferguson C, Wang CY, Domnik NJ, Phillips DB, Porszasz J, Stringer WW, O'Donnell DE. Beyond Spirometry: Linking Wasted Ventilation to Exertional Dyspnea in the Initial Stages of COPD. COPD 2024; 21:2301549. [PMID: 38348843 DOI: 10.1080/15412555.2023.2301549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/29/2023] [Indexed: 02/15/2024]
Abstract
Exertional dyspnea, a key complaint of patients with chronic obstructive pulmonary disease (COPD), ultimately reflects an increased inspiratory neural drive to breathe. In non-hypoxemic patients with largely preserved lung mechanics - as those in the initial stages of the disease - the heightened inspiratory neural drive is strongly associated with an exaggerated ventilatory response to metabolic demand. Several lines of evidence indicate that the so-called excess ventilation (high ventilation-CO2 output relationship) primarily reflects poor gas exchange efficiency, namely increased physiological dead space. Pulmonary function tests estimating the extension of the wasted ventilation and selected cardiopulmonary exercise testing variables can, therefore, shed unique light on the genesis of patients' out-of-proportion dyspnea. After a succinct overview of the basis of gas exchange efficiency in health and inefficiency in COPD, we discuss how wasted ventilation translates into exertional dyspnea in individual patients. We then outline what is currently known about the structural basis of wasted ventilation in "minor/trivial" COPD vis-à-vis the contribution of emphysema versus a potential impairment in lung perfusion across non-emphysematous lung. After summarizing some unanswered questions on the field, we propose that functional imaging be amalgamated with pulmonary function tests beyond spirometry to improve our understanding of this deeply neglected cause of exertional dyspnea. Advances in the field will depend on our ability to develop robust platforms for deeply phenotyping (structurally and functionally), the dyspneic patients showing unordinary high wasted ventilation despite relatively preserved FEV1.
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Affiliation(s)
- J Alberto Neder
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
| | - Giles Santyr
- Translational Medicine Department, Faculty of Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada
| | - Brandon Zanette
- Translational Medicine Department, Faculty of Physiology and Experimental Medicine, Hospital for Sick Children, Toronto, Canada
| | - Miranda Kirby
- Department of Physics, Faculty of Science, Toronto Metropolitan University, Toronto, Canada
| | - Marina Pourafkari
- Department of Radiology and Diagnostic Imaging, Kingston Health Sciences Centre, Kingston, Canada
| | - Matthew D James
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
| | - Sandra G Vincent
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
| | - Carrie Ferguson
- The Lundquist Institute for Biomedical Innovation, Harbor U.C.L.A Medical Centre, Torrance, CA, USA
| | - Chu-Yi Wang
- The Lundquist Institute for Biomedical Innovation, Harbor U.C.L.A Medical Centre, Torrance, CA, USA
| | - Nicolle J Domnik
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada
| | - Devin B Phillips
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Janos Porszasz
- The Lundquist Institute for Biomedical Innovation, Harbor U.C.L.A Medical Centre, Torrance, CA, USA
| | - William W Stringer
- The Lundquist Institute for Biomedical Innovation, Harbor U.C.L.A Medical Centre, Torrance, CA, USA
| | - Denis E O'Donnell
- Respiratory Investigation Unit, Division of Respirology, Department of Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Canada
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Ouyang T, Tang Y, Zhang C, Yang Q. Phase-resolved MRI for measurement of pulmonary perfusion and ventilation defects in comparison with dynamic contrast-enhanced MRI and 129Xe MRI. BMJ Open Respir Res 2024; 11:e002198. [PMID: 39117397 DOI: 10.1136/bmjresp-2023-002198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 07/08/2024] [Indexed: 08/10/2024] Open
Abstract
INTRODUCTION This meta-analysis aims to evaluate the agreement and correlation between phase-resolved functional lung MRI (PREFUL MRI) and dynamic contrast-enhanced (DCE) MRI in evaluating perfusion defect percentage (QDP), as well as the agreement between PREFUL MRI and 129Xe MRI in assessing ventilation defect percentage (VDP). METHOD A systematic search was conducted in the Medline, Embase and Cochrane Library databases to identify relevant studies comparing QDP and VDP measured by DCE MRI and 129Xe MRI compared with PREFUL MRI. Meta-analytical techniques were applied to calculate the pooled weighted bias, limits of agreement (LOA) and correlation coefficient. The publication bias was assessed using Egger's regression test, while heterogeneity was assessed using Cochran's Q test and Higgins I2 statistic. RESULTS A total of 399 subjects from 10 studies were enrolled. The mean difference and LOA were -2.31% (-8.01% to 3.40%) for QDP and 0.34% (-4.94% to 5.62%) for VDP. The pooled correlations (95% CI) were 0.65 (0.55 to 0.73) for QDP and 0.72 (0.61 to 0.80) for VDP. Furthermore, both QDP and VDP showed a negative correlation with forced expiratory volume in 1 s (FEV1). The pooled correlation between QDP and FEV1 was -0.51 (-0.74 to -0.18), as well as between VDP and FEV1 was -0.60 (-0.73 to -0.44). CONCLUSIONS PREFUL MRI is a promising imaging for the assessment of lung function, as it demonstrates satisfactory deviations and LOA when compared with DEC MRI and 129Xe MRI. PROSPERO REGISTRATION NUMBER CRD42023430847.
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Affiliation(s)
- Tao Ouyang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Yichen Tang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
| | - Chen Zhang
- MR Research Collaboration, Siemens Healthineers, Beijing, China
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Key Laboratory of Medical Engineering for Cardiovascular Disease, Ministry of Education, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China
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Tong Y, Udupa JK, McDonough JM, Wu C, Xie L, Rajapakse CS, Gogel S, Sarkar S, Mayer OH, Anari JB, Torigian DA, Cahill PJ. Characterizing Lung Parenchymal Aeration via Standardized Signal Intensity from Free-breathing 4D Dynamic MRI in Phantoms, Healthy Children, and Pediatric Patients with Thoracic Insufficiency Syndrome. Radiol Cardiothorac Imaging 2024; 6:e230262. [PMID: 39051878 DOI: 10.1148/ryct.230262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Purpose To investigate free-breathing thoracic bright-blood four-dimensional (4D) dynamic MRI (dMRI) to characterize aeration of parenchymal lung tissue in healthy children and patients with thoracic insufficiency syndrome (TIS). Materials and Methods All dMR images in patients with TIS were collected from July 2009 to June 2017. Standardized signal intensity (sSI) was investigated, first using a lung aeration phantom to establish feasibility and sensitivity and then in a retrospective research study of 40 healthy children (16 male, 24 female; mean age, 9.6 years ± 2.1 [SD]), 20 patients with TIS before and after surgery (11 male, nine female; mean age, 6.2 years ± 4.2), and another 10 healthy children who underwent repeated dMRI examinations (seven male, three female; mean age, 9 years ± 3.6). Individual lungs in 4D dMR images were segmented, and sSI was assessed for each lung at end expiration (EE), at end inspiration (EI), preoperatively, postoperatively, in comparison to normal lungs, and in repeated scans. Results Air content changes of approximately 6% were detectable in phantoms via sSI. sSI within phantoms significantly correlated with air occupation (Pearson correlation coefficient = -0.96 [P < .001]). For healthy children, right lung sSI was significantly lower than that of left lung sSI (at EE: 41 ± 6 vs 47 ± 6 and at EI: 39 ± 6 vs 43 ± 7, respectively; P < .001), lung sSI at EI was significantly lower than that at EE (P < .001), and left lung sSI at EE linearly decreased with age (r = -0.82). Lung sSI at EE and EI decreased after surgery for patients (although not statistically significantly, with P values of sSI before surgery vs sSI after surgery, left and right lung separately, in the range of 0.13-0.51). sSI varied within 1.6%-4.7% between repeated scans. Conclusion This study demonstrates the feasibility of detecting change in sSI in phantoms via bright-blood dMRI when air occupancy changes. The observed reduction in average lung sSI after surgery in pediatric patients with TIS may indicate postoperative improvement in parenchymal aeration. Keywords: MR Imaging, Thorax, Lung, Pediatrics, Thoracic Surgery, Lung Parenchymal Aeration, Free-breathing Dynamic MRI, MRI Intensity Standardization, Thoracic Insufficiency Syndrome Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Yubing Tong
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Jayaram K Udupa
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Joseph M McDonough
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Caiyun Wu
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Lipeng Xie
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Chamith S Rajapakse
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Samantha Gogel
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Sulagna Sarkar
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Oscar H Mayer
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Jason B Anari
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Drew A Torigian
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
| | - Patrick J Cahill
- From Department of Radiology, the Medical Image Processing Group, University of Pennsylvania, 3710 Hamilton Walk, Goddard Bldg, 6th Fl, Philadelphia, PA 19104 (Y.T., J.K.U., C.W., L.X., D.A.T.); The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, The Children's Hospital of Philadelphia, Philadelphia, Pa (J.M.D., S.G., S.S., J.B.A., P.J.C.); Departments of Radiology and Orthopedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, Pa (O.H.M.)
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Doellinger F, Bauman G, Roehmel J, Stahl M, Posch H, Steffen IG, Pusterla O, Bieri O, Wielpütz MO, Mall MA. Contrast agent-free functional magnetic resonance imaging with matrix pencil decomposition to quantify abnormalities in lung perfusion and ventilation in patients with cystic fibrosis. Front Med (Lausanne) 2024; 11:1349466. [PMID: 38903825 PMCID: PMC11188455 DOI: 10.3389/fmed.2024.1349466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Background Previous studies showed that contrast-enhanced (CE) morpho-functional magnetic resonance imaging (MRI) detects abnormalities in lung morphology and perfusion in patients with cystic fibrosis (CF). Novel matrix pencil decomposition MRI (MP-MRI) enables quantification of lung perfusion and ventilation without intravenous contrast agent administration. Objectives To compare MP-MRI with established morpho-functional MRI and spirometry in patients with CF. Methods Thirty-nine clinically stable patients with CF (mean age 21.6 ± 10.7 years, range 8-45 years) prospectively underwent morpho-functional MRI including CE perfusion MRI, MP-MRI and spirometry. Two blinded chest radiologists assessed morpho-functional MRI and MP-MRI employing the validated chest MRI score. In addition, MP-MRI data were processed by automated software calculating perfusion defect percentage (QDP) and ventilation defect percentage (VDP). Results MP perfusion score and QDP correlated strongly with the CE perfusion score (both r = 0.81; p < 0.01). MP ventilation score and VDP showed strong inverse correlations with percent predicted FEV1 (r = -0.75 and r = -0.83; p < 0.01). The comparison of visual and automated parameters showed that both MP perfusion score and QDP, and MP ventilation score and VDP were strongly correlated (r = 0.74 and r = 0.78; both p < 0.01). Further, the MP perfusion score and MP ventilation score, as well as QDP and VDP were strongly correlated (r = 0.88 and r = 0.86; both p < 0.01). Conclusion MP-MRI detects abnormalities in lung perfusion and ventilation in patients with CF without intravenous or inhaled contrast agent application, and correlates strongly with the well-established CE perfusion MRI score and spirometry. Automated analysis of MP-MRI may serve as quantitative noninvasive outcome measure for diagnostic monitoring and clinical trials.
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Affiliation(s)
- Felix Doellinger
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Jobst Roehmel
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany
| | - Helena Posch
- Department of Radiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ingo G. Steffen
- Department of Pediatric Hematology and Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Orso Pusterla
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of 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 of Heidelberg, Heidelberg, Germany
| | - Marcus A. Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research (DZL), Associated Partner Site, Berlin, Germany
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Peggs ZJT, Brooke JP, Bolton CE, Hall IP, Francis ST, Gowland PA. Free-Breathing Functional Pulmonary Proton MRI: A Novel Approach Using Voxel-Wise Lung Ventilation (VOLVE) Assessment in Healthy Volunteers and Patients With Chronic Obstructive Pulmonary Disease. J Magn Reson Imaging 2024. [PMID: 38819593 DOI: 10.1002/jmri.29444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND In respiratory medicine, there is a need for sensitive measures of regional lung function that can be performed using standard imaging technology, without the need for inhaled or intravenous contrast agents. PURPOSE To describe VOxel-wise Lung VEntilation (VOLVE), a new method for quantifying regional lung ventilation (V) and perfusion (Q) using free-breathing proton MRI, and to evaluate VOLVE in healthy never-smokers, healthy people with smoking history, and people with chronic obstructive pulmonary disease (COPD). STUDY TYPE Prospective pilot. POPULATION Twelve healthy never-smoker participants (age 30.3 ± 12.5 years, five male), four healthy participants with smoking history (>10 pack-years) (age 42.5 ± 18.3 years, one male), and 12 participants with COPD (age 62.8 ± 11.1 years, seven male). FIELD STRENGTH/SEQUENCE Single-slice free-breathing two-dimensional fast field echo sequence at 3 T. ASSESSMENT A novel postprocessing was developed to evaluate the MR signal changes in the lung parenchyma using a linear regression-based approach, which makes use of all the data in the time series for maximum sensitivity. V/Q-weighted maps were produced by computing the cross-correlation, lag and gradient between the respiratory/cardiac phase time course and lung parenchyma signal time courses. A comparison of histogram median and skewness values and spirometry was performed. STATISTICAL TESTS Kruskal-Wallis tests with Dunn's multiple comparison tests to compare VOLVE metrics between groups; Spearman correlation to assess the correlation between MRI and spirometry-derived parameters; and Bland-Altman analysis and coefficient of variation to evaluate repeatability were used. A P-value <0.05 was considered significant. RESULTS Significant differences between the groups were found for ventilation between healthy never-smoker and COPD groups (median XCCV, LagV, and GradV) and perfusion (median XCCQ, LagQ, and GradQ). Minimal bias and no significant differences between intravisit scans were found (P range = 0.12-0.97). DATA CONCLUSION This preliminary study showed that VOLVE has potential to provide metrics of function quantification. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Zachary J T Peggs
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Centre for Respiratory Research, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jonathan P Brooke
- Centre for Respiratory Research, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Charlotte E Bolton
- Centre for Respiratory Research, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ian P Hall
- Centre for Respiratory Research, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
- Centre for Respiratory Research, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Susan T Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Centre for Respiratory Research, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Penny A Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Centre for Respiratory Research, NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Moher Alsady T, Ruschepaul J, Voskrebenzev A, Klimes F, Poehler GH, Vogel-Claussen J. Estimating ventilation correlation coefficients in the lungs using PREFUL-MRI in chronic obstructive pulmonary disease patients and healthy adults. Magn Reson Med 2024; 91:2142-2152. [PMID: 38217450 DOI: 10.1002/mrm.29982] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Various parameters of regional lung ventilation can be estimated using phase-resolved functional lung (PREFUL)-MRI. The parameter "ventilation correlation coefficient (Vent-CC)" was shown advantageous because it assesses the dynamics of regional air flow. Calculating Vent-CC depends on a voxel-wise comparison to a healthy reference flow curve. This work examines the effect of placing a reference region of interest (ROI) in various lung quadrants or in different coronal slices. Furthermore, algorithms for automated ROI selection are presented and compared in terms of test-retest repeatability. METHODS Twenty-eight healthy subjects and 32 chronic obstructive pulmonary disease (COPD) patients were scanned twice using PREFUL-MRI. Retrospective analyses examined the homogeneity of air flow curves of various reference ROIs using cross-correlation. Vent-CC and ventilation defect percentage (VDP) calculated using various reference ROIs were compared using one-way analysis of variance (ANOVA). The coefficient of variation was calculated for Vent-CC and VDP when using different reference selection algorithms. RESULTS Flow-volume curves were highly correlated between ROIs placed at various lung quadrants in the same coronal slice (r > 0.97) with no differences in Vent-CC and VDP (ANOVA: p > 0.5). However, ROIs placed at different coronal slices showed lower correlation coefficients and resulted in significantly different Vent-CC and VDP values (ANOVA: p < 0.001). Vent-CC and VDP showed higher repeatability when calculated using the presented new algorithm. CONCLUSION In COPD and healthy cohorts, assessing regional ventilation dynamics using PREFUL-MRI in terms of the Vent-CC metric showed higher repeatability using a new algorithm for selecting a homogenous reference ROI from the same slice.
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Affiliation(s)
- Tawfik Moher Alsady
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Jakob Ruschepaul
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Filip Klimes
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Gesa Helen Poehler
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Lower Saxony, Germany
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Tong Y, Udupa JK, McDonough JM, Xie L, Hao Y, Akhtar Y, Wu C, Rajapakse CS, Gogel S, Mayer OH, Anari JB, Torigian DA, Cahill PJ. Virtual Growing Child (VGC): A general normative comparative system via quantitative dynamic MRI for quantifying pediatric regional respiratory anomalies with application in thoracic insufficiency syndrome (TIS). BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.28.591554. [PMID: 38746219 PMCID: PMC11092456 DOI: 10.1101/2024.04.28.591554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background A normative database of regional respiratory structure and function in healthy children does not exist. Methods VGC provides a database with four categories of regional respiratory measurement parameters including morphological, architectural, dynamic, and developmental. The database has 3,820 3D segmentations (around 100,000 2D slices with segmentations). Age and gender group analysis and comparisons for healthy children were performed using those parameters via two-sided t-testing to compare mean measurements, for left and right sides at end-inspiration (EI) and end-expiration (EE), for different age and gender specific groups. We also apply VGC measurements for comparison with TIS patients via an extrapolation approach to estimate the association between measurement and age via a linear model and to predict measurements for TIS patients. Furthermore, we check the Mahalanobis distance between TIS patients and healthy children of corresponding age. Findings The difference between male and female groups (10-12 years) behave differently from that in other age groups which is consistent with physiology/natural growth behavior related to adolescence with higher right lung and right diaphragm tidal volumes for females(p<0.05). The comparison of TIS patients before and after surgery show that the right and left components are not symmetrical, and the left side diaphragm height and tidal volume has been significantly improved after surgery (p <0.05). The left lung volume at EE, and left diaphragm height at EI of TIS patients after surgery are closer to the normal children with a significant smaller Mahalanobis distance (MD) after surgery (p<0.05). Interpretation The VGC system can serve as a reference standard to quantify regional respiratory abnormalities on dMRI in young patients with various respiratory conditions and facilitate treatment planning and response assessment. Funding The grant R01HL150147 from the National Institutes of Health (PI Udupa).
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8
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Dohna M, Voskrebenzev A, Klimeš F, Kaireit TF, Glandorf J, Pallenberg ST, Ringshausen FC, Hansen G, Renz DM, Wacker F, Dittrich AM, Vogel-Claussen J. PREFUL MRI for Monitoring Perfusion and Ventilation Changes after Elexacaftor-Tezacaftor-Ivacaftor Therapy for Cystic Fibrosis: A Feasibility Study. Radiol Cardiothorac Imaging 2024; 6:e230104. [PMID: 38573129 PMCID: PMC11056757 DOI: 10.1148/ryct.230104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 01/18/2024] [Accepted: 02/07/2024] [Indexed: 04/05/2024]
Abstract
Purpose To assess the feasibility of monitoring the effects of elexacaftor-tezacaftor-ivacaftor (ETI) therapy on lung ventilation and perfusion in people with cystic fibrosis (CF), using phase-resolved functional lung (PREFUL) MRI. Materials and Methods This secondary analysis of a multicenter prospective study was carried out between August 2020 and March 2021 and included participants 12 years or older with CF who underwent PREFUL MRI, spirometry, sweat chloride test, and lung clearance index assessment before and 8-16 weeks after ETI therapy. For PREFUL-derived ventilation and perfusion parameter extraction, two-dimensional coronal dynamic gradient-echo MR images were evaluated with an automated quantitative pipeline. T1- and T2-weighted MR images and PREFUL perfusion maps were visually assessed for semiquantitative Eichinger scores. Wilcoxon signed rank test compared clinical parameters and PREFUL values before and after ETI therapy. Correlation of parameters was calculated as Spearman ρ correlation coefficient. Results Twenty-three participants (median age, 18 years [IQR: 14-24.5 years]; 13 female) were included. Quantitative PREFUL parameters, Eichinger score, and clinical parameters (lung clearance index = 21) showed significant improvement after ETI therapy. Ventilation defect percentage of regional ventilation decreased from 18% (IQR: 14%-25%) to 9% (IQR: 6%-17%) (P = .003) and perfusion defect percentage from 26% (IQR: 18%-36%) to 19% (IQR: 13%-24%) (P = .002). Areas of matching normal (healthy) ventilation and perfusion increased from 52% (IQR: 47%-68%) to 73% (IQR: 61%-83%). Visually assessed perfusion scores did not correlate with PREFUL perfusion (P = .11) nor with ventilation-perfusion match values (P = .38). Conclusion The study demonstrates the feasibility of PREFUL MRI for semiautomated quantitative assessment of perfusion and ventilation changes in response to ETI therapy in people with CF. Keywords: Pediatrics, MR-Functional Imaging, Pulmonary, Lung, Comparative Studies, Cystic Fibrosis, Elexacaftor-Tezacaftor-Ivacaftor Therapy, Fourier Decomposition, PREFUL, Free-Breathing Proton MRI, Pulmonary MRI, Perfusion, Functional MRI, CFTR, Modulator Therapy, Kaftrio Clinical trial registration no. NCT04732910 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Martha Dohna
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Andreas Voskrebenzev
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Filip Klimeš
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Till F. Kaireit
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Julian Glandorf
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Sophia T. Pallenberg
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Felix C. Ringshausen
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Gesine Hansen
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Diane Miriam Renz
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
| | - Frank Wacker
- From the Department of Diagnostic and Interventional Radiology (M.D.,
A.V., F.K., T.F.K., J.G., D.M.R., F.W., J.V.C.), German Center for Lung Research
(DZL), Biomedical Research in Endstage and Obstructive Lung Disease (BREATH)
(A.V., F.K., T.F.K., J.G., S.T.P., F.C.R., G.H., F.W., A.M.D., J.V.C.),
Department for Pediatric Pneumology, Allergology and Neonatology (S.T.P., G.H.,
A.M.D., J.V.C.), and Department of Respiratory Medicine (F.C.R.), Hannover
Medical School, Carl-Neuberg-Str 1, 30625 Hannover, Germany; and European
Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG),
Frankfurt, Germany (F.C.R.)
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9
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Klimeš F, Obert AJ, Scheller J, Wernz MM, Voskrebenzev A, Gutberlet M, Grimm R, Suhling H, Müller RA, Kaireit TF, Glandorf J, Moher Alsady T, Wacker F, Vogel-Claussen J. Comparison of Free-Breathing 3D Phase-Resolved Functional Lung (PREFUL) MRI With Dynamic 19 F Ventilation MRI in Patients With Obstructive Lung Disease and Healthy Volunteers. J Magn Reson Imaging 2024. [PMID: 38214459 DOI: 10.1002/jmri.29221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Non-contrast-enhanced 1 H magnetic resonance imaging (MRI) with full lung coverage shows promise for assessment of regional lung ventilation but a comparison with direct ventilation measurement using 19 F MRI is lacking. PURPOSE To compare ventilation parameters calculated using 3D phase-resolved functional lung (PREFUL) MRI with 19 F MRI. STUDY TYPE Prospective. POPULATION Fifteen patients with asthma, 14 patients with chronic obstructive lung disease, and 13 healthy volunteers. FIELD STRENGTH/SEQUENCE A 3D gradient-echo pulse sequence with golden-angle increment and stack-of-stars encoding at 1.5 T. ASSESSMENT All participants underwent 3D PREFUL MRI and 19 F MRI. For 3D PREFUL, static regional ventilation (RVent) and dynamic flow-volume cross-correlation metric (FVL-CM) were calculated. For both parameters, ventilation defect percentage (VDP) values and ventilation defect (VD) maps (including a combination of both parameters [VDPCombined ]) were determined. For 19 F MRI, images from eight consecutive breaths under volume-controlled inhalation of perfluoropropane were acquired. Time-to-fill (TTF) and wash-in (WI) parameters were extracted. For all 19 F parameters, a VD map was generated and the corresponding VDP values were calculated. STATISTICAL TESTS For all parameters, the relationship between the two techniques was assessed using a Spearman correlation (r). Differences between VDP values were compared using Bland-Altman analysis. For regional comparison of VD maps, spatial overlap and Sørensen-Dice coefficients were computed. RESULTS 3D PREFUL VDP values were significantly correlated to VDP measures by 19 F (r range: 0.59-0.70). For VDPRVent , no significant bias was observed with VDP of the third and fourth breath (bias range = -6.8:7.7%, P range = 0.25:0.30). For VDPFVL-CM , no significant bias was found with VDP values of fourth-eighth breaths (bias range = -2.0:12.5%, P range = 0.12:0.75). The overall spatial overlap of all VD maps increased with each breath, ranging from 61% to 81%, stabilizing at the fourth breath. DATA CONCLUSION 3D PREFUL MRI parameters showed moderate to strong correlation with 19 F MRI. Depending on the 3D PREFUL VD map, the best regional agreement was found to 19 F VD maps of third-fifth breath. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Filip Klimeš
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Arnd J Obert
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Julienne Scheller
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Marius M Wernz
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Andreas Voskrebenzev
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Marcel Gutberlet
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthineers AG, Erlangen, Germany
| | - Hendrik Suhling
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hanover, Germany
| | - Robin A Müller
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Till F Kaireit
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Julian Glandorf
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Tawfik Moher Alsady
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
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10
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Klimeš F, Voskrebenzev A, Gutberlet M, Speth M, Grimm R, Dohna M, Hansen G, Wacker F, Renz DM, Dittrich AM, Vogel-Claussen J. Effect of CFTR modulator therapy with elexacaftor/tezacaftor/ivacaftor on pulmonary ventilation derived by 3D phase-resolved functional lung MRI in cystic fibrosis patients. Eur Radiol 2024; 34:80-89. [PMID: 37548691 PMCID: PMC10791851 DOI: 10.1007/s00330-023-09912-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES To investigate whether 3D phase-resolved functional lung (PREFUL)-MRI parameters are suitable to measure response to elexacaftor/tezacaftor/ivacaftor (ETI) therapy and their association with clinical outcomes in cystic fibrosis (CF) patients. METHODS Twenty-three patients with CF (mean age: 21; age range: 14-46) underwent MRI examination at baseline and 8-16 weeks after initiation of ETI. Morphological and 3D PREFUL scans assessed pulmonary ventilation. Morphological images were evaluated using a semi-quantitative scoring system, and 3D PREFUL scans were evaluated by ventilation defect percentage (VDP) values derived from regional ventilation (RVent) and cross-correlation maps. Improved ventilation volume (IVV) normalized to body surface area (BSA) between baseline and post-treatment visit was computed. Forced expiratory volume in 1 second (FEV1) and mid-expiratory flow at 25% of forced vital capacity (MEF25), as well as lung clearance index (LCI), were assessed. Treatment effects were analyzed using paired Wilcoxon signed-rank tests. Treatment changes and post-treatment agreement between 3D PREFUL and clinical parameters were evaluated by Spearman's correlation. RESULTS After ETI therapy, all 3D PREFUL ventilation markers (all p < 0.0056) improved significantly, except for the mean RVent parameter. The BSA normalized IVVRVent was significantly correlated to relative treatment changes of MEF25 and mucus plugging score (all |r| > 0.48, all p < 0.0219). In post-treatment analyses, 3D PREFUL VDP values significantly correlated with spirometry, LCI, MRI global, morphology, and perfusion scores (all |r| > 0.44, all p < 0.0348). CONCLUSIONS 3D PREFUL MRI is a very promising tool to monitor CFTR modulator-induced regional dynamic ventilation changes in CF patients. CLINICAL RELEVANCE STATEMENT 3D PREFUL MRI is sensitive to monitor CFTR modulator-induced regional ventilation changes in CF patients. Improved ventilation volume correlates with the relative change of mucus plugging, suggesting that reduced endobronchial mucus is predominantly responsible for regional ventilation improvement. KEY POINTS • 3D PREFUL MRI-derived ventilation maps show significantly reduced ventilation defects in CF patients after ETI therapy. • Significant post-treatment correlations of 3D PREFUL ventilation measures especially with LCI, FEV1 %pred, and global MRI score suggest that 3D PREFUL MRI is sensitive to measure improved regional ventilation of the lung parenchyma due to reduced inflammation induced by ETI therapy in CF patients. • 3D PREFUL MRI-derived improved ventilation volume (IVV) correlated with MRI mucus plugging score changes suggesting that reduced endobronchial mucus is predominantly responsible for regional ventilation improvement 8-16 weeks after ETI therapy.
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Affiliation(s)
- Filip Klimeš
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Andreas Voskrebenzev
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Marcel Gutberlet
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Milan Speth
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Martha Dohna
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Gesine Hansen
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Diane Miriam Renz
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Anna-Maria Dittrich
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department for Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany.
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11
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Munidasa S, Zanette B, Couch M, Grimm R, Seethamraju R, Dumas MP, Wee W, Au J, Braganza S, Li D, Woods J, Ratjen F, Santyr G. Inter- and intravisit repeatability of free-breathing MRI in pediatric cystic fibrosis lung disease. Magn Reson Med 2023; 89:2048-2061. [PMID: 36576212 DOI: 10.1002/mrm.29566] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study is to assess the intra- and interscan repeatability of free-breathing phase-resolved functional lung (PREFUL) MRI in stable pediatric cystic fibrosis (CF) lung disease in comparison to static breath-hold hyperpolarized 129-xenon MRI (Xe-MRI) and pulmonary function tests. METHODS Free-breathing 1-hydrogen MRI and Xe-MRI were acquired from 15 stable pediatric CF patients and seven healthy age-matched participants on two visits, 1 month apart. Same-visit MRI scans were also performed on a subgroup of the CF patients. Following the PREFUL algorithm, regional ventilation (RVent) and regional flow volume loop cross-correlation maps were determined from the free-breathing data. Ventilation defect percentage (VDP) was determined from RVent maps (VDPRVent ), regional flow volume loop cross-correlation maps (VDPCC ), VDPRVent ∪ VDPCC , and multi-slice Xe-MRI. Repeatability was evaluated using Bland-Altman analysis, coefficient of repeatability (CR), and intraclass correlation. RESULTS Minimal bias and no significant differences were reported for all PREFUL MRI and Xe-MRI VDP parameters between intra- and intervisits (all P > 0.05). Repeatability of VDPRVent , VDPCC , VDPRVent ∪ VDPCC , and multi-slice Xe-MRI were lower between the two-visit scans (CR = 14.81%, 15.36%, 16.19%, and 9.32%, respectively) in comparison to the same-day scans (CR = 3.38%, 2.90%, 1.90%, and 3.92%, respectively). pulmonary function tests showed high interscan repeatability relative to PREFUL MRI and Xe-MRI. CONCLUSION PREFUL MRI, similar to Xe-MRI, showed high intravisit repeatability but moderate intervisit repeatability in CF, which may be due to inherent disease instability, even in stable patients. Thus, PREFUL MRI may be considered a suitable outcome measure for future treatment response studies.
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Affiliation(s)
- Samal Munidasa
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Brandon Zanette
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marcus Couch
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Siemens Healthcare Limited, Montreal, Quebec, Canada
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Ravi Seethamraju
- MR Collaborations North East, Siemens Healthineers, Malvern, Pennsylvania, USA
| | - Marie-Pier Dumas
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Wallace Wee
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacky Au
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sharon Braganza
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel Li
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jason Woods
- Center for Pulmonary Imaging Research, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Felix Ratjen
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giles Santyr
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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12
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Foo CT, Langton D, Thompson BR, Thien F. Functional lung imaging using novel and emerging MRI techniques. Front Med (Lausanne) 2023; 10:1060940. [PMID: 37181360 PMCID: PMC10166823 DOI: 10.3389/fmed.2023.1060940] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Respiratory diseases are leading causes of death and disability in the world. While early diagnosis is key, this has proven difficult due to the lack of sensitive and non-invasive tools. Computed tomography is regarded as the gold standard for structural lung imaging but lacks functional information and involves significant radiation exposure. Lung magnetic resonance imaging (MRI) has historically been challenging due to its short T2 and low proton density. Hyperpolarised gas MRI is an emerging technique that is able to overcome these difficulties, permitting the functional and microstructural evaluation of the lung. Other novel imaging techniques such as fluorinated gas MRI, oxygen-enhanced MRI, Fourier decomposition MRI and phase-resolved functional lung imaging can also be used to interrogate lung function though they are currently at varying stages of development. This article provides a clinically focused review of these contrast and non-contrast MR imaging techniques and their current applications in lung disease.
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Affiliation(s)
- Chuan T. Foo
- Department of Respiratory Medicine, Eastern Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David Langton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Department of Thoracic Medicine, Peninsula Health, Frankston, VIC, Australia
| | - Bruce R. Thompson
- Melbourne School of Health Science, Melbourne University, Melbourne, VIC, Australia
| | - Francis Thien
- Department of Respiratory Medicine, Eastern Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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13
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Klimeš F, Voskrebenzev A, Gutberlet M, Grimm R, Wacker F, Vogel-Claussen J. Evaluation of image registration algorithms for 3D phase-resolved functional lung ventilation magnetic resonance imaging in healthy volunteers and chronic obstructive pulmonary disease patients. NMR IN BIOMEDICINE 2023; 36:e4860. [PMID: 36285811 DOI: 10.1002/nbm.4860] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
The purpose of the current study was to assess the influence of the registration algorithms on the repeatability of three-dimensional (3D) phase-resolved functional lung (PREFUL) ventilation magnetic resonance imaging (MRI). Twenty-three healthy volunteers and 10 patients with chronic obstructive pulmonary disease (COPD) underwent 3D PREFUL MRI during tidal breathing. The registration of dynamically acquired data to a fixed image was executed using single-step, stepwise, and group-oriented registration (GOREG) approaches. Advanced Normalization Tools (ANTs) and the Forsberg image-registration package were used for the registration. Image registration algorithms were tested for differences and evaluated by the repeatability analysis of ventilation parameters using coefficient of variation (CoV), intraclass-correlation coefficient, Bland-Altman plots, and correlation to spirometry. Also, the registration time and image quality were computed for all registration approaches. Very strong to strong correlations (r range: 0.917-0.999) were observed between ventilation parameters derived using various registration approaches. Median CoV values of the cross-correlation (CC) parameter were significantly lower (all p ≤ 0.0054) for ANTs GOREG compared with single-step and stepwise ANTs registration. The majority of comparisons between COPD patients and age-matched healthy volunteers showed agreement among the registration approaches. The repeatability of regional ventilation (RVent)-based ventilation defect percentage (VDPRVent ) and VDPCC was significantly higher (both p ≤ 0.0054) for Forsberg GOREG compared with ANTs GOREG. All 3D PREFUL-derived ventilation parameters correlated with forced expiratory volume in 1 s (FEV1 ) and the FEV1 / forced vital capacity (FVC) ratio (all |r| > 0.40, all p < 0.03). The image sharpness of RVent maps was statistically elevated (all p < 0.001) using GOREG compared with single-step and stepwise registration approaches using ANTs. The best computational performance was achieved with Forsberg GOREG. The GOREG scheme improves the repeatability and image quality of dynamic 3D PREFUL ventilation parameters. Registration time can be ~10-fold reduced to 9 min using the Forsberg method with equal or even improved repeatability and comparable PREFUL ventilation results compared with the ANTs method.
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Affiliation(s)
- Filip Klimeš
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Andreas Voskrebenzev
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Marcel Gutberlet
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Frank Wacker
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Institute of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
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14
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Zhang Z, Xu X, Kang L. Editorial for "Validation of Phase-Resolved Functional Lung (PREFUL) Magnetic Resonance Imaging Pulse Wave Transit Time in Healthy Subjects and Chronic Obstructive Pulmonary Disease". J Magn Reson Imaging 2021; 56:616-617. [PMID: 34953161 DOI: 10.1002/jmri.28041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Zhan Zhang
- Department of Radiology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Xiangfeng Xu
- Department of Radiology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China
| | - Liqing Kang
- Medical Imaging Department, Cangzhou Central Hospital, Cangzhou City, Hebei Province, China
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15
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Wang C. Editorial for "Repeatability of Dynamic 3D Phase-Resolved Functional Lung (PREFUL) Ventilation MR Imaging in Patients With Chronic Obstructive Pulmonary Disease and Healthy Volunteers". J Magn Reson Imaging 2021; 54:630. [PMID: 34137108 DOI: 10.1002/jmri.27786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Chengbo Wang
- Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China
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