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Lee S, Lee HY, Park J, Kim H, Park JY. Assessment of Pulmonary Ventilation Using 3D Ventilation Flow Capacity-Weighted and Ventilation-Weighted Maps From 3D Ultrashort Echo Time (UTE) MRI. J Magn Reson Imaging 2024; 60:483-494. [PMID: 37970646 DOI: 10.1002/jmri.29129] [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: 08/08/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) ventilation flow capacity-weighted (VFCW) maps together with 3D ventilation-weighted (VW) maps may help to better assess pulmonary function. PURPOSE To investigate the use of 3D VFCW and VW maps for evaluating pulmonary ventilation function. STUDY TYPE Prospective. POPULATION Two patients (one male, 85 years old; one female, 64 years old) with chronic obstructive pulmonary disease (COPD) and nine healthy subjects (all male; 23-27 years). FIELD STRENGTH/SEQUENCE 3-T, 3D radial UTE imaging. ASSESSMENT 3D VFCW and VW maps were calculated from 3D UTE MRI by voxel-wise subtraction of respiratory phase images. Their validation was tested in nine healthy volunteers using slow/deep and fast/shallow breathing conditions. Additional validation was performed by comparison with single photon emission computed tomography (SPECT) ventilation maps of one healthy participant. For comparison, gravity dependence of anterior-posterior regional ventilation was assessed by one-dimensional plot of the mean signal intensity for each coronal slice. Structural similarity index measure was also calculated. Finally, VW maps and VFCW maps of two COPD patients were evaluated for emphysema lesions with reference to CT images. STATISTICAL TESTS Wilcoxon sign-rank tests for regional Ventilation and ventilation flow capacity, analysis of variance, post-hoc t-tests and Bonferroni correction, coefficient of variation, Kullback-Liebler divergence. A P-value <0.05 was considered statistically significant. RESULTS The validation of 3D VFCW and VW maps was shown by statistically significant differences in ventilation flow capacity and ventilation between the breathing conditions. Additionally, UTE-MRI and SPECT-based ventilation maps showed gravitational dependence in the anteroposterior direction. When applied to patients with COPD, the use of 3D VFCW and VW maps was able to differentiate between two patients with different phenotypes. DATA CONCLUSION The use of 3D VFCW and VW maps can provide regional information on ventilation function and potentially contribute to assessment of COPD subtypes and disease progression. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Seokwon Lee
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jinil Park
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hyeonha Kim
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jang-Yeon Park
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
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2
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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 PMCID: PMC11369656 DOI: 10.1148/ryct.230262] [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: 09/07/2023] [Revised: 05/02/2024] [Accepted: 05/31/2024] [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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3
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Klimeš F, Kern AL, Voskrebenzev A, Gutberlet M, Grimm R, Müller RA, Behrendt L, Kaireit TF, Glandorf J, Alsady TM, Wacker F, Hohlfeld JM, Vogel-Claussen J. Free-breathing 3D phase-resolved functional lung MRI vs breath-hold hyperpolarized 129Xe ventilation MRI in patients with chronic obstructive pulmonary disease and healthy volunteers. Eur Radiol 2024:10.1007/s00330-024-10893-3. [PMID: 39060494 DOI: 10.1007/s00330-024-10893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVES 3D phase-resolved functional lung (PREFUL) MRI offers evaluation of pulmonary ventilation without inhalation of contrast agent. This study seeks to compare ventilation maps obtained from 3D PREFUL MRI with a direct ventilation measurement derived from 129Xe MRI in both patients with chronic obstructive pulmonary disease (COPD) and healthy volunteers. METHODS Thirty-one patients with COPD and 12 healthy controls underwent free-breathing 3D PREFUL MRI and breath-hold 129Xe MRI at 1.5 T. For both MRI techniques, ventilation defect (VD) maps were determined and respective ventilation defect percentage (VDP) values were computed. All parameters of both techniques were compared by Spearman correlation coefficient (r) and the differences between VDP values were quantified by Bland-Altman analysis and tested for significance using Wilcoxon signed-rank test. In a regional comparison of VD maps, spatial overlap and Sørensen-Dice coefficients of healthy and defect areas were computed. RESULTS On a global level, all 3D PREFUL VDP values correlated significantly to VDP measure derived by 129Xe ventilation imaging (all r > 0.65; all p < 0.0001). 129Xe VDP was significantly greater than 3D PREFUL derived VDPRVent (mean bias = 10.5%, p < 0.001) and VDPFVL-CM (mean bias = 11.3%, p < 0.0001) but not for VDPCombined (mean bias = 1.7%, p = 0.70). The total regional agreement of 129Xe and 3D PREFUL VD maps ranged between 60% and 63%. CONCLUSIONS Free-breathing 3D PREFUL MRI showed a strong correlation with breath-hold hyperpolarized 129Xe MRI regarding the VDP values and modest differences in the detection of VDs on a regional level. CLINICAL RELEVANCE STATEMENT 3D PREFUL MRI correlated with 129Xe MRI, unveiling regional differences in COPD defect identification. This proposes 3D PREFUL MRI as a ventilation mapping surrogate, eliminating the need for extra hardware or inhaled gases. KEY POINTS Current non-invasive evaluation techniques for lung diseases have drawbacks; 129Xe MRI is limited by cost and availability. 3D PREFUL MRI correlated with 129Xe MRI, with regional differences in identifying COPD defects. 3D PREFUL MRI can provide ventilation mapping without the need for additional hardware or inhaled gases.
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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
| | - Agilo Luitger Kern
- 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
| | - Robin Aaron 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
| | - Lea Behrendt
- 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 Frederik 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 M Hohlfeld
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research, Hanover, Germany
- Department of Clinical Airway Research, Fraunhofer Institute for Toxicology and Experimental Medicine, Hanover, Germany
- Department of Respiratory Medicine, Hannover Medical School, 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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4
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Hahn JJ, Voskrebenzev A, Behrendt L, Klimeš F, Pöhler GH, Wacker F, Vogel-Claussen J. Sequence comparison of spoiled gradient echo and balanced steady-state free precession for pulmonary free-breathing proton MRI in patients and healthy volunteers: Correspondence, repeatability, and validation with dynamic contrast-enhanced MRI. NMR IN BIOMEDICINE 2024:e5209. [PMID: 38994704 DOI: 10.1002/nbm.5209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/23/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024]
Abstract
Phase-resolved functional lung (PREFUL) MRI is a proton-based, contrast agent-free technique derived from the Fourier decomposition approach to measure regional ventilation and perfusion dynamics during free-breathing. Besides the necessity of extensive PREFUL postprocessing, the utilized MRI sequence must fulfill specific requirements. This study investigates the impact of sequence selection on PREFUL-MRI-derived functional parameters by comparing the standard spoiled gradient echo (SPGRE) sequence with a lung-optimized balanced steady-state free precession (bSSFP) sequence, thereby facilitating PREFULs clinical application in pulmonary disease assessment. This study comprised a prospective dataset of healthy volunteers and a retrospective dataset of patients with suspected chronic thromboembolic pulmonary hypertension. Both cohorts underwent PREFUL-MRI with both sequences to assess the correspondence of PREFUL ventilation and perfusion parameters (A). Additionally, healthy subjects were scanned a second time to evaluate repeatability (B), whereas patients received dynamic contrast-enhanced (DCE)-MRI, considered the perfusion gold standard for comparison with PREFUL-MRI (C). Signal-to-noise ratio (SNR), calculated from the unprocessed images, was compared alongside median differences of PREFUL-MRI-derived parameters using a paired Wilcoxon signed rank test. Further evaluations included calculation of the Pearson correlation, intraclass-correlation coefficient for repeatability assessment, and spatial overlap (SO) for regional comparison of PREFUL-MRI and DCE-MRI. bSSFP showed a clear SNR advantage over SPGRE (median: 23 vs. 9, p < 0.001). (A) Despite significant differences, parameter values were strongly correlated (r ≥ 0.75). After thresholding, binary maps showed high healthy overlap across both cohorts (SOHealthy > 86%) and high defect overlap in the patient cohort (SODefect ≥ 48%). (B) bSSFP demonstrated slightly higher repeatability across most parameters. (C) Both sequences demonstrated comparable correspondence to DCE-MRI, with SPGRE excelling in absolute quantification and bSSFP in spatial agreement. Although bSSFP showed superior SNR results, both sequences displayed spatial defect concordance and highly correlated PREFUL parameters with deviations regarding repeatability and alignment with DCE-MRI.
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Affiliation(s)
- Jonah J Hahn
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
| | - Andreas Voskrebenzev
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Lea Behrendt
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Filip Klimeš
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Gesa H Pöhler
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hanover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany
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5
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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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6
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Ota H, Higuchi S. Editorial for "Multicenter Standardization of Phase-Resolved Functional Lung MRI in Patients With Suspected Chronic Thromboembolic Pulmonary Hypertension". J Magn Reson Imaging 2024; 59:1965-1966. [PMID: 37682009 DOI: 10.1002/jmri.28992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
- Department of Advanced MRI Collaboration Research, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Higuchi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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7
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Streibel C, Willers CC, Bauman G, Pusterla O, Bieri O, Curdy M, Horn M, Casaulta C, Berger S, Dekany GM, Kieninger E, Bartenstein A, Latzin P. Long-term pulmonary outcome of children with congenital diaphragmatic hernia: functional lung MRI using matrix-pencil decomposition enables side-specific assessment of lung function. Eur Radiol 2024; 34:3773-3785. [PMID: 37982833 PMCID: PMC11166819 DOI: 10.1007/s00330-023-10395-8] [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: 06/06/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES In patients with congenital diaphragmatic hernia (CDH) the exact functional outcome of the affected lung side is still unknown, mainly due to the lack of spatially resolved diagnostic tools. Functional matrix-pencil decomposition (MP-) lung MRI fills this gap as it measures side-specific ventilation and perfusion. We aimed to assess the overall and side-specific pulmonary long-term outcomes of patients with CDH using lung function tests and MP-MRI. METHODS Thirteen school-aged children with CDH (seven with small and six with large defect-sized CDH, defined as > 50% of the chest wall circumference being devoid of diaphragm tissue) and thirteen healthy matched controls underwent spirometry, multiple-breath washout, and MP-MRI. The main outcomes were forced expiratory volume in 1 second (FEV1), lung clearance index (LCI2.5), ventilation defect percentage (VDP), and perfusion defect percentage (QDP). RESULTS Patients with a large CDH showed significantly reduced overall lung function compared to healthy controls (mean difference [95%-CIadjusted]: FEV1 (z-score) -4.26 [-5.61, -2.92], FVC (z-score) -3.97 [-5.68, -2.26], LCI2.5 (TO) 1.12 [0.47, 1.76], VDP (%) 8.59 [3.58, 13.60], QDP (%) 17.22 [13.16, 21.27]) and to patients with a small CDH. Side-specific examination by MP-MRI revealed particularly reduced ipsilateral ventilation and perfusion in patients with a large CDH (mean difference to contralateral side [95%-CIadjusted]: VDP (%) 14.80 [10.50, 19.00], QDP (%) 23.50 [1.75, 45.20]). CONCLUSIONS Data indicate impaired overall lung function with particular limitation of the ipsilateral side in patients with a large CDH. MP-MRI is a promising tool to provide valuable side-specific functional information in the follow-up of patients with CDH. CLINICAL RELEVANCE STATEMENT In patients with congenital diaphragmatic hernia, easily applicable MP-MRI allows specific examination of the lung side affected by the hernia and provides valuable information on ventilation and perfusion with implications for clinical practice, making it a promising tool for routine follow-up. KEY POINTS • Functional matrix pencil decomposition (MP) MRI data from a small sample indicate reduced ipsilateral pulmonary ventilation and perfusion in children with large congenital diaphragmatic hernia (CDH). • Easily applicable pencil decomposition MRI provides valuable side-specific diagnostic information on lung ventilation and perfusion. This is a clear advantage over conventional lung function tests, helping to comprehensively follow up patients with congenital diaphragmatic hernia and monitor therapy effects.
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Affiliation(s)
- Carmen Streibel
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
| | - C Corin Willers
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Paediatrics, Kantonsspital Aarau, Aarau, Switzerland
| | - Grzegorz Bauman
- Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Orso Pusterla
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Oliver Bieri
- Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Marion Curdy
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Horn
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carmen Casaulta
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Steffen Berger
- Department of Paediatric Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Gabriela Marta Dekany
- Department of Paediatric Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Elisabeth Kieninger
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Bartenstein
- Department of Paediatric Surgery, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Philipp Latzin
- Division of Paediatric Respiratory Medicine and Allergology, Department of Paediatrics Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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8
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Ilicak E, Thater G, Ozdemir S, Zapp J, Schad LR, Schoenberg SO, Zöllner FG, Weis M. Functional lung imaging of 2-year-old children after congenital diaphragmatic hernia repair using dynamic mode decomposition MRI. Eur Radiol 2024; 34:3761-3772. [PMID: 37940710 PMCID: PMC11166761 DOI: 10.1007/s00330-023-10335-6] [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: 06/30/2023] [Revised: 09/07/2023] [Accepted: 09/14/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES To investigate the feasibility of non-contrast-enhanced functional lung imaging in 2-year-old children after congenital diaphragmatic hernia (CDH) repair. METHODS Fifteen patients after CDH repair were examined using non-contrast-enhanced dynamic magnetic resonance imaging (MRI). For imaging two protocols were used during free-breathing: Protocol A with high temporal resolution and Protocol B with high spatial resolution. The dynamic images were then analysed through a recently developed post-processing method called dynamic mode decomposition (DMD) to obtain ventilation and perfusion maps. The ventilation ratios (VRatio) and perfusion ratios (QRatio) of ipsilateral to contralateral lung were compared to evaluate functional differences. Lastly, DMD MRI-based perfusion results were compared with perfusion parameters obtained using dynamic contrast-enhanced (DCE) MRI to assess agreement between methods. RESULTS Both imaging protocols successfully generated pulmonary ventilation (V) and perfusion (Q) maps in all patients. Overall, the VRatio and QRatio values were 0.84 ± 0.19 and 0.70 ± 0.24 for Protocol A, and 0.88 ± 0.18 and 0.72 ± 0.23 for Protocol B, indicating reduced ventilation ( p < 0.05 ) and perfusion ( p < 0.01 ) on the ipsilateral side. Moreover, there is a very strong positive correlation ( r > 0.89 , p < 0.01 ) and close agreement between DMD MRI-based perfusion values and DCE MRI-based perfusion parameters. CONCLUSIONS DMD MRI can obtain pulmonary functional information in 2-year-old CDH patients. The results obtained with DMD MRI correlate with DCE MRI, without the need for ionising radiation or exposure to contrast agents. While further studies with larger cohorts are warranted, DMD MRI is a promising option for functional lung imaging in CDH patients. CLINICAL RELEVANCE STATEMENT We demonstrate that pulmonary ventilation and perfusion information can be obtained in 2-year-old patients after CDH repair, without the need for ionising radiation or contrast agents by utilising non-contrast-enhanced MRI acquisitions together with dynamic mode decomposition analysis. KEY POINTS • Non-contrast-enhanced functional MR imaging is a promising option for functional lung imaging in 2-year-old children after congenital diaphragmatic hernia. • DMD MRI can generate pulmonary ventilation and perfusion maps from free-breathing dynamic acquisitions without the need for ionising radiation or contrast agents. • Lung perfusion parameters obtained with DMD MRI correlate with perfusion parameters obtained using dynamic contrast-enhanced MRI.
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Affiliation(s)
- Efe Ilicak
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Greta Thater
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Safa Ozdemir
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jascha Zapp
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Meike Weis
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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9
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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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11
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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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Wernz MM, Voskrebenzev A, Müller RA, Zubke M, Klimeš F, Glandorf J, Czerner C, Wacker F, Olsson KM, Hoeper MM, Hohlfeld JM, Vogel-Claussen J. Feasibility, Repeatability, and Correlation to Lung Function of Phase-Resolved Functional Lung (PREFUL) MRI-derived Pulmonary Artery Pulse Wave Velocity Measurements. J Magn Reson Imaging 2024. [PMID: 38460124 DOI: 10.1002/jmri.29337] [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: 12/21/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Pulse wave velocity (PWV) in the pulmonary arteries (PA) is a marker of vascular stiffening. Currently, only phase-contrast (PC) MRI-based options exist to measure PA-PWV. PURPOSE To test feasibility, repeatability, and correlation to clinical data of Phase-Resolved Functional Lung (PREFUL) MRI-based calculation of PA-PWV. STUDY TYPE Retrospective. SUBJECTS 79 (26 female) healthy subjects (age range 19-78), 58 (24 female) patients with chronic obstructive pulmonary disease (COPD, age range 40-77), 60 (33 female) patients with suspected pulmonary hypertension (PH, age range 28-85). SEQUENCE 2D spoiled gradient echo, 1.5T. ASSESSMENT PA-PWV was measured from PREFUL-derived cardiac cycles based on the determination of temporal and spatial distance between lung vasculature voxels using a simplified (sPWV) method and a more comprehensive (cPWV) method including more elaborate distance calculation. For 135 individuals, PC MRI-based PWV (PWV-QA) was measured. STATISTICAL TESTS Intraclass-correlation-coefficient (ICC) and coefficient of variation (CoV) were used to test repeatability. Nonparametric tests were used to compare cohorts. Correlation of sPWV/cPWV, PWV-QA, forced expiratory volume in 1 sec (FEV1 ) %predicted, residual volume (RV) %predicted, age, and right heart catheterization (RHC) data were tested. Significance level α = 0.05 was used. RESULTS sPWV and cPWV showed no significant differences between repeated measurements (P-range 0.10-0.92). CoV was generally lower than 15%. COPD and PH patients had significantly higher sPWV and cPWV than healthy subjects. Significant correlation was found between sPWV or cPWV and FEV1 %pred. (R = -0.36 and R = -0.44), but not with RHC (P-range -0.11 - 0.91) or age (P-range 0.23-0.89). Correlation to RV%pred. was significant for cPWV (R = 0.42) but not for sPWV (R = 0.34, P = 0.055). For all cohorts, sPWV and cPWV were significantly correlated with PWV-QA (R = -0.41 and R = 0.48). DATA CONCLUSION PREFUL-derived PWV is feasible and repeatable. PWV is increased in COPD and PH patients and correlates to airway obstruction and hyperinflation. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Marius M Wernz
- 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
| | - Robin A Müller
- 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
| | - Maximilian Zubke
- 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
| | - 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
| | - Julian Glandorf
- 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
| | - Christoph Czerner
- Department of Nuclear Medicine, 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
| | - Karen M Olsson
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
| | - Jens M Hohlfeld
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine, 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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13
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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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Benlala I, Klaar R, Gaass T, Macey J, Bui S, Senneville BDD, Berger P, Laurent F, Dournes G, Dinkel J. Non-Contrast-Enhanced Functional Lung MRI to Evaluate Treatment Response of Allergic Bronchopulmonary Aspergillosis in Patients With Cystic Fibrosis: A Pilot Study. J Magn Reson Imaging 2024; 59:909-919. [PMID: 37265441 DOI: 10.1002/jmri.28844] [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: 03/03/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is associated with severe lung damage and requires specific therapeutic management. Repeated imaging is recommended to both diagnose and follow-up response to treatment of ABPA in CF. However, high risk of cumulative radiation exposure requires evaluation of free-radiation techniques in the follow-up of CF patients with ABPA. PURPOSE To evaluate whether Fourier decomposition (FD) functional lung MRI can detect response to treatment of ABPA in CF patients. STUDY TYPE Retrospective longitudinal. POPULATION Twelve patients (7M, median-age:14 years) with CF and ABPA with pre- and post-treatment MRI. FIELD STRENGTH/SEQUENCE 2D-balanced-steady-state free-precession (bSSFP) sequence with FD at 1.5T. ASSESSMENT Ventilation-weighted (V) and perfusion-weighted (Q) maps were obtained after FD processing of 2D-coronal bSSFP time-resolved images acquired before and 3-9 months after treatment. Defects extent was assessed on the functional maps using a qualitative semi-quantitative score (0 = absence/negligible, 1 = <50%, 2 = >50%). Mean and coefficient of variation (CV) of the ventilation signal-intensity (VSI) and the perfusion signal-intensity (QSI) were calculated. Measurements were performed independently by three readers and averaged. Inter-reader reproducibility of the measurements was assessed. Pulmonary function tests (PFTs) were performed within 1 week of both MRI studies as markers of the airflow-limitation severity. STATISTICAL TESTS Comparisons of medians were performed using the paired Wilcoxon-test. Reproducibility was assessed using intraclass correlation coefficient (ICC). Correlations between MRI and PFT parameters were assessed using the Spearman-test (rho correlation-coefficient). A P-value <0.05 was considered as significant. RESULTS Defects extent on both V and Q maps showed a significant reduction after ABPA treatment (4.25 vs. 1.92 for V-defect-score and 5 vs. 2.75 for Q-defect-score). VSI_mean was significantly increased after treatment (280 vs. 167). Qualitative analyses reproducibility showed an ICC > 0.90, while the ICCs of the quantitative measurements was almost perfect (>0.99). Changes in VSI_cv and QSI_cv before and after treatment correlated inversely with changes of FEV1%p (rho = -0.68 for both). DATA CONCLUSION Non-contrast-enhanced FD lung MRI has potential to reproducibly assess response to treatment of ABPA in CF patients and correlates with PFT obstructive parameters. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Ilyes Benlala
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
- INSERM, U1045, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
| | - Rabea Klaar
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Thomas Gaass
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Julie Macey
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - Stéphanie Bui
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | | | - Patrick Berger
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - François Laurent
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - Gael Dournes
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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15
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Balu N, Pipavath S. Editorial for "Non-Contrast-Enhanced Functional Lung MRI to Evaluate Treatment Response of Allergic Bronchopulmonary Aspergillosis in Patients With Cystic Fibrosis: A Pilot Study". J Magn Reson Imaging 2024; 59:920-921. [PMID: 37285083 DOI: 10.1002/jmri.28845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/08/2023] Open
Affiliation(s)
- Niranjan Balu
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Sudhakar Pipavath
- Department of Radiology, University of Washington, Seattle, Washington, USA
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Kay FU, Madhuranthakam AJ. MR Perfusion Imaging of the Lung. Magn Reson Imaging Clin N Am 2024; 32:111-123. [PMID: 38007274 DOI: 10.1016/j.mric.2023.09.006] [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: 11/27/2023]
Abstract
Lung perfusion assessment is critical for diagnosing and monitoring a variety of respiratory conditions. MRI perfusion provides a radiation-free technique, making it an ideal choice for longitudinal imaging in younger populations. This review focuses on the techniques and applications of MRI perfusion, including contrast-enhanced (CE) MRI and non-CE methods such as arterial spin labeling (ASL), fourier decomposition (FD), and hyperpolarized 129-Xenon (129-Xe) MRI. ASL leverages endogenous water protons as tracers for a non-invasive measure of lung perfusion, while FD offers simultaneous measurements of lung perfusion and ventilation, enabling the generation of ventilation/perfusion mapsHyperpolarized 129-Xe MRI emerges as a novel tool for assessing regional gas exchange in the lungs. Despite the promise of MRI perfusion techniques, challenges persist, including competition with other imaging techniques and the need for additional validation and standardization. In conditions such as cystic fibrosis and lung cancer, MRI has displayed encouraging results, whereas in diseases like chronic obstructive pulmonary disease, further validation remains necessary. In conclusion, while MRI perfusion techniques hold immense potential for a comprehensive, non-invasive assessment of lung function and perfusion, their broader clinical adoption hinges on technological advancements, collaborative research, and rigorous validation.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Ananth J Madhuranthakam
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, North Campus 2201 Inwood Road, Dallas, TX 75390-8568, USA
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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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Triphan SMF, Konietzke M, Biederer J, Eichinger M, Vogelmeier CF, Jörres RA, Kauczor HU, Heußel CP, Jobst BJ, Wielpütz MO. Echo time-dependent observed T1 and quantitative perfusion in chronic obstructive pulmonary disease using magnetic resonance imaging. Front Med (Lausanne) 2024; 10:1254003. [PMID: 38249975 PMCID: PMC10797117 DOI: 10.3389/fmed.2023.1254003] [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: 07/06/2023] [Accepted: 12/08/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Due to hypoxic vasoconstriction, perfusion is interesting in the lungs. Magnetic Resonance Imaging (MRI) perfusion imaging based on Dynamic Contrast Enhancement (DCE) has been demonstrated in patients with Chronic Obstructive Pulmonary Diseases (COPD) using visual scores, and quantification methods were recently developed further. Inter-patient correlations of echo time-dependent observed T1 [T1(TE)] have been shown with perfusion scores, pulmonary function testing, and quantitative computed tomography. Here, we examined T1(TE) quantification and quantitative perfusion MRI together and investigated both inter-patient and local correlations between T1(TE) and quantitative perfusion. Methods 22 patients (age 68.0 ± 6.2) with COPD were examined using morphological MRI, inversion recovery multi-echo 2D ultra-short TE (UTE) in 1-2 slices for T1(TE) mapping, and 4D Time-resolved angiography With Stochastic Trajectories (TWIST) for DCE. T1(TE) maps were calculated from 2D UTE at five TEs from 70 to 2,300 μs. Pulmonary Blood Flow (PBF) and perfusion defect (QDP) maps were produced from DCE measurements. Lungs were automatically segmented on UTE images and morphological MRI and these segmentations registered to DCE images. DCE images were separately registered to UTE in corresponding slices and divided into corresponding subdivisions. Spearman's correlation coefficients were calculated for inter-patient correlations using the entire segmented slices and for local correlations separately using registered images and subdivisions for each TE. Median T1(TE) in normal and defect areas according to QDP maps were compared. Results Inter-patient correlations were strongest on average at TE2 = 500 μs, reaching up to |ρ| = 0.64 for T1 with PBF and |ρ| = 0.76 with QDP. Generally, local correlations of T1 with PBF were weaker at TE2 than at TE1 or TE3 and with maximum values of |ρ| = 0.66 (from registration) and |ρ| = 0.69 (from subdivision). In 18 patients, T1 was shorter in defect areas than in normal areas, with the relative difference smallest at TE2. Discussion The inter-patient correlations of T1 with PBF and QDP found show similar strength and TE-dependence as those previously reported for visual perfusion scores and quantitative computed tomography. The local correlations and median T1 suggest that not only base T1 but also the TE-dependence of observed T1 in normal areas is closer to that found previously in healthy volunteers than in defect areas.
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Affiliation(s)
- Simon M. F. Triphan
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Marilisa Konietzke
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Boehringer Ingelheim Pharma GmbH and Co. KG, Biberach an der Riß, Germany
| | - Jürgen Biederer
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Faculty of Medicine, University of Latvia, Riga, Latvia
- Faculty of Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Monika Eichinger
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Heidelberg, Germany
| | - Claus F. Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps-University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, Germany
| | - Rudolf A. Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, Ludwig Maximilians University (LMU) Munich, Munich, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Heidelberg, Germany
| | - Claus P. Heußel
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Heidelberg, Germany
| | - Bertram J. Jobst
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Heidelberg, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, Subdivision of Pulmonary Imaging, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at the University Hospital of Heidelberg, Heidelberg, Germany
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Nakamura H, Hirai T, Kurosawa H, Hamada K, Matsunaga K, Shimizu K, Konno S, Muro S, Fukunaga K, Nakano Y, Kuwahira I, Hanaoka M. Current advances in pulmonary functional imaging. Respir Investig 2024; 62:49-65. [PMID: 37948969 DOI: 10.1016/j.resinv.2023.09.004] [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: 03/21/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 11/12/2023]
Abstract
Recent advances in imaging analysis have enabled evaluation of ventilation and perfusion in specific regions by chest computed tomography (CT) and magnetic resonance imaging (MRI), in addition to modalities including dynamic chest radiography, scintigraphy, positron emission tomography (PET), ultrasound, and electrical impedance tomography (EIT). In this review, an overview of current functional imaging techniques is provided for each modality. Advances in chest CT have allowed for the analysis of local volume changes and small airway disease in addition to emphysema, using the Jacobian determinant and parametric response mapping with inspiratory and expiratory images. Airway analysis can reveal characteristics of airway lesions in chronic obstructive pulmonary disease (COPD) and bronchial asthma, and the contribution of dysanapsis to obstructive diseases. Chest CT is also employed to measure pulmonary blood vessels, interstitial lung abnormalities, and mediastinal and chest wall components including skeletal muscle and bone. Dynamic CT can visualize lung deformation in respective portions. Pulmonary MRI has been developed for the estimation of lung ventilation and perfusion, mainly using hyperpolarized 129Xe. Oxygen-enhanced and proton-based MRI, without a polarizer, has potential clinical applications. Dynamic chest radiography is gaining traction in Japan for ventilation and perfusion analysis. Single photon emission CT can be used to assess ventilation-perfusion (V˙/Q˙) mismatch in pulmonary vascular diseases and COPD. PET/CT V˙/Q˙ imaging has also been demonstrated using "Galligas". Both ultrasound and EIT can detect pulmonary edema caused by acute respiratory distress syndrome. Familiarity with these functional imaging techniques will enable clinicians to utilize these systems in clinical practice.
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Affiliation(s)
- Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hajime Kurosawa
- Center for Environmental Conservation and Research Safety and Department of Occupational Health, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuki Hamada
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Ichiro Kuwahira
- Division of Pulmonary Medicine, Department of Medicine, Tokai University Tokyo Hospital, Tokyo, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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20
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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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21
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Capaldi DPI, Konyer NB, Kjarsgaard M, Dvorkin-Gheva A, Dandurand RJ, Nair P, Svenningsen S. Specific Ventilation in Severe Asthma Evaluated with Noncontrast Tidal Breathing 1H MRI. Radiol Cardiothorac Imaging 2023; 5:e230054. [PMID: 38166343 PMCID: PMC11163249 DOI: 10.1148/ryct.230054] [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: 02/23/2023] [Revised: 08/21/2023] [Accepted: 11/01/2023] [Indexed: 01/04/2024]
Abstract
Purpose To determine if proton (1H) MRI-derived specific ventilation is responsive to bronchodilator (BD) therapy and associated with clinical biomarkers of type 2 airway inflammation and airways dysfunction in severe asthma. Materials and Methods In this prospective study, 27 participants with severe asthma (mean age, 52 years ± 9 [SD]; 17 female, 10 male) and seven healthy controls (mean age, 47 years ± 16; five female, two male), recruited between 2018 and 2021, underwent same-day spirometry, respiratory oscillometry, and tidal breathing 1H MRI. Participants with severe asthma underwent all assessments before and after BD therapy, and type 2 airway inflammatory biomarkers were determined (blood eosinophil count, sputum eosinophil percentage, sputum eosinophil-free granules, and fraction of exhaled nitric oxide) to generate a cumulative type 2 biomarker score. Specific ventilation was derived from tidal breathing 1H MRI and its response to BD therapy, and relationships with biomarkers of type 2 airway inflammation and airway dysfunction were evaluated. Results Mean MRI specific ventilation improved with BD inhalation (from 0.07 ± 0.04 to 0.11 ± 0.04, P < .001). Post-BD MRI specific ventilation (P = .046) and post-BD change in MRI specific ventilation (P = .006) were greater in participants with asthma with type 2 low biomarkers compared with participants with type 2 high biomarkers of airway inflammation. Post-BD change in MRI specific ventilation was correlated with change in forced expiratory volume in 1 second (r = 0.40, P = .04), resistance at 5 Hz (r = -0.50, P = .01), resistance at 19 Hz (r = -0.42, P = .01), reactance area (r = -0.54, P < .01), and reactance at 5 Hz (r = 0.48, P = .01). Conclusion Specific ventilation evaluated with tidal breathing 1H MRI was responsive to BD therapy and was associated with clinical biomarkers of airways disease in participants with severe asthma. Keywords: MRI, Severe Asthma, Ventilation, Type 2 Inflammation Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Moore and Chandarana in this issue.
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Affiliation(s)
- Dante P. I. Capaldi
- From the Department of Radiation Oncology, Division of Physics,
University of California San Francisco, San Francisco, Calif (D.P.I.C.);
Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging
Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health
(M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University,
50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital,
Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit
of the Centre for Innovative Medicine, McGill University Health Centre and
Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Norman B. Konyer
- From the Department of Radiation Oncology, Division of Physics,
University of California San Francisco, San Francisco, Calif (D.P.I.C.);
Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging
Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health
(M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University,
50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital,
Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit
of the Centre for Innovative Medicine, McGill University Health Centre and
Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Melanie Kjarsgaard
- From the Department of Radiation Oncology, Division of Physics,
University of California San Francisco, San Francisco, Calif (D.P.I.C.);
Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging
Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health
(M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University,
50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital,
Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit
of the Centre for Innovative Medicine, McGill University Health Centre and
Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Anna Dvorkin-Gheva
- From the Department of Radiation Oncology, Division of Physics,
University of California San Francisco, San Francisco, Calif (D.P.I.C.);
Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging
Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health
(M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University,
50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital,
Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit
of the Centre for Innovative Medicine, McGill University Health Centre and
Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Ronald J. Dandurand
- From the Department of Radiation Oncology, Division of Physics,
University of California San Francisco, San Francisco, Calif (D.P.I.C.);
Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging
Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health
(M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University,
50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital,
Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit
of the Centre for Innovative Medicine, McGill University Health Centre and
Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Parameswaran Nair
- From the Department of Radiation Oncology, Division of Physics,
University of California San Francisco, San Francisco, Calif (D.P.I.C.);
Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging
Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health
(M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University,
50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital,
Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit
of the Centre for Innovative Medicine, McGill University Health Centre and
Research Institute, and McGill University, Montreal, Canada (R.J.D.)
| | - Sarah Svenningsen
- From the Department of Radiation Oncology, Division of Physics,
University of California San Francisco, San Francisco, Calif (D.P.I.C.);
Division of Respirology, Department of Medicine (A.D.G., P.N., S.S.), Imaging
Research Centre (N.B.K., S.S.), and Firestone Institute for Respiratory Health
(M.K., P.N., S.S.), St Joseph's Healthcare Hamilton, McMaster University,
50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6; and Lakeshore General Hospital,
Montreal Chest Institute, Meakins-Christie Laboratories, and Oscillometry Unit
of the Centre for Innovative Medicine, McGill University Health Centre and
Research Institute, and McGill University, Montreal, Canada (R.J.D.)
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Tan F, Zhu X, Chan M, Deveshwar N, Willmering MM, Lustig M, Larson PEZ. Pulmonary Ventilation Analysis Using 1H Ultra-Short Echo Time (UTE) Lung MRI: A Reproducibility Study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.22.563196. [PMID: 37961357 PMCID: PMC10634712 DOI: 10.1101/2023.10.22.563196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Purpose To evaluate methods for quantification of pulmonary ventilation with ultrashort echo time (UTE) MRI. Methods We performed a reproducibility study, acquiring two free-breathing 1H UTE lung MRIs on the same day for six healthy volunteers. The 1) 3D + t cyclic b-spline and 2) symmetric image normalization (SyN) methods for image registration were applied after respiratory phase-resolved image reconstruction. Ventilation maps were calculated using 1) Jacobian determinant of the deformation fields minus one, termed regional ventilation, and 2) intensity percentage difference between the registered and fixed image, termed specific ventilation. We compared the reproducibility of all four method combinations via statistical analysis. Results Split violin plots and Bland-Altman plots are shown for whole lungs and lung sections. The cyclic b-spline registration and Jacobian determinant regional ventilation quantification provide total ventilation volumes that match the segmentation tidal volume, smooth and uniform ventilation maps. The cyclic b-spline registration and specific ventilation combination yields the smallest standard deviation in the Bland-Altman plot. Conclusion Cyclic registration performs better than SyN for respiratory phase-resolved 1H UTE MRI ventilation quantification. Regional ventilation correlates better with segmentation lung volume, while specific ventilation is more reproducible.
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Affiliation(s)
- Fei Tan
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA
| | - Xucheng Zhu
- Work done at UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA, Currently at GE Healthcare, CA
| | - Marilynn Chan
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, CA
| | - Nikhil Deveshwar
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA
| | - Matthew M Willmering
- Center for Pulmonary Imaging Research, Divisions of Pulmonary Medicine and Radiology, Cincinnati Children's Hospital Medical Center. Cincinnati, OH
| | - Michael Lustig
- Electrical Engineering and Computer Sciences, University of California, Berkeley, CA
| | - Peder E Z Larson
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
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Xu P, Meersmann T, Wang J, Wang C. Review of oxygen-enhanced lung mri: Pulse sequences for image acquisition and T 1 measurement. Med Phys 2023; 50:5987-6007. [PMID: 37345214 DOI: 10.1002/mp.16553] [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: 08/17/2021] [Revised: 03/23/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Oxygen-enhanced MR imaging (OE-MRI) is a special proton imaging technique that can be performed without modifying the scanner hardware. Many fundamental studies have been conducted following the initial reporting of this technique in 1996, illustrating the high potential for its clinical application. This review aims to summarise and analyse current pulse sequences and T1 measurement methods for OE-MRI, including fundamental theories, existing pulse sequences applied to OE-MRI acquisition and T1 mapping. Wash-in and wash-out time identify lung function and are sensitive to ventilation; thus, dynamic OE-MRI is also discussed in this review. We compare OE-MRI with the primary competitive technique, hyperpolarised gas MRI. Finally, an overview of lower-field applications of OE-MRI is highlighted, as relatively recent publications demonstrated positive results. Lower-field OE-MRI, which is lower than 1.5 T, could be an alternative modality for detecting lung diseases. This educational review is aimed at researchers who want a quick summary of the steps needed to perform pulmonary OE-MRI with a particular focus on sequence design, settings, and quantification methods.
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Affiliation(s)
- Pengfei Xu
- Department of Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China
| | - Thomas Meersmann
- Sir Peter Mansfield Magnetic Imaging Centre, University of Nottingham, Nottingham, UK
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, China
| | - Jing Wang
- Department of Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, China
| | - Chengbo Wang
- Department of Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo, China
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24
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Duan J, Xie S, Sun H, An J, Li H, Li L, Grimm R, Voskrebenzev A, Vogel-Claussen J. Diagnostic accuracy of perfusion-weighted phase-resolved functional lung magnetic resonance imaging in patients with chronic pulmonary embolism. Front Med (Lausanne) 2023; 10:1256925. [PMID: 37822465 PMCID: PMC10562573 DOI: 10.3389/fmed.2023.1256925] [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: 07/11/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose This study aimed to evaluate the diagnostic performance of perfusion-weighted phase-resolved functional lung (PW-PREFUL) magnetic resonance imaging (MRI) in patients with chronic pulmonary embolism (CPE). Materials and methods This study included 86 patients with suspected chronic thromboembolic pulmonary hypertension (CTEPH), who underwent PREFUL MRI and ventilation/perfusion (V/Q) single-photon emission computed tomography/computed tomography (SPECT/CT). PREFUL MRI was performed at 1.5 T using a balanced steady-state free precession sequence during free breathing. Color-coded PW images and quantitative parameters were obtained by postprocessing. Meanwhile, V/Q SPECT/CT imaging was performed as a reference standard. Hypoperfused areas in the lungs were scored for each lobe and segment using V/Q SPECT/CT images and PW-PREFUL MR images, respectively. Normalized perfusion (QN) and perfusion defect percentage (QDP) were calculated for all slices. For intra- and interobserver variability, the MRI images were analyzed 2 months after the first analysis by the same radiologist and another radiologist (11 years of lung MRI experience) blinded to the results of the first reader. Results Of the 86 enrolled patients, 77 met the inclusion criteria (36 diagnosed with CPE using V/Q SPECT/CT and 41 diagnosed with non-CPE etiology). For the PW-PREFUL MRI, the sensitivity, specificity, accuracy, and positive and negative predictive values for the diagnosis of CPE were 97, 95, 96, 95, and 98% at the patient level; 91, 94, 93, 91, and 94% at the lobe level, and 85, 94, 92, 88, and 94% at the segment level, respectively. The detection of segmental and subsegmental hypoperfusion using PW-PREFUL MRI revealed a moderate agreement with V/Q SPECT/CT (κ = 0.65; 95% confidence interval: 0.61-0.68). The quantitative results indicated that the QN was lower in the CPE group than in the non-CPE group [median score (interquartile range, IQR) 6.3 (2.8-9.2) vs. 13.0 (8.8-16.7), p < 0.001], and the QDP was higher [median score (IQR) 33.8 (15.7-51.7) vs. 2.2 (1.4-2.9), p < 0.001]. Conclusion PREFUL MRI could be an alternative test to detect CPE without requiring breath-hold, contrast agents, or ionizing radiation.
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Affiliation(s)
- Jianghui Duan
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Sheng Xie
- Department of Radiology, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Hongliang Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Jing An
- DL Department, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Huan Li
- Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ling Li
- Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Andreas Voskrebenzev
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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25
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Tan F, Zhu X, Chan M, Zapala MA, Vasanawala SS, Ong F, Lustig M, Larson PEZ. Motion-compensated low-rank reconstruction for simultaneous structural and functional UTE lung MRI. Magn Reson Med 2023; 90:1101-1113. [PMID: 37158318 PMCID: PMC10501714 DOI: 10.1002/mrm.29703] [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: 12/21/2022] [Revised: 03/23/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Three-dimensional UTE MRI has shown the ability to provide simultaneous structural and functional lung imaging, but it is limited by respiratory motion and relatively low lung parenchyma SNR. The purpose of this paper is to improve this imaging by using a respiratory phase-resolved reconstruction approach, named motion-compensated low-rank reconstruction (MoCoLoR), which directly incorporates motion compensation into a low-rank constrained reconstruction model for highly efficient use of the acquired data. THEORY AND METHODS The MoCoLoR reconstruction is formulated as an optimization problem that includes a low-rank constraint using estimated motion fields to reduce the rank, optimizing over both the motion fields and reconstructed images. The proposed reconstruction along with XD and motion state-weighted motion-compensation (MostMoCo) methods were applied to 18 lung MRI scans of pediatric and young adult patients. The data sets were acquired under free-breathing and without sedation with 3D radial UTE sequences in approximately 5 min. After reconstruction, they went through ventilation analyses. Performance across reconstruction regularization and motion-state parameters were also investigated. RESULTS The in vivo experiments results showed that MoCoLoR made efficient use of the data, provided higher apparent SNR compared with state-of-the-art XD reconstruction and MostMoCo reconstructions, and yielded high-quality respiratory phase-resolved images for ventilation mapping. The method was effective across the range of patients scanned. CONCLUSION The motion-compensated low-rank regularized reconstruction approach makes efficient use of acquired data and can improve simultaneous structural and functional lung imaging with 3D-UTE MRI. It enables the scanning of pediatric patients under free-breathing and without sedation.
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Affiliation(s)
- Fei Tan
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Xucheng Zhu
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
- GE Healthcare, Sunnyvale, California, USA
| | - Marilynn Chan
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Matthew A Zapala
- Pediatric Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Shreyas S Vasanawala
- Pediatric Radiology, Department of Radiology, Stanford University, Stanford, California, USA
| | - Frank Ong
- Pediatric Radiology, Department of Radiology, Stanford University, Stanford, California, USA
- Roblox, San Mateo, California, USA
- Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, California, USA
| | - Michael Lustig
- Electrical Engineering and Computer Sciences, University of California, Berkeley, Berkeley, California, USA
| | - Peder E Z Larson
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, San Francisco, California, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
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26
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Huang YH, Teng X, Zhang J, Chen Z, Ma Z, Ren G, Kong FMS, Ge H, Cai J. Respiratory Invariant Textures From Static Computed Tomography Scans for Explainable Lung Function Characterization. J Thorac Imaging 2023; 38:286-296. [PMID: 37265243 DOI: 10.1097/rti.0000000000000717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The inherent characteristics of lung tissue independent of breathing maneuvers may provide fundamental information for function assessment. This paper attempted to correlate textural signatures from computed tomography (CT) with pulmonary function measurements. MATERIALS AND METHODS Twenty-one lung cancer patients with thoracic 4-dimensional CT, DTPA-single-photon emission CT ventilation ( VNM ) scans, and available spirometry measurements (forced expiratory volume in 1 s, FEV 1 ; forced vital capacity, FVC; and FEV 1 /FVC) were collected. In subregional feature discovery, function-correlated candidates were identified from 79 radiomic features based on the statistical strength to differentiate defected/nondefected lung regions. Feature maps (FMs) of selected candidates were generated on 4-dimensional CT phases for a voxel-wise feature distribution study. Quantitative metrics were applied for validations, including the Spearman correlation coefficient (SCC) and the Dice similarity coefficient for FM- VNM spatial agreement assessments, intraclass correlation coefficient for FM interphase robustness evaluations, and FM-spirometry comparisons. RESULTS At the subregion level, 8 function-correlated features were identified (effect size>0.330). The FMs of candidates yielded moderate-to-strong voxel-wise correlations with the reference VNM . The FMs of gray level dependence matrix dependence nonuniformity showed the highest robust (intraclass correlation coefficient=0.96 and P <0.0001) spatial correlation, with median SCCs ranging from 0.54 to 0.59 throughout the 10 breathing phases. Its phase-averaged FM achieved a median SCC of 0.60, a median Dice similarity coefficient of 0.60 (0.65) for high (low) functional lung volumes, and a correlation of 0.565 (0.646) between the spatially averaged feature values and FEV 1 (FEV 1 /FVC). CONCLUSIONS The results provide further insight into the underlying association of specific pulmonary textures with both local ( VNM ) and global (FEV 1 /FVC, FEV 1 ) functions. Further validations of the FM generalizability and the standardization of implementation protocols are warranted before clinically relevant investigations.
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Affiliation(s)
- Yu-Hua Huang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University
| | - Xinzhi Teng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University
| | - Jiang Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University
| | - Zhi Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University
| | - Zongrui Ma
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University
| | - Ge Ren
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University
| | - Feng-Ming Spring Kong
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University
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27
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Bergmann LL, Ackman JB, Starekova J, Moeller A, Reeder S, Nagle SK, Schiebler ML. MR Angiography of Pulmonary Vasculature. Magn Reson Imaging Clin N Am 2023; 31:475-491. [PMID: 37414473 DOI: 10.1016/j.mric.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Pulmonary MR angiography (MRA) is a useful alternative to computed tomographic angiography (CTA) for the study of the pulmonary vasculature. For pulmonary hypertension and partial anomalous pulmonary venous return, a cardiac MR imaging and the pulmonary MRA are useful for flow quantification and planning treatment. For the diagnosis of pulmonary embolism (PE), MRA-PE has been shown to have non-inferior outcomes at 6 months when compared with CTA-PE. Over the last 15 years, pulmonary MRA has become a routine and reliable examination for the workup of pulmonary hypertension and the primary diagnosis of PE at the University of Wisconsin.
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Affiliation(s)
- Liisa L Bergmann
- Department of Radiology, University of Kentucky College of Medicine, 800 Rose Street, HX332E, Lexington, KY 40536-0293, USA; Department of Medicine, University of Kentucky College of Medicine, 800 Rose Street, HX332E, Lexington, KY 40536-0293, USA.
| | - Jeanne B Ackman
- Massachusetts General Hospital, Department of Radiology, Division of Thoracic Imaging and Intervention Austin Building 202, 55 Fruit Street, Boston, MA 02114, USA
| | - Jitka Starekova
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Alexander Moeller
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Scott Reeder
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Scott K Nagle
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA.
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28
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Kubovcikova M, Sobotova R, Zavisova V, Antal I, Khmara I, Lisnichuk M, Bednarikova Z, Jurikova A, Strbak O, Vojtova J, Mikolka P, Gombos J, Lokajova A, Gazova Z, Koneracka M. N-Acetylcysteine-Loaded Magnetic Nanoparticles for Magnetic Resonance Imaging. Int J Mol Sci 2023; 24:11414. [PMID: 37511170 PMCID: PMC10380599 DOI: 10.3390/ijms241411414] [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: 06/07/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by the rapid onset of lung inflammation Therefore, monitoring the spatial distribution of the drug directly administered to heterogeneously damaged lungs is desirable. In this work, we focus on optimizing the drug N-acetylcysteine (NAC) adsorption on poly-l-lysine-modified magnetic nanoparticles (PLLMNPs) to monitor the drug spatial distribution in the lungs using magnetic resonance imaging (MRI) techniques. The physicochemical characterizations of the samples were conducted in terms of morphology, particle size distributions, surface charge, and magnetic properties followed by the thermogravimetric quantification of NAC coating and cytotoxicity experiments. The sample with the theoretical NAC loading concentration of 0.25 mg/mL was selected as an optimum due to the hydrodynamic nanoparticle size of 154 nm, the surface charge of +32 mV, good stability, and no cytotoxicity. Finally, MRI relaxometry confirmed the suitability of the sample to study the spatial distribution of the drug in vivo using MRI protocols. We showed the prevailing transverse relaxation with high transverse relaxivity values and a high r2(*)/r1 ratio, causing visible hypointensity in the final MRI signal. Furthermore, NAC adsorption significantly affects the relaxation properties of PLLMNPs, which can help monitor drug release in vitro/in vivo.
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Affiliation(s)
- Martina Kubovcikova
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Radka Sobotova
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Vlasta Zavisova
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Iryna Antal
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Iryna Khmara
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Maksym Lisnichuk
- Faculty of Science, Pavol Jozef Safarik University, Park Angelinum 9, 04001 Kosice, Slovakia
| | - Zuzana Bednarikova
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Alena Jurikova
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Oliver Strbak
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4, 03601 Martin, Slovakia
| | - Jana Vojtova
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4, 03601 Martin, Slovakia
| | - Pavol Mikolka
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4, 03601 Martin, Slovakia
| | - Jan Gombos
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4, 03601 Martin, Slovakia
| | - Alica Lokajova
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4, 03601 Martin, Slovakia
| | - Zuzana Gazova
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Martina Koneracka
- Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
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Astley JR, Biancardi AM, Marshall H, Smith LJ, Hughes PJC, Collier GJ, Saunders LC, Norquay G, Tofan MM, Hatton MQ, Hughes R, Wild JM, Tahir BA. PhysVENeT: a physiologically-informed deep learning-based framework for the synthesis of 3D hyperpolarized gas MRI ventilation. Sci Rep 2023; 13:11273. [PMID: 37438406 DOI: 10.1038/s41598-023-38105-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
Functional lung imaging modalities such as hyperpolarized gas MRI ventilation enable visualization and quantification of regional lung ventilation; however, these techniques require specialized equipment and exogenous contrast, limiting clinical adoption. Physiologically-informed techniques to map proton (1H)-MRI ventilation have been proposed. These approaches have demonstrated moderate correlation with hyperpolarized gas MRI. Recently, deep learning (DL) has been used for image synthesis applications, including functional lung image synthesis. Here, we propose a 3D multi-channel convolutional neural network that employs physiologically-informed ventilation mapping and multi-inflation structural 1H-MRI to synthesize 3D ventilation surrogates (PhysVENeT). The dataset comprised paired inspiratory and expiratory 1H-MRI scans and corresponding hyperpolarized gas MRI scans from 170 participants with various pulmonary pathologies. We performed fivefold cross-validation on 150 of these participants and used 20 participants with a previously unseen pathology (post COVID-19) for external validation. Synthetic ventilation surrogates were evaluated using voxel-wise correlation and structural similarity metrics; the proposed PhysVENeT framework significantly outperformed conventional 1H-MRI ventilation mapping and other DL approaches which did not utilize structural imaging and ventilation mapping. PhysVENeT can accurately reflect ventilation defects and exhibits minimal overfitting on external validation data compared to DL approaches that do not integrate physiologically-informed mapping.
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Affiliation(s)
- Joshua R Astley
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alberto M Biancardi
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Helen Marshall
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Laurie J Smith
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Laura C Saunders
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Graham Norquay
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Malina-Maria Tofan
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Matthew Q Hatton
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Rod Hughes
- Early Development Respiratory Medicine, AstraZeneca, Cambridge, UK
| | - Jim M Wild
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Insigneo Institute for in Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Bilal A Tahir
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK.
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK.
- Insigneo Institute for in Silico Medicine, The University of Sheffield, Sheffield, UK.
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30
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Zanette B, Greer MLC, Moraes TJ, Ratjen F, Santyr G. The argument for utilising magnetic resonance imaging as a tool for monitoring lung structure and function in pediatric patients. Expert Rev Respir Med 2023; 17:527-538. [PMID: 37491192 DOI: 10.1080/17476348.2023.2241355] [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: 04/03/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Although historically challenging to perform in the lung, technological advancements have made Magnetic Resonance Imaging (MRI) increasingly applicable for pediatric pulmonary imaging. Furthermore, a wide array of functional imaging techniques has become available that may be leveraged alongside structural imaging for increasingly sensitive biomarkers, or as outcome measures in the evaluation of novel therapies. AREAS COVERED In this review, recent technical advancements and modern methodologies for structural and functional lung MRI are described. These include ultrashort echo time (UTE) MRI, free-breathing contrast agent-free, functional lung MRI, and hyperpolarized gas MRI, amongst other techniques. Specific examples of the application of these methods in children are provided, principally drawn from recent research in asthma, bronchopulmonary dysplasia, and cystic fibrosis. EXPERT OPINION Pediatric lung MRI is rapidly growing, and is well poised for clinical utilization, as well as continued research into early disease detection, disease processes, and novel treatments. Structure/function complementarity makes MRI especially attractive as a tool for increased adoption in the evaluation of pediatric lung disease. Looking toward the future, novel technologies, such as low-field MRI and artificial intelligence, mitigate some of the traditional drawbacks of lung MRI and will aid in improving access to MRI in general, potentially spurring increased adoption and demand for pulmonary MRI in children.
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Affiliation(s)
- Brandon Zanette
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Theo J Moraes
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Felix Ratjen
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Giles Santyr
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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31
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Marshall H, Voskrebenzev A, Smith LJ, Biancardi AM, Kern AL, Collier GJ, Wielopolski PA, Ciet P, Tiddens HAWM, Vogel‐Claussen J, Wild JM. 129 Xe and Free-Breathing 1 H Ventilation MRI in Patients With Cystic Fibrosis: A Dual-Center Study. J Magn Reson Imaging 2023; 57:1908-1921. [PMID: 36218321 PMCID: PMC10946578 DOI: 10.1002/jmri.28470] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Free-breathing 1 H ventilation MRI shows promise but only single-center validation has yet been performed against methods which directly image lung ventilation in patients with cystic fibrosis (CF). PURPOSE To investigate the relationship between 129 Xe and 1 H ventilation images using data acquired at two centers. STUDY TYPE Sequence comparison. POPULATION Center 1; 24 patients with CF (12 female) aged 9-47 years. Center 2; 7 patients with CF (6 female) aged 13-18 years, and 6 healthy controls (6 female) aged 21-31 years. Data were acquired in different patients at each center. FIELD STRENGTH/SEQUENCE 1.5 T, 3D steady-state free precession and 2D spoiled gradient echo. ASSESSMENT Subjects were scanned with 129 Xe ventilation and 1 H free-breathing MRI and performed pulmonary function tests. Ventilation defect percent (VDP) was calculated using linear binning and images were visually assessed by H.M., L.J.S., and G.J.C. (10, 5, and 8 years' experience). STATISTICAL TESTS Correlations and linear regression analyses were performed between 129 Xe VDP, 1 H VDP, FEV1 , and LCI. Bland-Altman analysis of 129 Xe VDP and 1 H VDP was carried out. Differences in metrics were assessed using one-way ANOVA or Kruskal-Wallis tests. RESULTS 129 Xe VDP and 1 H VDP correlated strongly with; each other (r = 0.84), FEV1 z-score (129 Xe VDP r = -0.83, 1 H VDP r = -0.80), and LCI (129 Xe VDP r = 0.91, 1 H VDP r = 0.82). Bland-Altman analysis of 129 Xe VDP and 1 H VDP from both centers had a bias of 0.07% and limits of agreement of -16.1% and 16.2%. Linear regression relationships of VDP with FEV1 were not significantly different between 129 Xe and 1 H VDP (P = 0.08), while 129 Xe VDP had a stronger relationship with LCI than 1 H VDP. DATA CONCLUSION 1 H ventilation MRI shows large-scale agreement with 129 Xe ventilation MRI in CF patients with established lung disease but may be less sensitive to subtle ventilation changes in patients with early-stage lung disease. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Helen Marshall
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)German Center for Lung Research (DZL)HannoverGermany
| | - Laurie J. Smith
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | - Alberto M. Biancardi
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | - Agilo L. Kern
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)German Center for Lung Research (DZL)HannoverGermany
| | - Guilhem J. Collier
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | | | - Pierluigi Ciet
- Department of Radiology and Nuclear medicineErasmus MCRotterdamThe Netherlands
- Department of Pediatric Pulmonology and AllergologySophia Children's Hospital, Erasmus MCRotterdamThe Netherlands
| | - Harm A. W. M. Tiddens
- Department of Radiology and Nuclear medicineErasmus MCRotterdamThe Netherlands
- Department of Pediatric Pulmonology and AllergologySophia Children's Hospital, Erasmus MCRotterdamThe Netherlands
| | - Jens Vogel‐Claussen
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)German Center for Lung Research (DZL)HannoverGermany
| | - Jim M. Wild
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
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Metz C, Weng AM, Heidenreich JF, Slawig A, Benkert T, Köstler H, Veldhoen S. Reproducibility of non-contrast enhanced multi breath-hold ultrashort echo time functional lung MRI. Magn Reson Imaging 2023; 98:149-154. [PMID: 36681313 DOI: 10.1016/j.mri.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/14/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE To evaluate the intraindividual reproducibility of functional lung imaging using non-contrast enhanced multi breath-hold 3D-UTE MRI. METHODS Ten healthy volunteers underwent non-contrast enhanced 3D-UTE MRI at three time points for same-day and different-day measurements employing a stack-of-spirals trajectory at 3 T. At each time point, inspiratory and expiratory breathing states were acquired for tidal and deep breathing, each within a single breath-hold. For functional image analysis, fractional ventilation (FV) was calculated pixelwise after image registration from the MR signal change. To decouple FV from breathing depth, the individual lung volume was used for volume adjustment (rFV). Reproducibility evaluation was performed in eight lung segments. Statistical analyses included two way mixed intraclass correlation (ICC), sign-test, Friedman-test and modified Bland-Altman analyses. RESULTS FV from tidal breathing showed an ICC of 0.81, a bias of 1.3% and an interval of confidence (CI) ranging from -67.1 to 69.6%. FV from deep breathing was higher reproducible with an ICC of 0.92 (bias, -0.2%; CI, -34.2 to 33.7%). Following volume adjustment, reproducibility of rFV for tidal breathing improved (ICC, 0,86; bias, 2.0%; CI, -34.3 to 38.3%), whereas it did not bear significant benefits for deep breathing (ICC, 0.89; bias, 2.8%; CI, -24.9 to 30.5%). Reproducibility was independent from the examination day. CONCLUSION Non-contrast-enhanced multi breath-hold 3D-UTE MRI allows for highly reproducible ventilation imaging.
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Affiliation(s)
- C Metz
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany.
| | - A M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - J F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - A Slawig
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - T Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - H Köstler
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - S Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
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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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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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Klaar R, Rabe M, Gaass T, Schneider MJ, Benlala I, Eze C, Corradini S, Belka C, Landry G, Kurz C, Dinkel J. Ventilation and perfusion MRI at a 0.35 T MR-Linac: feasibility and reproducibility study. Radiat Oncol 2023; 18:58. [PMID: 37013541 PMCID: PMC10069152 DOI: 10.1186/s13014-023-02244-1] [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: 01/20/2023] [Accepted: 03/07/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Hybrid devices that combine radiation therapy and MR-imaging have been introduced in the clinical routine for the treatment of lung cancer. This opened up not only possibilities in terms of accurate tumor tracking, dose delivery and adapted treatment planning, but also functional lung imaging. The aim of this study was to show the feasibility of Non-uniform Fourier Decomposition (NuFD) MRI at a 0.35 T MR-Linac as a potential treatment response assessment tool, and propose two signal normalization strategies for enhancing the reproducibility of the results. METHODS Ten healthy volunteers (median age 28 ± 8 years, five female, five male) were repeatedly scanned at a 0.35 T MR-Linac using an optimized 2D+t balanced steady-state free precession (bSSFP) sequence for two coronal slice positions. Image series were acquired in normal free breathing with breaks inside and outside the scanner as well as deep and shallow breathing. Ventilation- and perfusion-weighted maps were generated for each image series using NuFD. For intra-volunteer ventilation map reproducibility, a normalization factor was defined based on the linear correlation of the ventilation signal and diaphragm position of each scan as well as the diaphragm motion amplitude of a reference scan. This allowed for the correction of signal dependency on the diaphragm motion amplitude, which varies with breathing patterns. The second strategy, which can be used for ventilation and perfusion, eliminates the dependency on the signal amplitude by normalizing the ventilation/perfusion maps with the average ventilation/perfusion signal within a selected region-of-interest (ROI). The position and size dependency of this ROI was analyzed. To evaluate the performance of both approaches, the normalized ventilation/perfusion-weighted maps were compared and the deviation of the mean ventilation/perfusion signal from the reference was calculated for each scan. Wilcoxon signed-rank tests were performed to test whether the normalization methods can significantly improve the reproducibility of the ventilation/perfusion maps. RESULTS The ventilation- and perfusion-weighted maps generated with the NuFD algorithm demonstrated a mostly homogenous distribution of signal intensity as expected for healthy volunteers regardless of the breathing maneuver and slice position. Evaluation of the ROI's size and position dependency showed small differences in the performance. Applying both normalization strategies improved the reproducibility of the ventilation by reducing the median deviation of all scans to 9.1%, 5.7% and 8.6% for the diaphragm-based, the best and worst performing ROI-based normalization, respectively, compared to 29.5% for the non-normalized scans. The significance of this improvement was confirmed by the Wilcoxon signed rank test with [Formula: see text] at [Formula: see text]. A comparison of the techniques against each other revealed a significant difference in the performance between best ROI-based normalization and worst ROI ([Formula: see text]) and between best ROI-based normalization and scaling factor ([Formula: see text]), but not between scaling factor and worst ROI ([Formula: see text]). Using the ROI-based approach for the perfusion-maps, the uncorrected deviation of 10.2% was reduced to 5.3%, which was shown to be significant ([Formula: see text]). CONCLUSIONS Using NuFD for non-contrast enhanced functional lung MRI at a 0.35 T MR-Linac is feasible and produces plausible ventilation- and perfusion-weighted maps for volunteers without history of chronic pulmonary diseases utilizing different breathing patterns. The reproducibility of the results in repeated scans significantly benefits from the introduction of the two normalization strategies, making NuFD a potential candidate for fast and robust early treatment response assessment of lung cancer patients during MR-guided radiotherapy.
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Affiliation(s)
- Rabea Klaar
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Moritz Rabe
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Gaass
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Moritz J. Schneider
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Antaros Medical AB, BioVenture Hub, Mölndal, Sweden
| | - Ilyes Benlala
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, F-33600 Pessac, France
- CHU Bordeaux, Service d’Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d’Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, F-33600 Pessac, France
- INSERM, U1045, Centre de Recherche Cardio-thoracique de Bordeaux, F-33600 Pessac, France
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Papp D, Elders B, Wielopolski PA, Kotek G, Vogel M, Tiddens HAWM, Ciet P, Hernandez-Tamames JA. Lung parenchyma and structure visualisation in paediatric chest MRI: a comparison of different short and ultra-short echo time protocols. Clin Radiol 2023; 78:e319-e327. [PMID: 36746723 DOI: 10.1016/j.crad.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023]
Abstract
AIM To evaluate image quality acquired at lung imaging using magnetic resonance imaging (MRI) sequences using short and ultra-short (UTE) echo times (TEs) with different acquisition strategies (breath-hold, prospective, and retrospective gating) in paediatric patients and in healthy volunteers. MATERIALS AND METHODS End-inspiratory and end-expiratory three-dimensional (3D) spoiled gradient (SPGR3D) and 3D zero echo-time (ZTE3D), and 3D UTE free-breathing (UTE3D), prospective projection navigated radial ZTE3D (ZTE3D vnav), and four-dimensional ZTE (ZTE4D) were performed using a 1.5 T MRI system. For quantitative assessment, the contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) values were calculated. To evaluate image quality, qualitative scoring was undertaken on all sequences to evaluate depiction of intrapulmonary vessels, fissures, bronchi, imaging noise, artefacts, and overall acceptability. RESULTS Eight cystic fibrosis (CF) patients (median age 14 years, range 13-17 years), seven children with history of prematurity with or without bronchopulmonary dysplasia (BPD; median 10 years, range 10-11 years), and 10 healthy volunteers (median 32 years, range 20-52 years) were included in the study. ZTE3D vnav provided the most reliable output in terms of image quality, although scan time was highly dependent on navigator triggering efficiency and respiratory pattern. CONCLUSIONS Best image quality was achieved with prospective ZTE3D and UTE3D readouts both in children and volunteers. The current implementation of retrospective ZTE3D readout (ZTE4D) did not provide diagnostic image quality but rather introduced artefacts over the entire imaging volume mimicking lung pathology.
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Affiliation(s)
- D Papp
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - B Elders
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - P A Wielopolski
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - G Kotek
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - M Vogel
- General Electric Healthcare, Waukesha, WI, USA
| | - H A W M Tiddens
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - P Ciet
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands; Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - J A Hernandez-Tamames
- Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
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Ilicak E, Ozdemir S, Zapp J, Schad LR, Zöllner FG. Dynamic mode decomposition of dynamic MRI for assessment of pulmonary ventilation and perfusion. Magn Reson Med 2023; 90:761-769. [PMID: 36989180 DOI: 10.1002/mrm.29656] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE To introduce dynamic mode decomposition (DMD) as a robust alternative for the assessment of pulmonary functional information from dynamic non-contrast-enhanced acquisitions. METHODS Pulmonary fractional ventilation and normalized perfusion maps were obtained using DMD from simulated phantoms as well as in vivo dynamic acquisitions of healthy volunteers at 1.5T. The performance of DMD was compared with conventional Fourier decomposition (FD) and matrix pencil (MP) methods in estimating functional map values. The proposed method was evaluated based on estimated signal amplitude in functional maps across varying number of measurements. RESULTS Quantitative assessments performed on phantoms and in vivo measurements indicate that DMD is capable of successfully obtaining pulmonary functional maps. Specifically, compared to FD and MP methods, DMD is able to reduce variations in estimated amplitudes across different number of measurements. This improvement is evident in the fractional ventilation and normalized perfusion maps obtain from phantom simulations with frequency variations and noise, as well as in the maps obtained from in vivo measurements. CONCLUSIONS A robust method for accurately estimating pulmonary ventilation and perfusion related signal changes in dynamic acquisitions is presented. The proposed method uses DMD to obtain functional maps reliably, while reducing amplitude variations caused by differences in number of measurements.
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Affiliation(s)
- Efe Ilicak
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Safa Ozdemir
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jascha Zapp
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Abstract
The need for airway imaging is defined by the limited sensitivity of common clinical tests like spirometry, lung diffusion (DLCO) and blood gas analysis to early changes of peripheral airways and to inhomogeneous regional distribution of lung function deficits. Therefore, X-ray and computed tomography (CT) are frequently used to complement the standard tests.As an alternative, magnetic resonance imaging (MRI) offers radiation-free lung imaging, but at lower spatial resolution. Non-contrast enhanced MRI shows healthy airways down to the first subsegmental level/4th order (CT: eighth). Bronchiectasis can be identified by wall thickening and fluid accumulation. Smaller airways become visible, when altered by peribronchiolar inflammation or mucus retention (tree-in-bud sign).The strength of MRI is functional imaging. Dynamic, time-resolved MRI directly visualizes expiratory airway collapse down to the lobar level (CT: segmental level). Obstruction of even smaller airways becomes visible as air trapping on the expiratory scans. MRI with hyperpolarized noble gases (3He, 129Xe) directly shows the large airways and peripheral lung ventilation. Dynamic contrast-enhanced MRI (DCE MRI) indirectly shows airway dysfunction as perfusion deficits resulting from hypoxic vasoconstriction of the dependent lung volumes. Further promising scientific approaches such as non-contrast enhanced, ventilation-/perfusion-weighted MRI from periodic signal changes of respiration and blood flow are in development.In summary, MRI of the lungs and airways excels with its unique combination of morphologic and functional imaging capacities for research (e.g., in chronic obstructive lung disease or asthma) as well as for clinical imaging (e.g., in cystic fibrosis).
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Affiliation(s)
- Juergen Biederer
- Christian-Albrechts-Universität zu Kiel, Faculty of Medicine, Kiel, Germany.,University of Latvia, Faculty of Medicine, Raina bulvaris, Riga, Latvia.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Im Neuenheimer Feld, Heidelberg, Germany.,Department of Diagnostic and interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
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Hsia CCW, Bates JHT, Driehuys B, Fain SB, Goldin JG, Hoffman EA, Hogg JC, Levin DL, Lynch DA, Ochs M, Parraga G, Prisk GK, Smith BM, Tawhai M, Vidal Melo MF, Woods JC, Hopkins SR. Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report. Ann Am Thorac Soc 2023; 20:161-195. [PMID: 36723475 PMCID: PMC9989862 DOI: 10.1513/annalsats.202211-915st] [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] [Indexed: 02/02/2023] Open
Abstract
Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort-echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation-perfusion-diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)-derived endpoints have been developed to identify structure-function phenotypes, including air-blood-tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental "good practice" stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.
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Tong Y, Udupa JK, McDonough JM, Wu C, Sun C, Xie L, Lott C, Clark A, Mayer OH, Anari JB, Torigian DA, Cahill PJ. Assessment of Regional Functional Effects of Surgical Treatment in Thoracic Insufficiency Syndrome via Dynamic Magnetic Resonance Imaging. J Bone Joint Surg Am 2023; 105:53-62. [PMID: 36598475 DOI: 10.2106/jbjs.22.00324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Quantitative regional assessment of thoracic function would enable clinicians to better understand the regional effects of therapy and the degree of deviation from normality in patients with thoracic insufficiency syndrome (TIS). The purpose of this study was to determine the regional functional effects of surgical treatment in TIS via quantitative dynamic magnetic resonance imaging (MRI) in comparison with healthy children. METHODS Volumetric parameters were derived via 129 dynamic MRI scans from 51 normal children (November 2017 to March 2019) and 39 patients with TIS (preoperatively and postoperatively, July 2009 to May 2018) for the left and right lungs, the left and right hemi-diaphragms, and the left and right hemi-chest walls during tidal breathing. Paired t testing was performed to compare the parameters from patients with TIS preoperatively and postoperatively. Mahalanobis distances between parameters of patients with TIS and age-matched normal children were assessed to evaluate the closeness of patient lung function to normality. Linear regression functions were utilized to estimate volume deviations of patients with TIS from normality, taking into account the growth of the subjects. RESULTS The mean Mahalanobis distances for the right hemi-diaphragm tidal volume (RDtv) were -1.32 ± 1.04 preoperatively and -0.05 ± 1.11 postoperatively (p = 0.001). Similarly, the mean Mahalanobis distances for the right lung tidal volume (RLtv) were -1.12 ± 1.04 preoperatively and -0.10 ± 1.26 postoperatively (p = 0.01). The mean Mahalanobis distances for the ratio of bilateral hemi-diaphragm tidal volume to bilateral lung tidal volume (BDtv/BLtv) were -1.68 ± 1.21 preoperatively and -0.04 ± 1.10 postoperatively (p = 0.003). Mahalanobis distances decreased after treatment, suggesting reduced deviations from normality. Regression results showed that all volumes and tidal volumes significantly increased after treatment (p < 0.001), and the tidal volume increases were significantly greater than those expected from normal growth for RDtv, RLtv, BDtv, and BLtv (p < 0.05). CONCLUSIONS Postoperative tidal volumes of bilateral lungs and bilateral hemi-diaphragms of patients with TIS came closer to those of normal children, indicating positive treatment effects from the surgical procedure. Quantitative dynamic MRI facilitates the assessment of regional effects of a surgical procedure to treat TIS. LEVEL OF EVIDENCE Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yubing Tong
- Department of Radiology, Medical Image Processing Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jayaram K Udupa
- Department of Radiology, Medical Image Processing Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph M McDonough
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Caiyun Wu
- Department of Radiology, Medical Image Processing Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Changjian Sun
- Department of Radiology, Medical Image Processing Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lipeng Xie
- Department of Radiology, Medical Image Processing Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carina Lott
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Abigail Clark
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Oscar H Mayer
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason B Anari
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Drew A Torigian
- Department of Radiology, Medical Image Processing Group, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick J Cahill
- The Wyss/Campbell Center for Thoracic Insufficiency Syndrome, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Crisosto C, Voskrebenzev A, Gutberlet M, Klimeš F, Kaireit TF, Pöhler G, Moher T, Behrendt L, Müller R, Zubke M, Wacker F, Vogel-Claussen J. Artificially-generated consolidations and balanced augmentation increase performance of U-net for lung parenchyma segmentation on MR images. PLoS One 2023; 18:e0285378. [PMID: 37159468 PMCID: PMC10168553 DOI: 10.1371/journal.pone.0285378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/23/2023] [Indexed: 05/11/2023] Open
Abstract
PURPOSE To improve automated lung segmentation on 2D lung MR images using balanced augmentation and artificially-generated consolidations for training of a convolutional neural network (CNN). MATERIALS AND METHODS From 233 healthy volunteers and 100 patients, 1891 coronal MR images were acquired. Of these, 1666 images without consolidations were used to build a binary semantic CNN for lung segmentation and 225 images (187 without consolidations, 38 with consolidations) were used for testing. To increase CNN performance of segmenting lung parenchyma with consolidations, balanced augmentation was performed and artificially-generated consolidations were added to all training images. The proposed CNN (CNNBal/Cons) was compared to two other CNNs: CNNUnbal/NoCons-without balanced augmentation and artificially-generated consolidations and CNNBal/NoCons-with balanced augmentation but without artificially-generated consolidations. Segmentation results were assessed using Sørensen-Dice coefficient (SDC) and Hausdorff distance coefficient. RESULTS Regarding the 187 MR test images without consolidations, the mean SDC of CNNUnbal/NoCons (92.1 ± 6% (mean ± standard deviation)) was significantly lower compared to CNNBal/NoCons (94.0 ± 5.3%, P = 0.0013) and CNNBal/Cons (94.3 ± 4.1%, P = 0.0001). No significant difference was found between SDC of CNNBal/Cons and CNNBal/NoCons (P = 0.54). For the 38 MR test images with consolidations, SDC of CNNUnbal/NoCons (89.0 ± 7.1%) was not significantly different compared to CNNBal/NoCons (90.2 ± 9.4%, P = 0.53). SDC of CNNBal/Cons (94.3 ± 3.7%) was significantly higher compared to CNNBal/NoCons (P = 0.0146) and CNNUnbal/NoCons (P = 0.001). CONCLUSIONS Expanding training datasets via balanced augmentation and artificially-generated consolidations improved the accuracy of CNNBal/Cons, especially in datasets with parenchymal consolidations. This is an important step towards a robust automated postprocessing of lung MRI datasets in clinical routine.
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Affiliation(s)
- Cristian Crisosto
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), 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 for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), 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 for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Filip Klimeš
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Till F Kaireit
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Gesa Pöhler
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Tawfik Moher
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Lea Behrendt
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Robin Müller
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Maximilian Zubke
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), 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 for Diagnostic and Interventional Radiology, Hannover Medical School (MHH), 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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Pushparaj TL, Irudaya Raj EF, Irudaya Rani EF. A detailed review of contrast-enhanced fluorescence magnetic resonance imaging techniques for earlier prediction and easy detection of COVID-19. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2022. [DOI: 10.1080/21681163.2022.2144762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - E. Fantin Irudaya Raj
- Department of Electrical and Electronics Engineering, Dr. Sivanthi Aditanar College of Engineering, India
| | - E. Francy Irudaya Rani
- Department of Electronics and Communication Engineering, Francis Xavier Engineering College, India
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Lévy S, Heiss R, Grimm R, Grodzki D, Hadler D, Voskrebenzev A, Vogel-Claussen J, Fuchs F, Strauss R, Achenbach S, Hinsen M, Klett D, Schmid J, Kremer AE, Uder M, Nagel AM, Bickelhaupt S. Free-Breathing Low-Field MRI of the Lungs Detects Functional Alterations Associated With Persistent Symptoms After COVID-19 Infection. Invest Radiol 2022; 57:742-751. [PMID: 35640012 DOI: 10.1097/rli.0000000000000892] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES With the COVID-19 pandemic, repetitive lung examinations have become necessary to follow-up symptoms and associated alterations. Low-field MRI, benefiting from reduced susceptibility effects, is a promising alternative for lung imaging to limit radiations absorbed by patients during CT examinations, which also have limited capability to assess functional alterations. The aim of this investigative study was to explore the functional abnormalities that free-breathing 0.55 T MRI in combination with the phase-resolved functional lung (PREFUL) analysis could identify in patients with persistent symptoms after COVID-19 infection. MATERIALS AND METHODS Seventy-four COVID-19 patients and 8 healthy volunteers were prospectively scanned in free-breathing with a balanced steady-state free-precession sequence optimized at 0.55 T, 5 months postinfection on average. Normalized perfusion (Q), fractional ventilation (FV), and flow-volume loop correlation (FVLc) maps were extracted with the PREFUL technique. Q, FV, and FVLc defects as well as defect overlaps between these metrics were quantified. Morphological turbo-spin-echo images were also acquired, and the extent of abnormalities was scored by a board-certified radiologist. To investigate the functional correlates of persistent symptoms, a recursive feature elimination algorithm was applied to find the most informative variables to detect the presence of persistent symptoms with a logistic regression model and a cross-validation strategy. All MRI metrics, sex, age, body mass index, and the presence of preexisting lung conditions were included. RESULTS The most informative variables to detect persistent symptoms were the percentage of concurrent Q and FVLc defects and of areas free of those defects. A detection accuracy of 71.4% was obtained with these 2 variables when fitting the model on the entire dataset. Although none of the single variables differed between patients with and without persistent symptoms ( P > 0.05), the combined score of these 2 variables did ( P < 0.02). This score also showed a consistent increase from healthy volunteers (7.7) to patients without persistent symptoms (8.2) and with persistent symptoms (8.6). The morphological abnormality score showed poor correlation with the functional parameters. CONCLUSIONS Functional pulmonary examinations using free-breathing 0.55 T MRI with PREFUL analysis revealed potential quantitative markers of impaired lung function in patients with persistent symptoms after COVID-19 infection, potentially complementing morphologic imaging. Future work is needed to explore the translational relevance and clinical implication of these findings.
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Affiliation(s)
- Simon Lévy
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Rafael Heiss
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen
| | - David Grodzki
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen
| | - Dominique Hadler
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | | | | | - Florian Fuchs
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Richard Strauss
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Susanne Achenbach
- Department of Transfusion Medicine and Haemostaseology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian Hinsen
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Daniel Klett
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Jonas Schmid
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | | | - Michael Uder
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | | | - Sebastian Bickelhaupt
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
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Pusterla O, Heule R, Santini F, Weikert T, Willers C, Andermatt S, Sandkühler R, Nyilas S, Latzin P, Bieri O, Bauman G. MRI lung lobe segmentation in pediatric cystic fibrosis patients using a recurrent neural network trained with publicly accessible CT datasets. Magn Reson Med 2022; 88:391-405. [PMID: 35348244 PMCID: PMC9314108 DOI: 10.1002/mrm.29184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To introduce a widely applicable workflow for pulmonary lobe segmentation of MR images using a recurrent neural network (RNN) trained with chest CT datasets. The feasibility is demonstrated for 2D coronal ultrafast balanced SSFP (ufSSFP) MRI. METHODS Lung lobes of 250 publicly accessible CT datasets of adults were segmented with an open-source CT-specific algorithm. To match 2D ufSSFP MRI data of pediatric patients, both CT data and segmentations were translated into pseudo-MR images that were masked to suppress anatomy outside the lung. Network-1 was trained with pseudo-MR images and lobe segmentations and then applied to 1000 masked ufSSFP images to predict lobe segmentations. These outputs were directly used as targets to train Network-2 and Network-3 with non-masked ufSSFP data as inputs, as well as an additional whole-lung mask as input for Network-2. Network predictions were compared to reference manual lobe segmentations of ufSSFP data in 20 pediatric cystic fibrosis patients. Manual lobe segmentations were performed by splitting available whole-lung segmentations into lobes. RESULTS Network-1 was able to segment the lobes of ufSSFP images, and Network-2 and Network-3 further increased segmentation accuracy and robustness. The average all-lobe Dice similarity coefficients were 95.0 ± 2.8 (mean ± pooled SD [%]) and 96.4 ± 2.5, 93.0 ± 2.0; and the average median Hausdorff distances were 6.1 ± 0.9 (mean ± SD [mm]), 5.3 ± 1.1, 7.1 ± 1.3 for Network-1, Network-2, and Network-3, respectively. CONCLUSION Recurrent neural network lung lobe segmentation of 2D ufSSFP imaging is feasible, in good agreement with manual segmentations. The proposed workflow might provide access to automated lobe segmentations for various lung MRI examinations and quantitative analyses.
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Affiliation(s)
- Orso Pusterla
- Division of Radiological PhysicsDepartment of RadiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Division of Pediatric Respiratory Medicine and AllergologyDepartment of Pediatrics, InselspitalBern University HospitalUniversity of BernSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Rahel Heule
- High Field Magnetic ResonanceMax Planck Institute for Biological CyberneticsTübingenGermany
- Department of Biomedical Magnetic ResonanceUniversity of TübingenTübingenGermany
| | - Francesco Santini
- Division of Radiological PhysicsDepartment of RadiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
- Department of RadiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Thomas Weikert
- Department of RadiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
| | - Corin Willers
- Division of Pediatric Respiratory Medicine and AllergologyDepartment of Pediatrics, InselspitalBern University HospitalUniversity of BernSwitzerland
| | - Simon Andermatt
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Robin Sandkühler
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Sylvia Nyilas
- Department of Diagnostic, Interventional and Pediatric Radiology, InselspitalBern University HospitalUniversity of BernSwitzerland
| | - Philipp Latzin
- Division of Pediatric Respiratory Medicine and AllergologyDepartment of Pediatrics, InselspitalBern University HospitalUniversity of BernSwitzerland
| | - Oliver Bieri
- Division of Radiological PhysicsDepartment of RadiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
| | - Grzegorz Bauman
- Division of Radiological PhysicsDepartment of RadiologyUniversity Hospital BaselUniversity of BaselBaselSwitzerland
- Department of Biomedical EngineeringUniversity of BaselBaselSwitzerland
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45
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Ilicak E, Ozdemir S, Schad LR, Weis M, Schoenberg SO, Zöllner FG, Zapp J. Phase-cycled balanced SSFP imaging for non-contrast-enhanced functional lung imaging. Magn Reson Med 2022; 88:1764-1774. [PMID: 35608220 DOI: 10.1002/mrm.29302] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/11/2022] [Accepted: 04/25/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE To introduce phase-cycled balanced SSFP (bSSFP) acquisition as an alternative in Fourier decomposition MRI for improved robustness against field inhomogeneities. METHODS Series 2D dynamic lung images were acquired in 5 healthy volunteers at 1.5 T and 3 T using bSSFP sequence with multiple RF phase increments and compared with conventional single RF phase increment acquisitions. The approach was evaluated based on functional map homogeneity analysis, while ensuring image and functional map quality by means of SNR and contrast-to-noise ratio analyses. RESULTS At both field strengths, functional maps obtained with phase-cycled acquisitions displayed improved robustness against local signal losses compared with single-phase acquisitions. The coefficient of variation (mean ± SD, across volunteers) measured in the ventilation maps resulted in 29.7 ± 2.6 at 1.5 T and 37.5 ± 3.1 at 3 T for phase-cycled acquisitions, compared with 39.9 ± 5.2 at 1.5 T and 49.5 ± 3.7 at 3 T for single-phase acquisitions, indicating a significant improvement ( p < 0.05 $$ p<0.05 $$ ) in ventilation map homogeneity. CONCLUSIONS Phase-cycled bSSFP acquisitions improve robustness against field inhomogeneity artifacts and significantly improve ventilation map homogeneity at both field strengths. As such, phase-cycled bSSFP may serve as a robust alternative in lung function assessments.
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Affiliation(s)
- Efe Ilicak
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Safa Ozdemir
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Meike Weis
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank G Zöllner
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jascha Zapp
- Computer Assisted Clinical Medicine, Mannheim Institute for Intelligent Systems in Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Xu P, Zhang J, Nan Z, Meersmann T, Wang C. Free-Breathing Phase-Resolved Oxygen-Enhanced Pulmonary MRI Based on 3D Stack-of-Stars UTE Sequence. SENSORS (BASEL, SWITZERLAND) 2022; 22:3270. [PMID: 35590959 PMCID: PMC9105788 DOI: 10.3390/s22093270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/15/2022] [Accepted: 04/22/2022] [Indexed: 06/15/2023]
Abstract
Compared with hyperpolarized noble gas MRI, oxygen-enhanced lung imaging is a cost-effective approach to investigate lung function. In this study, we investigated the feasibility of free-breathing phase-resolved oxygen-enhanced pulmonary MRI based on a 3D stack-of-stars ultra-short echo time (UTE) sequence. We conducted both computer simulation and in vivo experiments and calculated percent signal enhancement maps of four different respiratory phases on four healthy volunteers from the end of expiration to the end of inspiration. The phantom experiment was implemented to verify simulation results. The respiratory phase was segmented based on the extracted respiratory signal and sliding window reconstruction, providing phase-resolved pulmonary MRI. Demons registration algorithm was applied to compensate for respiratory motion. The mean percent signal enhancement of the average phase increases from anterior to posterior region, matching previous literature. More details of pulmonary tissues were observed on post-oxygen inhalation images through the phase-resolved technique. Phase-resolved UTE pulmonary MRI shows the potential as a valuable method for oxygen-enhanced MRI that enables the investigation of lung ventilation on middle states of the respiratory cycle.
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Affiliation(s)
- Pengfei Xu
- Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo 315100, China; (P.X.); (J.Z.); (Z.N.)
| | - Jichang Zhang
- Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo 315100, China; (P.X.); (J.Z.); (Z.N.)
| | - Zhen Nan
- Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo 315100, China; (P.X.); (J.Z.); (Z.N.)
| | - Thomas Meersmann
- Sir Peter Mansfield Magnetic Imaging Center, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Chengbo Wang
- Electrical and Electronic Engineering, Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo 315100, China; (P.X.); (J.Z.); (Z.N.)
- Nottingham Ningbo China Beacons of Excellence Research and Innovation Institute, Ningbo 315040, China
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Hinsen M, Heiss R, Nagel AM, Lévy S, Uder M, Bickelhaupt S, May MS. [Imaging of the lung using low-field magnetic resonance imaging]. Radiologe 2022; 62:418-428. [PMID: 35416476 PMCID: PMC9006515 DOI: 10.1007/s00117-022-00996-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
Hintergrund Die Untersuchung der Lunge mit der Magnetresonanztomographie (MRT) geht mit hohen Herausforderungen einher und konnte sich im klinischen Alltag bisher nicht durchsetzen. Aktuelle Entwicklungen der Niederfeld-MRT, in Kombination mit neuen computergestützten Aufnahme- und Auswertungsalgorithmen, versprechen neue Perspektiven für die bildgebende Diagnostik pulmonaler Erkrankungen. Ziel dieser Arbeit Diese Übersichtsarbeit soll ein Verständnis der physikalischen Vorteile der Niederfeld-MRT für die Lungenbildgebung vermitteln, einen Überblick über die spärlich vorhandenen Vorkenntnisse aus der Literatur bieten und erste Ergebnisse eines neu entwickelten Niederfeld-MRT präsentieren. Methoden Inhalte dieses Artikels basieren auf physikalischen Grundlagen, Recherchen in Literaturdatenbanken und eigenen Erfahrungen in der Lungenbildgebung mit einem modernen 0,55-T-MRT. Schlussfolgerung Die Niederfeld-MRT (< 1 T) kann technische und ökonomische Vorteile gegenüber höheren Feldstärken für die Lungenbildgebung haben. Die physikalischen Voraussetzungen sind aufgrund geringerer Suszeptibilitätseffekte, längerer transversaler Relaxationszeiten und niedrigerer spezifischer Absorptionsraten besonders für die Anatomie der Lunge vorteilhaft. Die geringeren Anschaffungs- und Betriebskosten haben zudem ein großes Potenzial, die Verfügbarkeit zu erhöhen und gleichzeitig die Nachhaltigkeit zu verbessern. Durch die Kombination moderner Sequenzen und computergestützter Auswertungen kann die morphologische Bildgebung um orts- und zeitaufgelöste funktionelle Untersuchungen der Lunge ohne Strahlenbelastung ergänzt werden. Sowohl für kritische Szenarien, wie Screening und engmaschiges Therapiemonitoring, als auch für besonders gefährdete Patientengruppen könnten Lücken geschlossen werden. Dazu gehören beispielsweise akute und chronische Lungenerkrankungen bei Kindern oder die Abklärung einer Lungenembolie bei Schwangeren.
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Affiliation(s)
- Maximilian Hinsen
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Armin M Nagel
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Deutschland
| | - Simon Lévy
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Sebastian Bickelhaupt
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Matthias S May
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 3, 91054, Erlangen, Deutschland. .,Imaging Science Institute, Universitätsklinikum Erlangen, Erlangen, Deutschland.
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Nyilas S, Bauman G, Korten I, Pusterla O, Singer F, Ith M, Groen C, Schoeni A, Heverhagen JT, Christe A, Rodondi N, Bieri O, Geiser T, Auer R, Funke-Chambour M, Ebner L. MRI Shows Lung Perfusion Changes after Vaping and Smoking. Radiology 2022; 304:195-204. [PMID: 35380498 DOI: 10.1148/radiol.211327] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Evidence regarding short-term effects of electronic nicotine delivery systems (ENDS) and tobacco smoke on lung ventilation and perfusion is limited. Purpose To examine the immediate effect of ENDS exposure and tobacco smoke on lung ventilation and perfusion by functional MRI and lung function tests. Materials and Methods This prospective observational pilot study was conducted from November 2019 to September 2021 (substudy of randomized controlled trial NCT03589989). Included were 44 healthy adult participants (10 control participants, nine former tobacco smokers, 13 ENDS users, and 12 active tobacco smokers; mean age, 41 years ± 12 [SD]; 28 men) who underwent noncontrast-enhanced matrix pencil MRI and lung function tests before and immediately after the exposure to ENDS products or tobacco smoke. Baseline measurements were acquired after 2 hours of substance abstinence. Postexposure measurements were performed immediately after the exposure. MRI showed semiquantitative measured impairment of lung perfusion (RQ) and fractional ventilation (RFV) impairment as percentages of affected lung volume. Lung clearance index (LCI) was assessed by nitrogen multiple-breath washout to capture ventilation inhomogeneity and spirometry to assess airflow limitation. Absolute differences were calculated with paired Wilcoxon signed-rank test and differences between groups with unpaired Mann-Whitney test. Healthy control participants underwent two consecutive MRI measurements to assess MRI reproducibility. Results MRI was performed and lung function measurement was acquired in tobacco smokers and ENDS users before and after exposure. MRI showed a decrease of perfusion after exposure (RQ, 8.6% [IQR, 7.2%-10.0%] to 9.1% [IQR, 7.8%-10.7%]; P = .03) and no systematic change in RFV (P = .31) among tobacco smokers. Perfusion increased in participants who used ENDS after exposure (RQ, 9.7% [IQR, 7.1%-10.9%] to 9.0% [IQR, 6.9%-10.0%]; P = .01). RFV did not change (P = .38). Only in tobacco smokers was LCI elevated after smoking (P = .02). Spirometry indexes did not change in any participants. Conclusion MRI showed a decrease of lung perfusion after exposure to tobacco smoke and an increase of lung perfusion after use of electronic nicotine delivery systems. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Kligerman in this issue.
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Affiliation(s)
- Sylvia Nyilas
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Grzegorz Bauman
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Insa Korten
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Orso Pusterla
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Florian Singer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Michael Ith
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Cindy Groen
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Anna Schoeni
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Johannes T Heverhagen
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Andreas Christe
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Nicolas Rodondi
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Oliver Bieri
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Thomas Geiser
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Reto Auer
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Manuela Funke-Chambour
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
| | - Lukas Ebner
- From the Department of Diagnostic, Interventional and Pediatric Radiology (S.N., M.I., J.T.H., A.C., L.E.), Department of Pediatrics, Division of Pediatric Respiratory Medicine and Allergology (I.K.), Department of General Internal Medicine (N.R.), and Department of Pulmonary Medicine (T.G., M.F.C.), Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern 3010, Switzerland; Department of Radiology, Division of Radiological Physics, University of Basel Hospital, Basel, Switzerland (G.B., O.P., O.B.); Department of Biomedical Engineering, University of Basel, Basel, Switzerland (G.B., O.P., O.B.); Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland (O.P.); Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria (F.S.); Department of Respiratory Medicine, University Children's Hospital Zurich and Childhood Research Center, Zurich, Switzerland (F.S.); Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland (C.G., A.S., N.R., R.A.); and Center for Primary Care and Public Health, Unisanté, Lausanne, Switzerland (R.A.)
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49
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Behrendt L, Smith LJ, Voskrebenzev A, Klimeš F, Kaireit TF, Pöhler GH, Kern AL, Gonzalez CC, Dittrich AM, Marshall H, Schütz K, Hughes PJC, Ciet P, Tiddens HAWM, Wild JM, Vogel-Claussen J. A dual center and dual vendor comparison study of automated perfusion-weighted phase-resolved functional lung magnetic resonance imaging with dynamic contrast-enhanced magnetic resonance imaging in patients with cystic fibrosis. Pulm Circ 2022; 12:e12054. [PMID: 35514781 PMCID: PMC9063970 DOI: 10.1002/pul2.12054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/17/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
For sensitive diagnosis and monitoring of pulmonary disease, ionizing radiation-free imaging methods are of great importance. A noncontrast and free-breathing proton magnetic resonance imaging (MRI) technique for assessment of pulmonary perfusion is phase-resolved functional lung (PREFUL) MRI. Since there is no validation of PREFUL MRI across different centers and scanners, the purpose of this study was to compare perfusion-weighted PREFUL MRI with the well-established dynamic contrast-enhanced (DCE) MRI across two centers on scanners from two different vendors. Sixteen patients with cystic fibrosis (CF) (Center 1: 10 patients; Center 2: 6 patients) underwent PREFUL and DCE MRI at 1.5T in the same imaging session. Normalized perfusion-weighted values and perfusion defect percentage (QDP) values were calculated for the whole lung and three central slices (dorsal, central, ventral of the carina). Obtained parameters were compared using Pearson correlation, Spearman correlation, Bland-Altman analysis, Wilcoxon signed-rank test, and Wilcoxon rank-sum test. Moderate-to-strong correlations between normalized perfusion-weighted PREFUL and DCE values were found (posterior slice: r = 0.69, p < 0.01). Spatial overlap of PREFUL and DCE QDP maps showed an agreement of 79.4% for the whole lung. Further, spatial overlap values of Center 1 were not significantly different to those of Center 2 for the three central slices (p > 0.07). The feasibility of PREFUL MRI across two different centers and two different vendors was shown in patients with CF and obtained results were in agreement with DCE MRI.
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Affiliation(s)
- Lea Behrendt
- Department for 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
| | - Laurie J Smith
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Andreas Voskrebenzev
- Department for 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
| | - Filip Klimeš
- Department for 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
| | - Till F Kaireit
- Department for 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
| | - Gesa H Pöhler
- Department for 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
| | - Agilo L Kern
- Department for 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
| | - Cristian Crisosto Gonzalez
- Department for 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
| | - Anna-Maria Dittrich
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany.,Department for Pediatric Pulmonology, Allergology and Neonatology Hannover Medical School Hannover Germany
| | - Helen Marshall
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Katharina Schütz
- Department for Pediatric Pulmonology, Allergology and Neonatology Hannover Medical School Hannover Germany
| | - Paul J C Hughes
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Pierluigi Ciet
- Department of Pediatric Pulmonology and Allergology Sophia Children's Hospital, Erasmus MC Rotterdam The Netherlands
| | - Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology Sophia Children's Hospital, Erasmus MC Rotterdam The Netherlands.,Department of Radiology and Nuclear medicine Erasmus MC Rotterdam The Netherlands
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Jens Vogel-Claussen
- Department for 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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50
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Astley JR, Wild JM, Tahir BA. Deep learning in structural and functional lung image analysis. Br J Radiol 2022; 95:20201107. [PMID: 33877878 PMCID: PMC9153705 DOI: 10.1259/bjr.20201107] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The recent resurgence of deep learning (DL) has dramatically influenced the medical imaging field. Medical image analysis applications have been at the forefront of DL research efforts applied to multiple diseases and organs, including those of the lungs. The aims of this review are twofold: (i) to briefly overview DL theory as it relates to lung image analysis; (ii) to systematically review the DL research literature relating to the lung image analysis applications of segmentation, reconstruction, registration and synthesis. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 479 studies were initially identified from the literature search with 82 studies meeting the eligibility criteria. Segmentation was the most common lung image analysis DL application (65.9% of papers reviewed). DL has shown impressive results when applied to segmentation of the whole lung and other pulmonary structures. DL has also shown great potential for applications in image registration, reconstruction and synthesis. However, the majority of published studies have been limited to structural lung imaging with only 12.9% of reviewed studies employing functional lung imaging modalities, thus highlighting significant opportunities for further research in this field. Although the field of DL in lung image analysis is rapidly expanding, concerns over inconsistent validation and evaluation strategies, intersite generalisability, transparency of methodological detail and interpretability need to be addressed before widespread adoption in clinical lung imaging workflow.
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Affiliation(s)
| | - Jim M Wild
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
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