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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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2
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MR Imaging for the Evaluation of Diffuse Lung Disease. Radiol Clin North Am 2022; 60:1021-1032. [DOI: 10.1016/j.rcl.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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3
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State of the Art: Lung Cancer Staging Using Updated Imaging Modalities. Bioengineering (Basel) 2022; 9:bioengineering9100493. [PMID: 36290461 PMCID: PMC9598500 DOI: 10.3390/bioengineering9100493] [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] [Received: 09/07/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
Lung cancer is among the most common mortality causes worldwide. This scientific article is a comprehensive review of current knowledge regarding screening, subtyping, imaging, staging, and management of treatment response for lung cancer. The traditional imaging modality for screening and initial lung cancer diagnosis is computed tomography (CT). Recently, a dual-energy CT was proven to enhance the categorization of variable pulmonary lesions. The National Comprehensive Cancer Network (NCCN) recommends usage of fluorodeoxyglucose positron emission tomography (FDG PET) in concert with CT to properly stage lung cancer and to prevent fruitless thoracotomies. Diffusion MR is an alternative to FDG PET/CT that is radiation-free and has a comparable diagnostic performance. For response evaluation after treatment, FDG PET/CT is a potent modality which predicts survival better than CT. Updated knowledge of lung cancer genomic abnormalities and treatment regimens helps to improve the radiologists’ skills. Incorporating the radiologic experience is crucial for precise diagnosis, therapy planning, and surveillance of lung cancer.
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4
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Stewart NJ, Smith LJ, Chan HF, Eaden JA, Rajaram S, Swift AJ, Weatherley ND, Biancardi A, Collier GJ, Hughes D, Klafkowski G, Johns CS, West N, Ugonna K, Bianchi SM, Lawson R, Sabroe I, Marshall H, Wild JM. Lung MRI with hyperpolarised gases: current & future clinical perspectives. Br J Radiol 2022; 95:20210207. [PMID: 34106792 PMCID: PMC9153706 DOI: 10.1259/bjr.20210207] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The use of pulmonary MRI in a clinical setting has historically been limited. Whilst CT remains the gold-standard for structural lung imaging in many clinical indications, technical developments in ultrashort and zero echo time MRI techniques are beginning to help realise non-ionising structural imaging in certain lung disorders. In this invited review, we discuss a complementary technique - hyperpolarised (HP) gas MRI with inhaled 3He and 129Xe - a method for functional and microstructural imaging of the lung that has great potential as a clinical tool for early detection and improved understanding of pathophysiology in many lung diseases. HP gas MRI now has the potential to make an impact on clinical management by enabling safe, sensitive monitoring of disease progression and response to therapy. With reference to the significant evidence base gathered over the last two decades, we review HP gas MRI studies in patients with a range of pulmonary disorders, including COPD/emphysema, asthma, cystic fibrosis, and interstitial lung disease. We provide several examples of our experience in Sheffield of using these techniques in a diagnostic clinical setting in challenging adult and paediatric lung diseases.
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Affiliation(s)
- Neil J Stewart
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Laurie J Smith
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ho-Fung Chan
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James A Eaden
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Smitha Rajaram
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Nicholas D Weatherley
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alberto Biancardi
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David Hughes
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Christopher S Johns
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Noreen West
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Kelechi Ugonna
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Stephen M Bianchi
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Rod Lawson
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Ian Sabroe
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Helen Marshall
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
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5
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Bayfield KJ, Douglas TA, Rosenow T, Davies JC, Elborn SJ, Mall M, Paproki A, Ratjen F, Sly PD, Smyth AR, Stick S, Wainwright CE, Robinson PD. Time to get serious about the detection and monitoring of early lung disease in cystic fibrosis. Thorax 2021; 76:1255-1265. [PMID: 33927017 DOI: 10.1136/thoraxjnl-2020-216085] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/24/2021] [Accepted: 03/10/2021] [Indexed: 12/26/2022]
Abstract
Structural and functional defects within the lungs of children with cystic fibrosis (CF) are detectable soon after birth and progress throughout preschool years often without overt clinical signs or symptoms. By school age, most children have structural changes such as bronchiectasis or gas trapping/hypoperfusion and lung function abnormalities that persist into later life. Despite improved survival, gains in forced expiratory volume in one second (FEV1) achieved across successive birth cohorts during childhood have plateaued, and rates of FEV1 decline in adolescence and adulthood have not slowed. This suggests that interventions aimed at preventing lung disease should be targeted to mild disease and commence in early life. Spirometry-based classifications of 'normal' (FEV1≥90% predicted) and 'mild lung disease' (FEV1 70%-89% predicted) are inappropriate, given the failure of spirometry to detect significant structural or functional abnormalities shown by more sensitive imaging and lung function techniques. The state and readiness of two imaging (CT and MRI) and two functional (multiple breath washout and oscillometry) tools for the detection and monitoring of early lung disease in children and adults with CF are discussed in this article.Prospective research programmes and technological advances in these techniques mean that well-designed interventional trials in early lung disease, particularly in young children and infants, are possible. Age appropriate, randomised controlled trials are critical to determine the safety, efficacy and best use of new therapies in young children. Regulatory bodies continue to approve medications in young children based on safety data alone and extrapolation of efficacy results from older age groups. Harnessing the complementary information from structural and functional tools, with measures of inflammation and infection, will significantly advance our understanding of early CF lung disease pathophysiology and responses to therapy. Defining clinical utility for these novel techniques will require effective collaboration across multiple disciplines to address important remaining research questions. Future impact on existing management burden for patients with CF and their family must be considered, assessed and minimised.To address the possible role of these techniques in early lung disease, a meeting of international leaders and experts in the field was convened in August 2019 at the Australiasian Cystic Fibrosis Conference. The meeting entitiled 'Shaping imaging and functional testing for early disease detection of lung disease in Cystic Fibrosis', was attended by representatives across the range of disciplines involved in modern CF care. This document summarises the proceedings, key priorities and important research questions highlighted.
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Affiliation(s)
- Katie J Bayfield
- Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Tonia A Douglas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Tim Rosenow
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Microscopy, Characterisation and Analysis, The University of Western Australia, Perth, Western Australia, Australia
| | - Jane C Davies
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stuart J Elborn
- Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Marcus Mall
- Department of Pediatric Pulmonology, Immunology, and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Translational Pulmonology, German Center for Lung Research, Berlin, Germany
| | - Anthony Paproki
- The Australian e-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Felix Ratjen
- Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Peter D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queenland, Herston, Queensland, Australia
| | - Alan R Smyth
- Division of Child Health, Obstetrics & Gynaecology. School of Medicine, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Stephen Stick
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Claire E Wainwright
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul D Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia .,Airway Physiology and Imaging Group, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia.,The Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, New South Wales, Australia
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6
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Goralski JL, Stewart NJ, Woods JC. Novel imaging techniques for cystic fibrosis lung disease. Pediatr Pulmonol 2021; 56 Suppl 1:S40-S54. [PMID: 32592531 PMCID: PMC7808406 DOI: 10.1002/ppul.24931] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022]
Abstract
With an increasing number of patients with cystic fibrosis (CF) receiving highly effective CFTR (cystic fibrosis transmembrane regulator protein) modulator therapy, particularly at a young age, there is an increasing need to identify imaging tools that can detect and regionally visualize mild CF lung disease and subtle changes in disease state. In this review, we discuss the latest developments in imaging modalities for both structural and functional imaging of the lung available to CF clinicians and researchers, from the widely available, clinically utilized imaging methods for assessing CF lung disease-chest radiography and computed tomography-to newer techniques poised to become the next phase of clinical tools-structural/functional proton and hyperpolarized gas magnetic resonance imaging (MRI). Finally, we provide a brief discussion of several newer lung imaging techniques that are currently available only in selected research settings, including chest tomosynthesis, and fluorinated gas MRI. We provide an update on the clinical and/or research status of each technique, with a focus on sensitivity, early disease detection, and possibilities for monitoring treatment efficacy.
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Affiliation(s)
- Jennifer L Goralski
- UNC Cystic Fibrosis Center, Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Pediatric Pulmonology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neil J Stewart
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Infection, Immunity & Cardiovascular Disease, POLARIS Group, Imaging Sciences, University of Sheffield, Sheffield, UK
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.,Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio
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Mallallah F, Packham A, Lee E, Hind D. Is hyperpolarised gas magnetic resonance imaging a valid and reliable tool to detect lung health in cystic fibrosis patients? a cosmin systematic review. J Cyst Fibros 2021; 20:906-919. [PMID: 33454201 DOI: 10.1016/j.jcf.2020.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/13/2020] [Accepted: 12/24/2020] [Indexed: 12/31/2022]
Abstract
This paper systematically reviewed the literature reporting the validity and reliability of hyperpolarised gas MRI as a marker of lung health in cystic fibrosis (CF). MEDLINE, EMBASE and grey literature were searched for studies assessing the measurement properties of hyperpolarised helium-3 or xenon-129 MRI. The COSMIN risk of bias tool was used to critically appraise eligible studies. Findings show hyperpolarised gas MRI was able to detect structural and functional abnormalities in the lungs, detect response to treatments, and is more sensitive than FEV1 in detecting ventilation defects in CF patients. There was moderately robust evidence for construct validity of hyperpolarised gas MRI, although evidence for other types of validity is currently low. Nonetheless, high quality studies concluded that hyperpolarised gas MRI is a reliable tool and test results are reproducible in CF patients. Hyperpolarised gas MRI is a promising tool for detecting early CF pulmonary disease and for longitudinal monitoring of CF.
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Affiliation(s)
- Fatmah Mallallah
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Packham
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ellen Lee
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Daniel Hind
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK.
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8
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Woods JC, Wild JM, Wielpütz MO, Clancy JP, Hatabu H, Kauczor HU, van Beek EJ, Altes TA. Current state of the art MRI for the longitudinal assessment of cystic fibrosis. J Magn Reson Imaging 2020; 52:1306-1320. [PMID: 31846139 PMCID: PMC7297663 DOI: 10.1002/jmri.27030] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
Pulmonary MRI can now provide high-resolution images that are sensitive to early disease and specific to inflammation in cystic fibrosis (CF) lung disease. With specificity and function limited via computed tomography (CT), there are significant advantages to MRI. Many of the modern MRI techniques can be performed throughout life, and can be employed to understand changes over time, in addition to quantification of treatment response. Proton density and T1 /T2 contrast images can be obtained within a single breath-hold, providing depiction of structural abnormalities and active inflammation. Modern radial and/or spiral ultrashort echo-time (UTE) techniques rival CT in resolution for depiction and quantification of structure, for both airway and parenchymal abnormalities. Contrast perfusion MRI techniques are now utilized routinely to visualize changes in pulmonary and bronchial circulation that routinely occur in CF lung disease, and noncontrast techniques are moving closer to clinical translation. Functional information can be obtained from noncontrast proton images alone, using techniques such as Fourier decomposition. Hyperpolarized-gas MRI, increasingly using 129 Xe, is now becoming more widespread and has been demonstrated to have high sensitivity to early airway obstruction in CF via ventilation MRI. The sensitivity of 129 Xe MRI promises future use in personalized medicine, management of early CF lung disease, and in future clinical trials. By combining structural and functional techniques, with or without hyperpolarized gases, regional structure-function relationships can be obtained, giving insight into the pathophysiology of disease and improved clinical management. This article reviews the modern MRI techniques that can routinely be employed for CF lung disease in nearly any large medical center. Level of Evidence: 4 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2019.
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Affiliation(s)
- Jason C. Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital and University of Cincinnati; Cincinnati OH, USA
| | - Jim M. Wild
- Department of Radiology, University of Sheffield, Sheffield UK
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC) Heidelberg, German Center for lung Research (DZL), Heidelberg, Germany
| | - John P. Clancy
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital and University of Cincinnati; Cincinnati OH, USA
| | - Hiroto Hatabu
- Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center (TLRC) Heidelberg, German Center for lung Research (DZL), Heidelberg, Germany
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Talissa A Altes
- Department of Radiology, University of Missouri, Columbia, MO, USA
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9
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[Assessment of lung impairment in patients with cystic fibrosis : Novel magnetic resonance imaging methods]. Radiologe 2020; 60:823-830. [PMID: 32776240 DOI: 10.1007/s00117-020-00730-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE The differentiated assessment of respiratory mechanics, gas exchange and pulmonary circulation, as well as structural impairment of the lung are essential for the treatment of patients with cystic fibrosis (CF). Clinical lung function measurements are often not sufficiently specific and are often difficult to perform. STANDARD RADIOLOGICAL METHODS The standard procedures for pulmonary imaging are chest X‑ray and computed tomography (CT) for assessing lung morphology. In more recent studies, an increasing number of centers are using magnetic resonance imaging (MRI) to assess lung structure and function. However, functional imaging is currently limited to specialized centers. METHODOLOGICAL INNOVATIONS In patients with CF, studies showed that MRI with hyperpolarized gases and Fourier decomposition/matrix pencil MRI (FD/MP-MRI) are feasible for assessing pulmonary ventilation. For pulmonary perfusion, dynamic contrast-enhanced MRI (DCE-MRI) or contrast-free methods, e.g., FD-MRI, can be used. PERFORMANCE Functional MRI provides more accurate insight into the pathophysiology of pulmonary function at the regional level. Advantages of MRI over X‑ray are its lack of ionizing radiation, the large number of lung function parameters that can be extracted using different contrast mechanisms, and ability to be used repeatedly over time. ACHIEVEMENTS Early assessment of lung function impairment is needed as the structural changes usually occur later in the course of the disease. However, sufficient experience in clinical application exist only for certain functional lung MRI procedures. PRACTICAL RECOMMENDATIONS Clinical application of the aforementioned techniques, except for DCE-MRI, should be restricted to scientific studies.
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Smith LJ, Horsley A, Bray J, Hughes PJC, Biancardi A, Norquay G, Wildman M, West N, Marshall H, Wild JM. The assessment of short and long term changes in lung function in CF using 129Xe MRI. Eur Respir J 2020; 56:2000441. [PMID: 32631840 DOI: 10.1183/13993003.00441-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/29/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION 129Xe ventilation MRI is sensitive to detect early CF lung disease and response to treatment. 129Xe-MRI could play a significant role in clinical trials and patient management. Here we present data on the repeatability of imaging measurements and their sensitivity to longitudinal change. METHODS 29 children and adults with CF and a range of disease severity were assessed twice, a median [IQR] of 16.0 [14.4,19.5] months apart. Patients performed 129Xe-MRI, lung clearance index (LCI), body plethysmography and spirometry at both visits. Eleven patients repeated 129Xe-MRI in the same session to assess the within-visit repeatability. The ventilation defect percentage (VDP) was the primary metric calculated from 129Xe-MRI. RESULTS At baseline, mean (sd) age=23.0 (11.1) years and FEV1 z-score=-2.2 (2.0). Median [IQR] VDP=9.5 [3.4,31.6]%, LCI=9.0 [7.7,13.7]. Within-visit and inter-visit repeatability of VDP was high. At 16 months there was no single trend of 129Xe-MRI disease progression. Visible 129Xe-MRI ventilation changes were common, which reflected changes in VDP. Based on the within-visit repeatability, a significant short-term change in VDP is >±1.6%. For longer-term follow up, changes in VDP of up to ±7.7% can be expected, or ±4.1% for patients with normal FEV1. No patient had a significant change in FEV1, however 59% had change in VDP >±1.6%. In patients with normal FEV1, there were significant changes in ventilation and in VDP. CONCLUSIONS 129Xe-MRI is a highly effective method for assessing longitudinal lung disease in patients with CF. VDP has great potential as a sensitive clinical outcome measure of lung function and endpoint for clinical trials.
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Affiliation(s)
- Laurie J Smith
- POLARIS, Imaging Sciences, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Alex Horsley
- POLARIS, Imaging Sciences, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Respiratory Research Group, Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Jody Bray
- POLARIS, Imaging Sciences, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- POLARIS, Imaging Sciences, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alberto Biancardi
- POLARIS, Imaging Sciences, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Graham Norquay
- POLARIS, Imaging Sciences, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Martin Wildman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Noreen West
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Helen Marshall
- POLARIS, Imaging Sciences, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M Wild
- POLARIS, Imaging Sciences, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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11
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Meerburg JJ, Veerman GDM, Aliberti S, Tiddens HAWM. Diagnosis and quantification of bronchiectasis using computed tomography or magnetic resonance imaging: A systematic review. Respir Med 2020; 170:105954. [PMID: 32843159 DOI: 10.1016/j.rmed.2020.105954] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bronchiectasis is an irreversible dilatation of the airways caused by inflammation and infection. To diagnose bronchiectasis in clinical care and to use bronchiectasis as outcome parameter in clinical trials, a radiological definition with exact cut-off values along with image analysis methods to assess its severity are needed. The aim of this study was to review diagnostic criteria and quantification methods for bronchiectasis. METHODS A systematic literature search was performed using Embase, Medline Ovid, Web of Science, Cochrane and Google Scholar. English written, clinical studies that included bronchiectasis as outcome measure and used image quantification methods were selected. Criteria for bronchiectasis, quantification methods, patient demographics, and data on image acquisition were extracted. RESULTS We screened 4182 abstracts, selected 972 full texts, and included 122 studies. The most often used criterion for bronchiectasis was an inner airway-artery ratio ≥1.0 (42%), however no validation studies for this cut-off value were found. Importantly, studies showed that airway-artery ratios are influenced by age. To quantify bronchiectasis, 42 different scoring methods were described. CONCLUSION Different diagnostic criteria for bronchiectasis are being used, but no validation studies were found to support these criteria. To use bronchiectasis as outcome in future studies, validated and age-specific cut-off values are needed.
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Affiliation(s)
- Jennifer J Meerburg
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre -Sophia Children's Hospital, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands.
| | - G D Marijn Veerman
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Centre, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands.
| | - Stefano Aliberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Adult Cystic Fibrosis Center, Dept of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre -Sophia Children's Hospital, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Centre, Wytemaweg 80, 3015CN, Rotterdam, the Netherlands.
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12
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Pennati F, Salito C, Borzani I, Cervellin G, Gambazza S, Guarise R, Russo MC, Colombo C, Aliverti A. Quantitative multivolume proton-magnetic resonance imaging in patients with cystic fibrosis lung disease: comparison with clinical indicators. Eur Respir J 2019; 53:13993003.02020-2017. [PMID: 30819810 DOI: 10.1183/13993003.02020-2017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/03/2019] [Indexed: 11/05/2022]
Abstract
This cross-sectional study aims to verify the relationship between quantitative multivolume proton-magnetic resonance imaging (1H-MRI) and clinical indicators of ventilatory abnormalities in cystic fibrosis (CF) lung disease.Non-enhanced chest MRI, spirometry and multiple breath washout was performed by 28 patients (10-27 years) with CF lung disease. Images acquired at end-inspiration and end-expiration were registered by optical flow to estimate expiratory-inspiratory proton-density change (Δ1H-MRI) as a measure of regional ventilation. Magnetic resonance images were also evaluated using a CF-specific scoring system.Biomarkers of CF ventilation impairment were defined from the Δ1H-MRI as follows: Δ1H-MRI median, Δ1H-MRI quartile coefficient of variation (QCV) and percentage of low-ventilation volume (%LVV). Imaging biomarkers correlated to all the clinical measures of ventilation abnormality, with the strongest correlation between Δ1H-MRI median and forced expiratory volume in 1 s (r2=0.44, p<0.001), Δ1H-MRI QCV and lung clearance index (LCI) (r2=0.51, p<0.001) and %LVV and LCI (r2=0.66, p<0.001). Correlations were also found between imaging biomarkers of ventilation and morphological scoring.The study showed a significant correlation between quantitative multivolume MRI and clinical indicators of CF lung disease. MRI, as a non-ionising imaging technique, may be particularly attractive in CF care for longitudinal evaluation, providing a new imaging biomarker to detect early ventilatory abnormalities.
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Affiliation(s)
- Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Caterina Salito
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Irene Borzani
- Radiologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Cervellin
- Radiologia Pediatrica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Gambazza
- U.O.C. Direzione Professioni Sanitarie, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Guarise
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Chiara Russo
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carla Colombo
- Cystic Fibrosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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13
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A Model for Predicting Future FEV1 Decline in Smokers Using Hyperpolarized 3He Magnetic Resonance Imaging. Acad Radiol 2019; 26:383-394. [PMID: 30087068 DOI: 10.1016/j.acra.2018.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 01/19/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to assess the effectiveness of hyperpolarized helium-3 magnetic resonance (MR)-based imaging markers in predicting future forced expiratory volume in one second decline/chronic obstructive pulmonary disorder progression in smokers compared to current diagnostic techniques. MATERIALS AND METHODS Total 60 subjects (15 nonsmokers and 45 smokers) participated in both baseline and follow-up visits (∼1.4 years apart). At both visits, subjects completed pulmonary function testing, a six-minute walk test , and the St. George Respiratory Questionnaire. Using helium-3 MR imaging, means (M) and standard deviations (H) of oxygen tension (PAO2), fractional ventilation, and apparent diffusion coefficient were calculated across 12 regions of interest in the lungs. Subjects who experienced FEV1 decline >100 mL/year were deemed "decliners," while those who did not were deemed "sustainers." Nonimaging and imaging prediction models were generated through a logistic regression model, which utilized measurements from sustainers and decliners. RESULTS The nonimaging prediction model included the St. George Respiratory Questionnaire total score, diffusing capacity of carbon monoxide by the alveolar volume (DLCO/VA), and distance walked in a six-minute walk test. A receiving operating character curve for this model yielded a sensitivity of 75% and specificity of 68% with an overall area under the curve of 65%. The imaging prediction model generated following the same methodology included ADCH, FVH, and PAO2H. The resulting receiving operating character curve yielded a sensitivity of 87.5%, specificity of 82.8%, and an area under the curve of 89.7%. CONCLUSION The imaging predication model generated from measurements obtained during 3He MR imaging is better able to predict future FEV1 decline compared to one based on current clinical tests and demographics. The imaging model's superiority appears to arise from its ability to distinguish well-circumscribed, severe disease from a more uniform distribution of moderately altered lung function, which is more closely associated with subsequent FEV1 decline.
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14
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Navaratnam V, Forrester DL, Eg KP, Chang AB. Paediatric and adult bronchiectasis: Monitoring, cross-infection, role of multidisciplinary teams and self-management plans. Respirology 2018; 24:115-126. [PMID: 30500093 DOI: 10.1111/resp.13451] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/29/2018] [Accepted: 11/05/2018] [Indexed: 01/21/2023]
Abstract
Bronchiectasis is a chronic lung disease associated with structurally abnormal bronchi, clinically manifested by a persistent wet/productive cough, airway infections and recurrent exacerbations. Early identification and treatment of acute exacerbations is an integral part of monitoring and annual review, in both adults and children, to minimize further damage due to infection and inflammation. Common modalities used to monitor disease progression include clinical signs and symptoms, frequency of exacerbations and/or number of hospital admissions, lung function (forced expiratory volume in 1 s (FEV1 )% predicted), imaging (radiological severity of disease) and sputum microbiology (chronic infection with Pseudomonas aeruginosa). There is good evidence that these monitoring tools can be used to accurately assess severity of disease and predict prognosis in terms of mortality and future hospitalization. Other tools that are currently used in research settings such as health-related quality of life (QoL) questionnaires, magnetic resonance imaging and lung clearance index can be burdensome and require additional expertise or resource, which limits their use in clinical practice. Studies have demonstrated that cross-infection, especially with P. aeruginosa between patients with bronchiectasis is possible but infrequent. This should not limit participation of patients in group activities such as pulmonary rehabilitation, and simple infection control measures should be carried out to limit the risk of cross-transmission. A multidisciplinary approach to care which includes respiratory physicians, chest physiotherapists, nurse specialists and other allied health professionals are vital in providing holistic care. Patient education and personalized self-management plans are also important despite limited evidence it improves QoL or frequency of exacerbations.
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Affiliation(s)
- Vidya Navaratnam
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Douglas L Forrester
- Department of Respiratory Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Kah Peng Eg
- Respiratory and Sleep Unit, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia.,Department of Respiratory and Sleep Medicine, Children's Health Queensland, Queensland University of Technology, Brisbane, QLD, Australia
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15
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Smith LJ, Collier GJ, Marshall H, Hughes PJ, Biancardi AM, Wildman M, Aldag I, West N, Horsley A, Wild JM. Patterns of regional lung physiology in cystic fibrosis using ventilation magnetic resonance imaging and multiple-breath washout. Eur Respir J 2018; 52:13993003.00821-2018. [DOI: 10.1183/13993003.00821-2018] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/10/2018] [Indexed: 11/05/2022]
Abstract
Hyperpolarised helium-3 (3He) ventilation magnetic resonance imaging (MRI) and multiple-breath washout (MBW) are sensitive methods for detecting lung disease in cystic fibrosis (CF). We aimed to explore their relationship across a broad range of CF disease severity and patient age, as well as assess the effect of inhaled lung volume on ventilation distribution.32 children and adults with CF underwent MBW and 3He-MRI at a lung volume of end-inspiratory tidal volume (EIVT). In addition, 28 patients performed 3He-MRI at total lung capacity. 3He-MRI scans were quantitatively analysed for ventilation defect percentage (VDP), ventilation heterogeneity index (VHI) and the number and size of individual contiguous ventilation defects. From MBW, the lung clearance index, convection-dependent ventilation heterogeneity (Scond) and convection–diffusion-dependent ventilation heterogeneity (Sacin) were calculated.VDP and VHI at EIVT strongly correlated with lung clearance index (r=0.89 and r=0.88, respectively), Sacin (r=0.84 and r=0.82, respectively) and forced expiratory volume in 1 s (FEV1) (r=−0.79 and r=−0.78, respectively). Two distinct 3He-MRI patterns were highlighted: patients with abnormal FEV1 had significantly (p<0.001) larger, but fewer, contiguous defects than those with normal FEV1, who tended to have numerous small volume defects. These two MRI patterns were delineated by a VDP of ∼10%. At total lung capacity, when compared to EIVT, VDP and VHI reduced in all subjects (p<0.001), demonstrating improved ventilation distribution and regions of volume-reversible and nonreversible ventilation abnormalities.
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16
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Breuer O, Caudri D, Stick S, Turkovic L. Predicting disease progression in cystic fibrosis. Expert Rev Respir Med 2018; 12:905-917. [PMID: 30173593 DOI: 10.1080/17476348.2018.1519400] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Progressive lung disease is the major cause of morbidity and mortality in patients with cystic fibrosis (CF). Methods of correctly predicting the future progression of lung disease in patients with CF are essential for directing aggressive treatment to prevent loss of lung function and end stage respiratory failure. Areas covered: This review addresses predictors of respiratory disease progression in patients with CF. We searched Web of Science and Medline, with no restriction on publication date, with the search terms 'cystic fibrosis' and 'disease progression', 'lung function decline', 'prognosis', 'prediction/predictive', 'prediction/prognostic scores', 'risk factors', 'outcome measures/endpoints/disease surrogate', 'longitudinal/long term', 'statistical model', and 'survival'. Expert commentary: Forced expiratory volume in 1 sec (FEV1) and rate of FEV1 decline, remain the most significant predictors of mortality in patients with CF while CT scores and airway secretion biomarkers are the main predictors of early CF lung disease. Comprehensive scores incorporating clinical, lung function, imaging and laboratory data will become essential in the future for predicting disease progression and for use in clinical trials. Early interventions may delay the progression of structural lung disease.
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Affiliation(s)
- Oded Breuer
- a Telethon Kids Institute , University of Western Australia , Perth , Australia.,b Department of Respiratory and Sleep Medicine , Princess Margaret Hospital for Children , Perth , Australia
| | - Daan Caudri
- a Telethon Kids Institute , University of Western Australia , Perth , Australia.,b Department of Respiratory and Sleep Medicine , Princess Margaret Hospital for Children , Perth , Australia.,c Department of Pediatrics/Respiratory Medicine , Erasmus MC , Rotterdam , The Netherlands
| | - Stephen Stick
- a Telethon Kids Institute , University of Western Australia , Perth , Australia.,b Department of Respiratory and Sleep Medicine , Princess Margaret Hospital for Children , Perth , Australia
| | - Lidija Turkovic
- a Telethon Kids Institute , University of Western Australia , Perth , Australia
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17
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Verbanck S, King GG, Zhou W, Miller A, Thamrin C, Schuermans D, Ilsen B, Ernst CW, de Mey J, Vincken W, Vanderhelst E. The quantitative link of lung clearance index to bronchial segments affected by bronchiectasis. Thorax 2017; 73:82-84. [PMID: 28866642 DOI: 10.1136/thoraxjnl-2017-210496] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/14/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
In adult patients with cystic fibrosis (CF), the lung clearance index (LCI) derived from the multiple breath washout relates to both acinar and conductive ventilation heterogeneity. The latter component predicts an association between LCI and the number of bronchial segments affected by bronchiectasis. Here, we experimentally demonstrated this association in patients with CF, and also examined an ancillary group of patients with non-CF bronchiectasis. We conclude that lung disease severity in terms of number of bronchial segments results in an associated LCI increase, likely constituting a portion of LCI that cannot be reversed by treatment in patients with CF lung disease.
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Affiliation(s)
- Sylvia Verbanck
- Respiratory Division, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Gregory G King
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Wenxiao Zhou
- Department of Radiology and Nuclear Medicine, North Shore Hospital, Sydney, New South Wales, Australia
| | - Anne Miller
- Department of Radiology and Nuclear Medicine, North Shore Hospital, Sydney, New South Wales, Australia
| | - Cindy Thamrin
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel Schuermans
- Respiratory Division, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Bart Ilsen
- Department of Radiology, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline W Ernst
- Department of Radiology, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Walter Vincken
- Respiratory Division, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - Eef Vanderhelst
- Respiratory Division, University Hospital UZBrussel, Vrije Universiteit Brussel, Brussel, Belgium
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18
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Altes TA, Meyer CH, Mata JF, Froh DK, Paget-Brown A, Gerald Teague W, Fain SB, de Lange EE, Ruppert K, Botfield MC, Johnson MA, Mugler JP. Hyperpolarized helium-3 magnetic resonance lung imaging of non-sedated infants and young children: a proof-of-concept study. Clin Imaging 2017. [DOI: 10.1016/j.clinimag.2017.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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19
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Hyperpolarized Gas Magnetic Resonance Lung Imaging in Children and Young Adults. J Thorac Imaging 2017; 31:285-95. [PMID: 27428024 DOI: 10.1097/rti.0000000000000218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The assessment of early pulmonary disease and its severity can be difficult in young children, as procedures such as spirometry cannot be performed on them. Computed tomography provides detailed structural images of the pulmonary parenchyma, but its major drawback is that the patient is exposed to ionizing radiation. In this context, magnetic resonance imaging (MRI) is a promising technique for the evaluation of pediatric lung disease, especially when serial imaging is needed. Traditionally, MRI played a small role in evaluating the pulmonary parenchyma. Because of its low proton density, the lungs display low signal intensity on conventional proton-based MRI. Hyperpolarized (HP) gases are inhaled contrast agents with an excellent safety profile and provide high signal within the lung, allowing for high temporal and spatial resolution imaging of the lung airspaces. Besides morphologic information, HP MR images also offer valuable information about pulmonary physiology. HP gas MRI has already made new contributions to the understanding of pediatric lung diseases and may become a clinically useful tool. In this article, we discuss the HP gas MRI technique, special considerations that need to be made when imaging children, and the role of MRI in 2 of the most common chronic pediatric lung diseases, asthma and cystic fibrosis. We also will discuss how HP gas MRI may be used to evaluate normal lung growth and development and the alterations occurring in chronic lung disease of prematurity and in patients with a congenital diaphragmatic hernia.
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20
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Kołodziej M, de Veer MJ, Cholewa M, Egan GF, Thompson BR. Lung function imaging methods in Cystic Fibrosis pulmonary disease. Respir Res 2017; 18:96. [PMID: 28514950 PMCID: PMC5436457 DOI: 10.1186/s12931-017-0578-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/09/2017] [Indexed: 01/02/2023] Open
Abstract
Monitoring of pulmonary physiology is fundamental to the clinical management of patients with Cystic Fibrosis. The current standard clinical practise uses spirometry to assess lung function which delivers a clinically relevant functional readout of total lung function, however does not supply any visible or localised information. High Resolution Computed Tomography (HRCT) is a well-established current 'gold standard' method for monitoring lung anatomical changes in Cystic Fibrosis patients. HRCT provides excellent morphological information, however, the X-ray radiation dose can become significant if multiple scans are required to monitor chronic diseases such as cystic fibrosis. X-ray phase-contrast imaging is another emerging X-ray based methodology for Cystic Fibrosis lung assessment which provides dynamic morphological and functional information, albeit with even higher X-ray doses than HRCT. Magnetic Resonance Imaging (MRI) is a non-ionising radiation imaging method that is garnering growing interest among researchers and clinicians working with Cystic Fibrosis patients. Recent advances in MRI have opened up the possibilities to observe lung function in real time to potentially allow sensitive and accurate assessment of disease progression. The use of hyperpolarized gas or non-contrast enhanced MRI can be tailored to clinical needs. While MRI offers significant promise it still suffers from poor spatial resolution and the development of an objective scoring system especially for ventilation assessment.
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Affiliation(s)
- Magdalena Kołodziej
- Monash Biomedical Imaging, Monash University, Melbourne, 3800 Australia
- Institute of Nursing and Health Sciences, Medical Faculty, University of Rzeszow, 35-959 Rzeszow, Poland
| | | | - Marian Cholewa
- Department of Biophysics, Faculty of Mathematics and Natural Sciences, University of Rzeszow, 35-959 Rzeszow, Poland
| | - Gary F. Egan
- Monash Biomedical Imaging, Monash University, Melbourne, 3800 Australia
| | - Bruce R. Thompson
- Department of Medicine, Monash University, Melbourne, 3800 Australia
- Physiology Service, Allergy Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, 3800 Australia
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21
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Use of hyperpolarized helium-3 MRI to assess response to ivacaftor treatment in patients with cystic fibrosis. J Cyst Fibros 2017; 16:267-274. [DOI: 10.1016/j.jcf.2016.12.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/02/2016] [Accepted: 12/03/2016] [Indexed: 11/23/2022]
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22
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Walkup LL, Thomen RP, Akinyi T, Watters E, Ruppert K, Clancy JP, Woods JC, Cleveland ZI. Feasibility, tolerability and safety of pediatric hyperpolarized 129Xe magnetic resonance imaging in healthy volunteers and children with cystic fibrosis. Pediatr Radiol 2016; 46:1651-1662. [PMID: 27492388 PMCID: PMC5083137 DOI: 10.1007/s00247-016-3672-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/05/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hyperpolarized 129Xe is a promising contrast agent for MRI of pediatric lung function, but its safety and tolerability in children have not been rigorously assessed. OBJECTIVE To assess the feasibility, safety and tolerability of hyperpolarized 129Xe gas as an inhaled contrast agent for pediatric pulmonary MRI in healthy control subjects and in children with cystic fibrosis. MATERIALS AND METHODS Seventeen healthy control subjects (ages 6-15 years, 11 boys) and 11 children with cystic fibrosis (ages 8-16 years, 4 boys) underwent 129Xe MRI, receiving up to three doses of 129Xe gas prepared by either a commercially available or a homebuilt 129Xe polarizer. Subject heart rate and SpO2 were monitored for 2 min post inhalation and compared to resting baseline values. Adverse events were reported via follow-up phone call at days 1 and 30 (range ±7 days) post-MRI. RESULTS All children tolerated multiple doses of 129Xe, and no children withdrew from the study. Relative to baseline, most children who received a full dose of gas for imaging (10 of 12 controls and 8 of 11 children with cystic fibrosis) experienced a nadir in SpO2 (mean -6.0 ± standard deviation 7.2%, P≤0.001); however within 2 min post inhalation SpO2 values showed no significant difference from baseline (P=0.11). There was a slight elevation in heart rate (mean +6.6 ± 13.9 beats per minute [bpm], P=0.021), which returned from baseline within 2 min post inhalation (P=0.35). Brief side effects related to the anesthetic properties of xenon were mild and quickly resolved without intervention. No serious or severe adverse events were observed; in total, four minor adverse events (14.3%) were reported following 129Xe MRI, but all were deemed unrelated to the study. CONCLUSION The feasibility, safety and tolerability of 129Xe MRI has been assessed in a small group of children as young as 6 years. SpO2 changes were consistent with the expected physiological effects of a short anoxic breath-hold, and other mild side effects were consistent with the known anesthetic properties of xenon and with previous safety assessments of 129Xe MRI in adults. Hyperpolarized 129Xe is a safe and well-tolerated inhaled contrast agent for pulmonary MR imaging in healthy children and in children with cystic fibrosis who have mild to moderate lung disease.
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Affiliation(s)
- Laura L. Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA
| | - Robert P. Thomen
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA,Department of Physics, Washington University in St. Louis, St. Louis, MO, USA
| | - Teckla Akinyi
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA,Biomedical Engineering Program, University of Cincinnati, Cincinnati, OH, USA
| | - Erin Watters
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA
| | - Kai Ruppert
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA
| | - John P. Clancy
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA,Department of Physics, Washington University in St. Louis, St. Louis, MO, USA
| | - Zackary I. Cleveland
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., MLC 5033, Cincinnati, OH 45229, USA,Biomedical Engineering Program, University of Cincinnati, Cincinnati, OH, USA
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23
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Stewart NJ, Parra-Robles J, Wild JM. Finite element modeling of (129)Xe diffusive gas exchange NMR in the human alveoli. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2016; 271:21-33. [PMID: 27526397 DOI: 10.1016/j.jmr.2016.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/18/2016] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Abstract
Existing models of (129)Xe diffusive exchange for lung microstructural modeling with time-resolved MR spectroscopy data have considered analytical solutions to one-dimensional, homogeneous models of the lungs with specific assumptions about the alveolar geometry. In order to establish a model system for simulating the effects of physiologically-realistic changes in physical and microstructural parameters on (129)Xe exchange NMR, we have developed a 3D alveolar capillary model for finite element analysis. To account for the heterogeneity of the alveolar geometry across the lungs, we have derived realistic geometries for finite element analysis based on 2D histological samples and 3D micro-CT image volumes obtained from ex vivo biopsies of lung tissue from normal subjects and patients with interstitial lung disease. The 3D alveolar capillary model permits investigation of the impact of alveolar geometrical parameters and diffusion and perfusion coefficients on the in vivo measured (129)Xe CSSR signal response. The heterogeneity of alveolar microstructure that is accounted for in image-based models resulted in considerable alterations to the shape of the (129)Xe diffusive uptake curve when compared to 1D models. Our findings have important implications for the future design and optimization of (129)Xe MR experiments and in the interpretation of lung microstructural changes from this data.
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Affiliation(s)
- Neil J Stewart
- POLARIS, Academic Unit of Radiology, University of Sheffield, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Juan Parra-Robles
- POLARIS, Academic Unit of Radiology, University of Sheffield, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Jim M Wild
- POLARIS, Academic Unit of Radiology, University of Sheffield, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
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24
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Thomen RP, Walkup LL, Roach DJ, Cleveland ZI, Clancy JP, Woods JC. Hyperpolarized 129Xe for investigation of mild cystic fibrosis lung disease in pediatric patients. J Cyst Fibros 2016; 16:275-282. [PMID: 27477942 DOI: 10.1016/j.jcf.2016.07.008] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic disease which carries high morbidity and mortality from lung-function decline. Monitoring disease progression and treatment response in young patients is desirable, but serial imaging via CT is often considered prohibitive, and detailed functional information cannot be obtained using conventional imaging techniques. Hyperpolarized 129Xe magnetic resonance imaging (MRI) can depict and quantify regional ventilation, but has not been investigated in pediatrics. We hypothesized that 129Xe MRI is feasible and would demonstrate ventilation defects in mild CF lung disease with greater sensitivity than FEV1. METHODS 11 healthy controls (age 6-16years) and 11 patients with mild CF (age 8-16years, Forced Expiratory Volume (FEV1) percent predicted >70%) were recruited for this study. Nine CF patients had an FEV1>85%. Each subject was imaged via hyperpolarized 129Xe MRI, and the ventilation defect percentage (VDP) was measured. FEV1 and VDP were compared between the groups. RESULTS FEV1 for controls was 100.3%±8.5% (mean±sd) and for CF patients was 97.9%±16.0% (p=0.67). VDP was 6.4%±2.8% for controls and 18.3%±8.6% for CF (p<0.001). When considering the 9 CF patients with normal FEV1 (>85%), the mean FEV1 was 103.1%±12.3% (p=0.57 compared to controls) and VDP was 15.4%±6.3% (p=0.002). CONCLUSIONS Hyperpolarized 129Xe MRI demonstrated ventilation defects in CF patients with normal FEV1 and more effectively discriminated CF from controls than FEV1. Thus 129Xe may be a useful outcome measure to detect mild CF lung disease, to investigate regional lung function in pediatric lung diseases, and to follow disease progression.
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Affiliation(s)
- Robert P Thomen
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Physics, Washington University in St. Louis, St. Louis, MO, United States
| | - Laura L Walkup
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - David J Roach
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Zackary I Cleveland
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - John P Clancy
- Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, OH, United States
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Physics, Washington University in St. Louis, St. Louis, MO, United States; Division of Pulmonary Medicine, Cincinnati Children's Hospital, Cincinnati, OH, United States.
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25
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Roos JE, McAdams HP, Kaushik SS, Driehuys B. Hyperpolarized Gas MR Imaging: Technique and Applications. Magn Reson Imaging Clin N Am 2016; 23:217-29. [PMID: 25952516 DOI: 10.1016/j.mric.2015.01.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional imaging offers information more sensitive to changes in lung structure and function. Hyperpolarized helium ((3)He) and xenon ((129)Xe) MR imaging of the lungs provides sensitive contrast mechanisms to probe changes in pulmonary ventilation, microstructure, and gas exchange. Gas imaging has shifted to the use of (129)Xe. Xenon is well-tolerated. (129)Xe is soluble in pulmonary tissue, which allows exploring specific lung function characteristics involved in gas exchange and alveolar oxygenation. Hyperpolarized gases and (129)Xe in particular stand to be an excellent probe of pulmonary structure and function, and provide sensitive and noninvasive biomarkers for pulmonary diseases.
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Affiliation(s)
- Justus E Roos
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
| | - Holman P McAdams
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| | - S Sivaram Kaushik
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
| | - Bastiaan Driehuys
- Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
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26
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Kirby M, Lane P, Coxson HO. Measurement of pulmonary structure and function. IMAGING 2016. [DOI: 10.1183/2312508x.10003415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tepper LA, Ciet P, Caudri D, Quittner AL, Utens EMWJ, Tiddens HAWM. Validating chest MRI to detect and monitor cystic fibrosis lung disease in a pediatric cohort. Pediatr Pulmonol 2016; 51:34-41. [PMID: 26436668 DOI: 10.1002/ppul.23328] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 08/20/2015] [Accepted: 09/18/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Computed Tomography (CT) is the gold standard to assess bronchiectasis and trapped air in cystic fibrosis (CF) lung disease, but has the disadvantage of radiation exposure. Magnetic Resonance Imaging (MRI) is a radiation free alternative. OBJECTIVE To validate MRI as outcome measure by: correlating MRI scores for bronchiectasis and trapped air with clinical parameters, and by comparing those MRI scores with CT scores. METHODS In patients with CF (aged 5.6-17.4 years), MRI and CT were alternated annually during routine annual check-ups between July 2007 and January 2010. Twenty-three children had an MRI performed 1 year prior to CT, 34 children had a CT 1 year prior to MRI. Bronchiectasis and trapped air were scored using the CF-MRI and CF-CT scoring system. CF-MRI scores were correlated with clinical parameters: FEV1 , Pseudomonas aeruginosa, pulmonary exacerbations and patient-reported respiratory symptoms measured on the Cystic Fibrosis Questionnaire-Revised (CFQ-R), using Spearman's correlation coefficient. MRI and CT scores were compared using intra-class correlation coefficients (ICC) and Bland-Altman plots. RESULTS Fifty-seven patients who had an MRI, CT and CFQ-R during the study period were included. CF-MRI bronchiectasis correlated with FEV1 , Pseudomonas aeruginosa, pulmonary exacerbations and patient-reported respiratory symptoms. CF-MRI trapped air only correlated with FEV1 and Pseudomonas aeruginosa. ICCs between MRI and CT bronchiectasis and trapped air were 0.41 and 0.35 respectively. MRI tended to overestimate bronchiectasis compared to CT. CONCLUSION The associations between CF-MRI scores and several important clinical parameters further contributes to the validation of MRI. MRI provides different information than CT.
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Affiliation(s)
- Leonie A Tepper
- Department of Pediatric Pulmonology, Erasmus Medical Centre (MC)/Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Department of Pediatric Pulmonology, Erasmus Medical Centre (MC)/Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Daan Caudri
- Department of Pediatric Pulmonology, Erasmus Medical Centre (MC)/Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Alexandra L Quittner
- Departments of Psychology and Pediatrics, University of Miami, Coral Gables, Florida
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus MC/ Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Pediatric Pulmonology, Erasmus Medical Centre (MC)/Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands
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28
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Walkup LL, Woods JC. Advances in Imaging Cystic Fibrosis Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:220-229. [DOI: 10.1089/ped.2015.0588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Laura L. Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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29
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Pittman JE. Assessment and Detection of Early Lung Disease in Cystic Fibrosis. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:212-219. [DOI: 10.1089/ped.2015.0568] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jessica E. Pittman
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, Saint Louis, Missouri
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Ventilation heterogeneity and the benefits and challenges of multiple breath washout testing in patients with cystic fibrosis. Paediatr Respir Rev 2015; 16 Suppl 1:15-8. [PMID: 26420586 DOI: 10.1016/j.prrv.2015.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Multiple breath inert gas washout tests offer a simple and non-invasive method of measuring the effects of peripheral airway disease on ventilation efficiency, and have been the subject of intense research and commercial interest in the last decade. Although highly sensitive, these tests are not specific to disease in the small airways and are not suited to all patients with cystic fibrosis. They are harder to perform in subjects with more severe lung disease, with longer test time and poorer reproducibility in this population. The clinical advantages are more obvious in those with milder airways disease, where they are more sensitive to early changes than spirometry. In this population they are also quicker to complete and reproducible. A particular advantage in children is a stable range of normal which does not change during adolescence. Different inert gases give different washout results, and the technology to measure MBW is itself still evolving. Newer technologies such as hyperpolarised gas MRI are now helping us to understand how disease-related changes in lung ventilation influences inert gas washout.
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31
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Flors L, Altes T, Mugler J, de Lange E, Miller G, Mata J, Ruset I, Hersman F. New insights into lung diseases using hyperpolarized gas MRI. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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New insights into lung diseases using hyperpolarized gas MRI. RADIOLOGIA 2015; 57:303-13. [PMID: 25747807 DOI: 10.1016/j.rx.2014.12.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/23/2014] [Accepted: 12/28/2014] [Indexed: 11/23/2022]
Abstract
Hyperpolarized (HP) gases are a new class of contrast agents that permit to obtain high temporal and spatial resolution magnetic resonance images (MRI) of the lung airspaces. HP gas MRI has become important research tool not only for morphological and functional evaluation of normal pulmonary physiology but also for regional quantification of pathologic changes occurring in several lung diseases. The purpose of this work is to provide an introduction to MRI using HP noble gases, describing both the basic principles of the technique and the new information about lung disease provided by clinical studies with this method. The applications of the technique in normal subjects, smoking related lung disease, asthma, and cystic fibrosis are reviewed.
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33
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Walkup LL, Woods JC. Translational applications of hyperpolarized 3He and 129Xe. NMR IN BIOMEDICINE 2014; 27:1429-1438. [PMID: 24953709 DOI: 10.1002/nbm.3151] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/07/2014] [Accepted: 05/19/2014] [Indexed: 06/03/2023]
Abstract
Clinical magnetic resonance imaging of the lung is technologically challenging, yet over the past two decades hyperpolarized noble gas ((3)He and (129)Xe) imaging has demonstrated the ability to measure multiple pulmonary functional biomarkers. There is a growing need for non-ionizing, non-invasive imaging techniques due to increased concern about cancer risk from ionizing radiation, but the translation of hyperpolarized gas imaging to the pulmonary clinic has been stunted by limited access to the technology. New developments may open doors to greater access and more translation to clinical studies. Here we briefly review a few translational applications of hyperpolarized gas MRI in the contexts of ventilation, diffusion, and dissolved-phase imaging, as well as comparing and contrasting (3)He and (129)Xe gases for these applications. Simple static ventilation MRI reveals regions of the lung not participating in normal ventilation, and these defects have been observed in many pulmonary diseases. Biomarkers related to airspace size and connectivity can be quantified by apparent diffusion coefficient measurements of hyperpolarized gas, and have been shown to be more sensitive to small changes in lung morphology than standard clinical pulmonary functional tests and have been validated by quantitative histology. Parameters related to gas uptake and exchange and lung tissue density can be determined using (129)Xe dissolved-phase MRI. In most cases functional biomarkers can be determined via MRI of either gas, but for some applications one gas may be preferred, such as (3)He for long-range diffusion measurements and (129)Xe for dissolved-phase imaging. Greater access to hyperpolarized gas imaging coupled with newly developing therapeutics makes pulmonary medicine poised for a potential revolution, further adding to the prospects of personalized medicine already evidenced by advancements in molecular biology. Hyperpolarized gas researchers have the opportunity to contribute to this revolution, particularly if greater clinical application of hyperpolarized gas imaging is realized.
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Affiliation(s)
- Laura L Walkup
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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34
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Santyr G, Fox M, Thind K, Hegarty E, Ouriadov A, Jensen M, Scholl TJ, Van Dyk J, Wong E. Anatomical, functional and metabolic imaging of radiation-induced lung injury using hyperpolarized MRI. NMR IN BIOMEDICINE 2014; 27:1515-1524. [PMID: 25156928 DOI: 10.1002/nbm.3180] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 07/02/2014] [Accepted: 07/08/2014] [Indexed: 06/03/2023]
Abstract
MRI of hyperpolarized (129)Xe gas and (13)C-enriched substrates (e.g. pyruvate) presents an unprecedented opportunity to map anatomical, functional and metabolic changes associated with lung injury. In particular, inhaled hyperpolarized (129)Xe gas is exquisitely sensitive to changes in alveolar microanatomy and function accompanying lung inflammation through decreases in the apparent diffusion coefficient (ADC) of alveolar gas and increases in the transfer time (T(tr)) of xenon exchange from the gas and into the dissolved phase in the lung. Furthermore, metabolic changes associated with hypoxia arising from lung injury may be reflected by increases in lactate-to-pyruvate signal ratio obtained by magnetic resonance spectroscopic imaging following injection of hyperpolarized [1-(13)C]pyruvate. In this work, the application of hyperpolarized (129)Xe and (13)C MRI to radiation-induced lung injury (RILI) is reviewed and results of ADC, T(tr) and lactate-to-pyruvate signal ratio changes in a rat model of RILI are summarized. These results are consistent with conventional functional (i.e. blood gases) and histological (i.e. tissue density) changes, and correlate significantly with inflammatory cell counts (i.e. macrophages). Hyperpolarized MRI may provide an earlier indication of lung injury associated with radiotherapy of thoracic tumors, potentially allowing adjustment of treatment before the onset of severe complications and irreversible fibrosis.
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Affiliation(s)
- Giles Santyr
- Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Medical Biophysics, Western University, London, Ontario, Canada; Department of Medical Imaging, Western University, London, Ontario, Canada; Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada
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35
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Horn FC, Tahir BA, Stewart NJ, Collier GJ, Norquay G, Leung G, Ireland RH, Parra-Robles J, Marshall H, Wild JM. Lung ventilation volumetry with same-breath acquisition of hyperpolarized gas and proton MRI. NMR IN BIOMEDICINE 2014; 27:1461-1467. [PMID: 25208220 DOI: 10.1002/nbm.3187] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 07/19/2014] [Accepted: 07/21/2014] [Indexed: 06/03/2023]
Abstract
The purpose of this work was to assess the reproducibility of percentage of ventilated lung volume (PV) measured from hyperpolarized (HP) (3)He and (1)H anatomical images acquired in the same breath-hold when compared with PV measured from (3)He and (1)H images from separate breath-holds. Volumetric (3)He ventilation and (1)H anatomical images of the same resolution were acquired during the same breath-hold. To assess reproducibility, this procedure was performed twice with a short gap between acquisitions. In addition, (1)H images were also acquired in a separate breath for comparison. PV ((3)He ventilated volume divided by (1)H total lung volume) was calculated using the single-breath-hold images (PV(single)) and the separate-breath-hold images (PV(separate)). Short-term reproducibility of PV measurement was assessed for both single- and separate-breath acquisitions. Dice similarity coefficients (DSCs) were calculated to quantify spatial overlap between (3)He and (1)H segmentations for the single- and separate-breath-hold acquisitions. The efficacy of using the separate-breath method combined with image registration was also assessed. The mean magnitude difference between the two sets of PV values (±standard deviation) was 1.49 ± 1.32% for PV(single) and 4.19 ± 4.10% for PV(separate), with a significant difference (p < 0.01). The mean magnitude difference between the two PV values for the registered separate-breath technique (PV(sep-registered)) was 2.27 ± 2.23%. Bland-Altman analysis showed that PV measured with single-breath acquisitions was more repeatable than PV measured with separate-breath acquisitions, regardless of image registration. DSC values were significantly greater (p < 0.01) for single-breath acquisition than for separate-breath acquisition. Acquisition of HP gas ventilation and (1)H anatomical images in a single breath-hold provides a more reproducible means of percentage lung ventilation volume measurement than the previously used separate-breath-hold scan approach, and reduces errors.
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Affiliation(s)
- F C Horn
- Academic Radiology, Department of Cardiovascular Sciences, University of Sheffield, UK
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36
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Horsley A, Siddiqui S. Putting lung function and physiology into perspective: cystic fibrosis in adults. Respirology 2014; 20:33-45. [PMID: 25219816 DOI: 10.1111/resp.12382] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
Adult cystic fibrosis (CF) is notable for the wide heterogeneity in severity of disease expression, both between patients and within the lungs of individuals. Although CF airways disease appears to start in the small airways, in adults there is typically widespread bronchiectasis, increased airway secretions, and extensive obstruction and inflammation of the small airways. The complexity and heterogeneity of airways disease in CF means that although there are many different methods of assessing and describing lung 'function', none of these single-dimensional tests is able to provide a comprehensive assessment of lung physiology across the spectrum seen in adult CF. The most widely described measure, the forced expiratory volume in 1 s, remains a useful and simple clinical tool, but is insensitive to early changes and may be dissociated from other more detailed assessments of disease severity such as computed tomography. In this review, we also discuss the use of more sensitive novel assessments such as multiple breath washout tests and impulse oscillometry, as well as the role of cardiopulmonary exercise testing. In the future, hyperpolarized gas magnetic resonance imaging techniques that combine regional structural and functional information may help us to better understand these measures, their applications and limitations.
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Affiliation(s)
- Alex Horsley
- Respiratory Research Group, Institute of Inflammation and Repair, University of Manchester, Manchester, UK; Manchester Adult Cystic Fibrosis Centre, North West Lung Centre, University Hospital of South Manchester, Manchester, UK
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Singh D, Bhalla AS, Veedu PT, Arora A. Imaging evaluation of hemoptysis in children. World J Clin Pediatr 2013; 2:54-64. [PMID: 25254175 PMCID: PMC4145653 DOI: 10.5409/wjcp.v2.i4.54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/04/2013] [Accepted: 10/16/2013] [Indexed: 02/06/2023] Open
Abstract
Hemoptysis is an uncommon but distressing symptom in children. It poses a diagnostic challenge as it is difficult to elicit a clear history and perform thorough physical examination in a child. The cause of hemoptysis in children can vary with the child's age. It can range from infection, milk protein allergy and congenital heart disease in early childhood, to vasculitis, bronchial tumor and bronchiectasis in older children. Acute lower respiratory tract infections are the most common cause of pediatric hemoptysis. The objective of imaging is to identify the source of bleeding, underlying primary cause, and serve as a roadmap for invasive procedures. Hemoptysis originates primarily from the bronchial arteries. The imaging modalities available for the diagnostic evaluation of hemoptysis include chest radiography, multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI) and catheter angiography. Chest radiography is the initial screening tool. It can help in lateralizing the bleeding with high degree of accuracy and can detect several parenchymal and pleural abnormalities. However, it may be normal in up to 30% cases. MDCT is a rapid, non-invasive multiplanar imaging modality. It aids in evaluation of hemoptysis by depiction of underlying disease, assessment of consequences of hemorrhage and provides panoramic view of the thoracic vasculature. The various structures which need to be assessed carefully include the pulmonary parenchyma, tracheobronchial tree, pulmonary arteries, bronchial arteries and non-bronchial systemic arteries. Since the use of MDCT entails radiation exposure, optimal low dose protocols should be used so as to keep radiation dose as low as reasonably achievable. MRI and catheter angiography have limited application.
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Abstract
A better understanding of the anatomic structure and physiological function of the lung is fundamental to understanding the pathogenesis of pulmonary disease and how to design and deliver better treatments and measure response to intervention. Magnetic resonance imaging (MRI) with the hyperpolarised noble gases helium-3 ((3)He) and xenon-129 ((129)Xe) provides both structural and functional pulmonary measurements, and because it does not require the use of x-rays or other ionising radiation, offers the potential for intensive serial and longitudinal studies in paediatric patients. These facts are particularly important in the evaluation of chronic lung diseases such as asthma and cystic fibrosis- both of which can be considered paediatric respiratory diseases with unmet therapy needs. This review discusses MRI-based imaging methods with a focus on hyperpolarised gas MRI. We also discuss the strengths and limitations as well as the future work required for clinical translation towards paediatric respiratory disease.
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Affiliation(s)
- Miranda Kirby
- Imaging Research Laboratories, Robarts Research Institute, London, Canada.
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Acinar and conductive ventilation heterogeneity in severe CF lung disease: Back to the model. Respir Physiol Neurobiol 2013; 188:124-32. [DOI: 10.1016/j.resp.2013.05.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 05/07/2013] [Accepted: 05/13/2013] [Indexed: 11/19/2022]
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Virgincar RS, Cleveland ZI, Kaushik SS, Freeman MS, Nouls J, Cofer GP, Martinez-Jimenez S, He M, Kraft M, Wolber J, McAdams HP, Driehuys B. Quantitative analysis of hyperpolarized 129Xe ventilation imaging in healthy volunteers and subjects with chronic obstructive pulmonary disease. NMR IN BIOMEDICINE 2013; 26:424-35. [PMID: 23065808 PMCID: PMC3624045 DOI: 10.1002/nbm.2880] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 05/12/2023]
Abstract
In this study, hyperpolarized (129) Xe MR ventilation and (1) H anatomical images were obtained from three subject groups: young healthy volunteers (HVs), subjects with chronic obstructive pulmonary disease (COPD) and age-matched controls (AMCs). Ventilation images were quantified by two methods: an expert reader-based ventilation defect score percentage (VDS%) and a semi-automated segmentation-based ventilation defect percentage (VDP). Reader-based values were assigned by two experienced radiologists and resolved by consensus. In the semi-automated analysis, (1) H anatomical images and (129) Xe ventilation images were both segmented following registration to obtain the thoracic cavity volume and ventilated volume, respectively, which were then expressed as a ratio to obtain the VDP. Ventilation images were also characterized by generating signal intensity histograms from voxels within the thoracic cavity volume, and heterogeneity was analyzed using the coefficient of variation (CV). The reader-based VDS% correlated strongly with the semi-automatically generated VDP (r = 0.97, p < 0.0001) and with CV (r = 0.82, p < 0.0001). Both (129) Xe ventilation defect scoring metrics readily separated the three groups from one another and correlated significantly with the forced expiratory volume in 1 s (FEV1 ) (VDS%: r = -0.78, p = 0.0002; VDP: r = -0.79, p = 0.0003; CV: r = -0.66, p = 0.0059) and other pulmonary function tests. In the healthy subject groups (HVs and AMCs), the prevalence of ventilation defects also increased with age (VDS%: r = 0.61, p = 0.0002; VDP: r = 0.63, p = 0.0002). Moreover, ventilation histograms and their associated CVs distinguished between subjects with COPD with similar ventilation defect scores, but visibly different ventilation patterns.
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Affiliation(s)
- Rohan S. Virgincar
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Zackary I. Cleveland
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - S. Sivaram Kaushik
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Matthew S. Freeman
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Medical Physics Graduate Program, Duke University, Durham, NC, USA
| | - John Nouls
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Gary P. Cofer
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | | | - Mu He
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Electrical and Computer Engineering, Duke University, Durham, NC, USA
| | - Monica Kraft
- Department of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Jan Wolber
- GE Healthcare, The Grove Center, White Lion Rd, Amersham, UK
- Academic Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
| | - H. Page McAdams
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
- Medical Physics Graduate Program, Duke University, Durham, NC, USA
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Semiautomatic segmentation of ventilated airspaces in healthy and asthmatic subjects using hyperpolarized 3He MRI. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:624683. [PMID: 23606904 PMCID: PMC3626384 DOI: 10.1155/2013/624683] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 01/25/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022]
Abstract
A segmentation algorithm to isolate areas of ventilation from hyperpolarized helium-3 magnetic resonance imaging (HP 3He MRI) is described. The algorithm was tested with HP 3He MRI data from four healthy and six asthmatic subjects. Ventilated lung volume (VLV) measured using our semiautomated technique was compared to that obtained from manual outlining of ventilated lung regions and to standard spirometric measurements. VLVs from both approaches were highly correlated (R = 0.99; P < 0.0001) with a mean difference of 3.8 mL and 95% agreement indices of −30.8 mL and 38.4 mL. There was no significant difference between the VLVs obtained through the semiautomatic approach and the manual approach. A Dice coefficient which quantified the intersection of the two datasets was calculated and ranged from 0.95 to 0.97 with a mean of 0.96 ± 0.01 (mean ± SD). VLVs obtained through the semiautomatic algorithm were also highly correlated with measurements of forced expiratory volume in one second (FEV1) (R = 0.82; P = 0.0035) and forced vital capacity (FVC) (R = 0.95; P < 0.0001). The technique may open new pathways toward advancing more quantitative characterization of ventilation for routine clinical assessment for asthma severity as well as a number of other respiratory diseases.
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Emami K, Xu Y, Hamedani H, Xin Y, Profka H, Rajaei J, Kadlecek S, Ishii M, Rizi RR. Multislice fractional ventilation imaging in large animals with hyperpolarized gas MRI. NMR IN BIOMEDICINE 2012; 25:1015-1025. [PMID: 22290603 PMCID: PMC3362674 DOI: 10.1002/nbm.2763] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 11/17/2011] [Accepted: 11/22/2011] [Indexed: 05/31/2023]
Abstract
The noninvasive assessment of regional lung ventilation is of critical importance in the quantification of the severity of disease and evaluation of response to therapy in many pulmonary diseases. This work presents, for the first time, the implementation of a hyperpolarized (HP) gas MRI technique to measure whole-lung regional fractional ventilation (r) in Yorkshire pigs (n = 5) through the use of a gas mixing and delivery device in the supine position. The proposed technique utilizes a series of back-to-back HP gas breaths with images acquired during short end-inspiratory breath-holds. In order to decouple the radiofrequency pulse decay effect from the ventilatory signal build-up in the airways, the regional distribution of the flip angle (α) was estimated in the imaged slices by acquiring a series of back-to-back images with no interscan time delay during a breath-hold at the tail end of the ventilation sequence. Analysis was performed to assess the sensitivity of the multislice ventilation model to noise, oxygen and the number of flip angle images. The optimal α value was determined on the basis of the minimization of the error in r estimation: α(opt) = 5-6º for the set of acquisition parameters in pigs. The mean r values for the group of pigs were 0.27 ± 0.09, 0.35 ± 0.06 and 0.40 ± 0.04 for the ventral, middle and dorsal slices, respectively (excluding conductive airways r 0.9). A positive gravitational (ventral-dorsal) ventilation gradient effect was present in all animals. The trachea and major conductive airways showed a uniform near-unity r value, with progressively smaller values corresponding to smaller diameter airways, and ultimately leading to lung parenchyma. The results demonstrate the feasibility of the measurement of the fractional ventilation in large species, and provide a platform to address the technical challenges associated with long breathing time scales through the optimization of acquisition parameters in species with a pulmonary physiology very similar to that of humans.
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Affiliation(s)
- Kiarash Emami
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abstract
Pulmonary magnetic resonance (MR) imaging has been put forward as a new research and diagnostic tool mainly to overcome the limitations of computed tomography and nuclear medicine studies. However, pulmonary MR imaging has been difficult to use because of inherently low proton density, a multitude of air-tissue interfaces, which create significant magnetic field distortions and are commonly referred to as susceptibility artifacts; diminishing signal in the lung; and respiratory and/or cardiac motion artifacts. To overcome these drawbacks of pulmonary MR imaging, technical advances made during the last decade in sequencing, scanner and coil, adaptation of parallel imaging techniques, and utilization of contrast media have been reported as being useful for functional and morphologic assessment of various pulmonary diseases including airway diseases. This review article covers (1) pulmonary MR techniques for morphologic and functional assessment of airway diseases, and (2) pulmonary MR imaging for cystic fibrosis, asthma, and chronic obstructive pulmonary disease. Pulmonary MR imaging provides not only morphology-related but also pulmonary function-related information. It has the potential to replace nuclear medicine studies for the identification of regional pulmonary function and may perform a complementary role in airway disease assessment instead of nuclear medicine study. We believe that the findings of further basic studies as well as clinical applications of this new technique will validate the real significance of pulmonary MR imaging for the future of airway disease assessment and its usefulness for diagnostic radiology and pulmonary medicine.
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Sun Y, O'Sullivan BP, Roche JP, Walvick R, Reno A, Baker D, Mansour JK, Albert MS. Using hyperpolarized 3He MRI to evaluate treatment efficacy in cystic fibrosis patients. J Magn Reson Imaging 2011; 34:1206-11. [PMID: 21932361 DOI: 10.1002/jmri.22724] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 06/23/2011] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To use hyperpolarized (HP) (3)He MR imaging to assess functional lung ventilation in subjects with cystic fibrosis (CF) before and after treatment. MATERIALS AND METHODS We performed HP (3)He static ventilation MRI scans on three subjects, using a Philips 3.0 Tesla (T) Achieva MRI scanner, before and after 11 days of in-patient treatment with combined intravenous and inhaled therapies for pulmonary exacerbations of CF. We also collected spirometry data. We quantified pulmonary ventilation volume measured with HP (3)He MRI using an advanced semi-automated analysis technique. RESULTS Following 11 days of treatment with intravenous antibiotics, hypertonic saline, and rhDNase, HP (3)He MR images in one subject displayed a 25% increase in total ventilation volume. Total ventilation volume in the other two subjects slightly decreased. All three subjects showed increases in FEV(1) and FVC following treatment. CONCLUSION In all subjects, the HP (3)He MR images provided detailed information on precisely where in the lungs gas was reaching. These data provide additional support for the conclusion that HP noble gas MRI can be a powerful tool for evaluating lung ventilation in patients with cystic fibrosis, but also raise important questions about the correlation between spirometry and HP gas MRI measurements.
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Affiliation(s)
- Yanping Sun
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Kirby M, Svenningsen S, Ahmed H, Wheatley A, Etemad-Rezai R, Paterson NAM, Parraga G. Quantitative evaluation of hyperpolarized helium-3 magnetic resonance imaging of lung function variability in cystic fibrosis. Acad Radiol 2011; 18:1006-13. [PMID: 21536462 DOI: 10.1016/j.acra.2011.03.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 03/14/2011] [Accepted: 03/14/2011] [Indexed: 12/11/2022]
Abstract
RATIONALE AND OBJECTIVES To better understand imaging measurement precision and reproducibility and to provide guidance for measurements in individual cystic fibrosis (CF) subjects, we evaluated CF adults on two occasions 7 ± 2 days apart using spirometry, plethysmography, and hyperpolarized helium-3 ((3)He) magnetic resonance imaging (MRI). MATERIALS AND METHODS Twelve CF subjects underwent spirometry, plethysmography, and (3)He MRI twice within 7 ± 2 days, reporting (3)He ventilation defect volume (VDV) and ventilation defect percent (VDP). RESULTS Based on measurement variability, the smallest detectable difference (SDD) for (3)He VDV and VDP was determined to be 120 mL and 2%, respectively. Although no significant difference in spirometry or plethysmography was detected after 7 days, there was a significant difference in mean (3)He VDV (130 mL ± 250 mL, P < .0001) and VDP (3% ± 4%, P < .0001), although baseline and 7-day measurements were highly correlated (VDV: r = .85, P = .001; VDP: r = .94, P < .0001). We estimated the sample sizes required to detect a 5%/7%/10% change in (3)He VDP as 60/15/5 subjects per group. CONCLUSION Hyperpolarized (3)He MRI VDP measurement precision resulted in an SDD for individual CF subjects of 2%, indicating that changes greater than this can be attributed to lung functional changes and not measurement error. After 7 days, significant changes in mean (3)He VDV and VDP were detected and these changes were not reflected by changes in pulmonary function measurements. These findings demonstrate the high sensitivity and reproducibility of (3)He MRI functional imaging that permits the use of relatively small samples sizes in CF interventional studies.
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Affiliation(s)
- Miranda Kirby
- Imaging Research Laboratories, Robarts Research Institute, London, Canada N6A 5K8
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Fain S, Schiebler ML, McCormack DG, Parraga G. Imaging of lung function using hyperpolarized helium-3 magnetic resonance imaging: Review of current and emerging translational methods and applications. J Magn Reson Imaging 2011; 32:1398-408. [PMID: 21105144 DOI: 10.1002/jmri.22375] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
During the past several years there has been extensive development and application of hyperpolarized helium-3 (HP (3)He) magnetic resonance imaging (MRI) in clinical respiratory indications such as asthma, chronic obstructive pulmonary disease, cystic fibrosis, radiation-induced lung injury, and transplantation. This review focuses on the state-of-the-art of HP (3)He MRI and its application to clinical pulmonary research. This is not an overview of the physics of the method, as this topic has been covered previously. We focus here on the potential of this imaging method and its challenges in demonstrating new types of information that has the potential to influence clinical research and decision making in pulmonary medicine. Particular attention is given to functional imaging approaches related to ventilation and diffusion-weighted imaging with applications in chronic obstructive pulmonary disease, cystic fibrosis, asthma, and radiation-induced lung injury. The strengths and challenges of the application of (3)He MRI in these indications are discussed along with a comparison to established and emerging imaging techniques.
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Affiliation(s)
- Sean Fain
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Yamamoto T, Kabus S, Klinder T, Lorenz C, von Berg J, Blaffert T, Loo BW, Keall PJ. Investigation of four-dimensional computed tomography-based pulmonary ventilation imaging in patients with emphysematous lung regions. Phys Med Biol 2011; 56:2279-98. [PMID: 21411868 DOI: 10.1088/0031-9155/56/7/023] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A pulmonary ventilation imaging technique based on four-dimensional (4D) computed tomography (CT) has advantages over existing techniques. However, physiologically accurate 4D-CT ventilation imaging has not been achieved in patients. The purpose of this study was to evaluate 4D-CT ventilation imaging by correlating ventilation with emphysema. Emphysematous lung regions are less ventilated and can be used as surrogates for low ventilation. We tested the hypothesis: 4D-CT ventilation in emphysematous lung regions is significantly lower than in non-emphysematous regions. Four-dimensional CT ventilation images were created for 12 patients with emphysematous lung regions as observed on CT, using a total of four combinations of two deformable image registration (DIR) algorithms: surface-based (DIR(sur)) and volumetric (DIR(vol)), and two metrics: Hounsfield unit (HU) change (V(HU)) and Jacobian determinant of deformation (V(Jac)), yielding four ventilation image sets per patient. Emphysematous lung regions were detected by density masking. We tested our hypothesis using the one-tailed t-test. Visually, different DIR algorithms and metrics yielded spatially variant 4D-CT ventilation images. The mean ventilation values in emphysematous lung regions were consistently lower than in non-emphysematous regions for all the combinations of DIR algorithms and metrics. V(HU) resulted in statistically significant differences for both DIR(sur) (0.14 ± 0.14 versus 0.29 ± 0.16, p = 0.01) and DIR(vol) (0.13 ± 0.13 versus 0.27 ± 0.15, p < 0.01). However, V(Jac) resulted in non-significant differences for both DIR(sur) (0.15 ± 0.07 versus 0.17 ± 0.08, p = 0.20) and DIR(vol) (0.17 ± 0.08 versus 0.19 ± 0.09, p = 0.30). This study demonstrated the strong correlation between the HU-based 4D-CT ventilation and emphysema, which indicates the potential for HU-based 4D-CT ventilation imaging to achieve high physiologic accuracy. A further study is needed to confirm these results.
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Affiliation(s)
- Tokihiro Yamamoto
- Department of Radiation Oncology, Stanford University School of Medicine, 875 Blake Wilbur Dr, Stanford, CA 94305-5847, USA.
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Arthurs OJ, Gallagher FA. Functional and molecular imaging with MRI: potential applications in paediatric radiology. Pediatr Radiol 2011; 41:185-98. [PMID: 20972674 DOI: 10.1007/s00247-010-1842-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 07/29/2010] [Accepted: 08/25/2010] [Indexed: 01/17/2023]
Abstract
MRI is a very versatile tool for noninvasive imaging and it is particularly attractive as an imaging technique in paediatric patients given the absence of ionizing radiation. Recent advances in the field of MRI have enabled tissue function to be probed noninvasively, and increasingly MRI is being used to assess cellular and molecular processes. For example, dynamic contrast-enhanced MRI has been used to assess tissue vascularity, diffusion-weighted imaging can quantify molecular movements of water in tissue compartments and MR spectroscopy provides a quantitative assessment of metabolite levels. A number of targeted contrast agents have been developed that bind specifically to receptors on the vascular endothelium or cell surface and there are several MR methods for labelling cells and tracking cellular movements. Hyperpolarization techniques have the capability of massively increasing the sensitivity of MRI and these have been used to image tissue pH, successful response to drug treatment as well as imaging the microstructure of the lungs. Although there are many challenges to be overcome before these techniques can be translated into routine paediatric imaging, they could potentially be used to aid diagnosis, predict disease outcome, target biopsies and determine treatment response noninvasively.
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Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, University of Cambridge, Box 218, Level 5, Hills Road, Cambridge, CB2 0QQ, UK
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Wild JM, Ajraoui S, Deppe MH, Parnell SR, Marshall H, Parra-Robles J, Ireland RH. Synchronous acquisition of hyperpolarised 3He and 1H MR images of the lungs - maximising mutual anatomical and functional information. NMR IN BIOMEDICINE 2011; 24:130-134. [PMID: 20821726 DOI: 10.1002/nbm.1565] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/06/2010] [Accepted: 04/19/2010] [Indexed: 05/29/2023]
Abstract
The development of hybrid medical imaging scanners has allowed imaging with different detection modalities at the same time, providing different anatomical and functional information within the same physiological time course with the patient in the same position. Until now, the acquisition of proton MRI of lung anatomy and hyperpolarised gas MRI of lung function required separate breath-hold examinations, meaning that the images were not spatially registered or temporally synchronised. We demonstrate the spatially registered concurrent acquisition of lung images from two different nuclei in vivo. The temporal and spatial registration of these images is demonstrated by a high degree of mutual consistency that is impossible to achieve in separate scans and breath holds.
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Affiliation(s)
- Jim M Wild
- Unit of Academic Radiology, University of Sheffield, Sheffield, UK.
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Deppe MH, Parra-Robles J, Ajraoui S, Wild JM. Combined measurement of pulmonary inert gas washout and regional ventilation heterogeneity by MR of a single dose of hyperpolarized 3
He. Magn Reson Med 2010; 65:1075-83. [DOI: 10.1002/mrm.22709] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 09/08/2010] [Accepted: 10/08/2010] [Indexed: 11/11/2022]
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