Delayed ventilation assessment using fast dynamic hyperpolarised Xenon-129 magnetic resonance imaging

Hyperpolarized Gas Imaging in Lung Diseases: Functional and Artificial Intelligence Perspective

Pathophysiologic changes in lung diseases are often accompanied by changes in ventilation and gas exchange. Comprehensive evaluation of lung function cannot be obtained through chest X-ray and computed tomography. Proton-based lung MRI is particularly challenging due to low proton density within the lung tissue. In this review, we discuss an emerging technology--hyperpolarized gas MRI with inhaled 129Xe, which provides functional and microstructural information and has the potential as a clinical tool for detecting the early stage and progression of certain lung diseases. We review the hyperpolarized 129Xe MRI studies in patients with a range of pulmonary diseases, including chronic obstructive pulmonary disease, asthma, cystic fibrosis, pulmonary hypertension, radiation-induced lung injury and interstitial lung disease, and the applications of artificial intelligence were reviewed as well.

Functional lung imaging using novel and emerging MRI techniques

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.

A 3D stack-of-spirals approach for rapid hyperpolarized 129 Xe ventilation mapping in pediatric cystic fibrosis lung disease

PURPOSE

To demonstrate the feasibility of a rapid 3D stack-of-spirals (3D-SoS) imaging acquisition for hyperpolarized ¹²⁹ Xe ventilation mapping in healthy pediatric participants and pediatric cystic fibrosis (CF) participants, in comparison to conventional Cartesian multislice (2D) gradient-recalled echo (GRE) imaging.

METHODS

The 2D-GRE and 3D-SoS acquisitions were performed in 13 pediatric participants (5 healthy, 8 CF) during separate breath-holds. Images from both sequences were compared on the basis of ventilation defect percent (VDP) and other measures of image similarity. The nadir of transient oxygen saturation (SpO₂ ) decline due to xenon breath-holding was measured with pulse oximetry, and expressed as a percent change relative to baseline.

RESULTS

¹²⁹ Xe ventilation images were acquired in a breath-hold of 1.2-1.8 s with the 3D-SoS sequence, compared to 6.2-8.8 s for 2D-GRE. Mean ± SD VDP measures for 2D-GRE and 3D-SoS sequences were 5.02 ± 1.06% and 5.28 ± 1.08% in healthy participants, and 18.05 ± 8.26% and 18.75 ± 6.74% in CF participants, respectively. Across all participants, the intraclass correlation coefficient of VDP measures for both sequences was 0.98 (95% confidence interval: 0.94-0.99). The percent change in SpO₂ was reduced to -2.1 ± 2.7% from -5.2 ± 3.5% with the shorter 3D-SoS breath-hold.

CONCLUSION

Hyperpolarized ¹²⁹ Xe ventilation imaging with 3D-SoS yielded images approximately five times faster than conventional 2D-GRE, reducing SpO₂ desaturation and improving tolerability of the xenon administration. Analysis of VDP and other measures of image similarity demonstrate excellent agreement between images obtained with both sequences. 3D-SoS holds significant potential for reducing the acquisition time of hyperpolarized ¹²⁹ Xe MRI, and/or increasing spatial resolution while adhering to clinical breath-hold constraints.

Bias field correction in hyperpolarized 129 Xe ventilation MRI using templates derived by RF-depolarization mapping

PURPOSE

To correct for RF inhomogeneity for in vivo 129 Xe ventilation MRI using flip-angle mapping enabled by randomized 3D radial acquisitions. To extend this RF-depolarization mapping approach to create a flip-angle map template applicable to arbitrary acquisition strategies, and to compare these approaches to conventional bias field correction.

METHODS

RF-depolarization mapping was evaluated first in digital simulations and then in 51 subjects who had undergone radial 129 Xe ventilation MRI in the supine position at 3T (views = 3600; samples/view = 128; TR/TE = 4.5/0.45 ms; flip angle = 1.5; FOV = 40 cm). The images were corrected using newly developed RF-depolarization and templated-based methods and the resulting quantitative ventilation metrics (mean, coefficient of variation, and gradient) were compared to those resulting from N4ITK correction.

RESULTS

RF-depolarization and template-based mapping methods yielded a pattern of RF-inhomogeneity consistent with the expected variation based on coil architecture. The resulting corrected images were visually similar, but meaningfully distinct from those generated using standard N4ITK correction. The N4ITK algorithm eliminated the physiologically expected anterior-posterior gradient (-0.04 ± 1.56%/cm, P < 0.001). These 2 newly introduced methods of RF-depolarization and template correction retained the physiologically expected anterior-posterior ventilation gradient in healthy subjects (2.77 ± 2.09%/cm and 2.01 ± 2.73%/cm, respectively).

CONCLUSIONS

Randomized 3D 129 Xe MRI ventilation acquisitions can inherently be corrected for bias field, and this technique can be extended to create flip angle templates capable of correcting images from a given coil regardless of acquisition strategy. These methods may be more favorable than the de facto standard N4ITK because they can remove undesirable heterogeneity caused by RF effects while retaining results from known physiology.

Cryptophane-xenon complexes for 129Xe MRI applications

The use of magnetic resonance imaging (MRI) and spectroscopy (MRS) in the clinical setting enables the acquisition of valuable anatomical information in a rapid, non-invasive fashion. However, MRI applications for identifying disease-related biomarkers are limited due to low sensitivity at clinical magnetic field strengths. The development of hyperpolarized (hp) ¹²⁹Xe MRI/MRS techniques as complements to traditional ¹H-based imaging has been a burgeoning area of research over the past two decades. Pioneering experiments have shown that hp ¹²⁹Xe can be encapsulated within host molecules to generate ultrasensitive biosensors. In particular, xenon has high affinity for cryptophanes, which are small organic cages that can be functionalized with affinity tags, fluorophores, solubilizing groups, and other moieties to identify biomedically relevant analytes. Cryptophane sensors designed for proteins, metal ions, nucleic acids, pH, and temperature have achieved nanomolar-to-femtomolar limits of detection via a combination of ¹²⁹Xe hyperpolarization and chemical exchange saturation transfer (CEST) techniques. This review aims to summarize the development of cryptophane biosensors for ¹²⁹Xe MRI applications, while highlighting innovative biosensor designs and the consequent enhancements in detection sensitivity, which will be invaluable in expanding the scope of ¹²⁹Xe MRI.

This review aims to summarize the development of cryptophane biosensors for ¹²⁹Xe MRI applications, while highlighting innovative biosensor designs and the consequent enhancements in detection sensitivity, which will be invaluable in expanding the scope of ¹²⁹Xe MRI.

Hyperpolarized 129Xe MRI Abnormalities in Dyspneic Participants 3 Months after COVID-19 Pneumonia: Preliminary Results

Background

SARS-CoV-2 targets angiotensin-converting enzyme 2 (ACE2) expressing cells in the respiratory tract. There are reports of breathlessness in patients many months post-infection.

Purpose

This study aimed to determine if hyperpolarized ¹²⁹Xe MRI (XeMRI) imaging could identify the possible cause of breathlessness in patients three months after hospital discharge following COVID-19 infection.

Materials and Methods

This prospective study was undertaken between August and December 2020, with patients and healthy control volunteers enrolled. All patients underwent: lung function tests; ventilation and dissolved phase XeMRI, with the mean Red Blood Cell (RBC):Tissue Plasma (TP) ratio to be calculated; and a low dose chest CT scored for the degree of post-COVID-19 abnormalities. Healthy controls underwent XeMRI. The intraclass correlation coefficient was calculated for volunteer and patient scans, to assess repeatability. A Wilcoxon rank-sum test and Cohen's effect size calculated to assess for differences between RBC:TP in patient and controls.

Results

9 patients (mean age 57±7 years, Male = 6) and 5 volunteers (29 ± 3 years, Female = 5) were enrolled. Patient mean time from hospital discharge was 169, range 116-254 days. There was a difference in RBC:TP between patients and controls (0.3 ± 0.1 versus 0.5 ± 0.1, respectively, p = 0.001, effect size = 1.36). There was significant difference between the RBC and gas phase spectral full width at half maximum (FWHM) between volunteers and patients (median ± 95 % confidence interval, 567 ± 1 vs 507 ± 81, p = 0.002 and 104 ± 2 vs 122 ± 17, p = 0.004, respectively). Results were reproducible with Intraclass Correlation Coefficients of 0.82 and 0.88 for patients and volunteers respectively. Participants had normal or near normal CT scans, mean 7/25, range 0-10/25.

Conclusion

Xe MRI showed alveolar-capillary diffusion limitation in all 9 post COVID-19 pneumonia patients despite normal or nearly normal CT scans.

See also the editorial by Dietrich.

In vivo methods and applications of xenon-129 magnetic resonance

Hyperpolarised gas lung MRI using xenon-129 can provide detailed 3D images of the ventilated lung airspaces, and can be applied to quantify lung microstructure and detailed aspects of lung function such as gas exchange. It is sensitive to functional and structural changes in early lung disease and can be used in longitudinal studies of disease progression and therapy response. The ability of 129Xe to dissolve into the blood stream and its chemical shift sensitivity to its local environment allow monitoring of gas exchange in the lungs, perfusion of the brain and kidneys, and blood oxygenation. This article reviews the methods and applications of in vivo129Xe MR in humans, with a focus on the physics of polarisation by optical pumping, radiofrequency coil and pulse sequence design, and the in vivo applications of 129Xe MRI and MRS to examine lung ventilation, microstructure and gas exchange, blood oxygenation, and perfusion of the brain and kidneys.

Heterogeneous Parahydrogen-Induced Polarization of Diethyl Ether for Magnetic Resonance Imaging Applications

Magnetic resonance imaging (MRI) with the use of hyperpolarized gases as contrast agents provides valuable information on lungs structure and function. While the technology of 129 Xe hyperpolarization for clinical MRI research is well developed, it requires the expensive equipment for production and detection of hyperpolarized 129 Xe. Herein we present the 1 H hyperpolarization of diethyl ether vapor that can be imaged on any clinical MRI scanner. 1 H nuclear spin polarization of up to 1.3 % was achieved using heterogeneous hydrogenation of ethyl vinyl ether with parahydrogen over Rh/TiO2 catalyst. Liquefaction of diethyl ether vapor proceeds with partial preservation of hyperpolarization and prolongs its lifetime by ≈10 times. The proof-of-principle 2D 1 H MRI of hyperpolarized diethyl ether was demonstrated with 0.1×1.1 mm2 spatial and 120 ms temporal resolution. The long history of use of diethyl ether for anesthesia is expected to facilitate the clinical translation of the presented approach.