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Triphan SMF, Bauman G, Konietzke P, Konietzke M, Wielpütz MO. Magnetic Resonance Imaging of Lung Perfusion. J Magn Reson Imaging 2024; 59:784-796. [PMID: 37466278 DOI: 10.1002/jmri.28912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
"Lung perfusion" in the context of imaging conventionally refers to the delivery of blood to the pulmonary capillary bed through the pulmonary arteries originating from the right ventricle required for oxygenation. The most important physiological mechanism in the context of imaging is the so-called hypoxic pulmonary vasoconstriction (HPV, also known as "Euler-Liljestrand-Reflex"), which couples lung perfusion to lung ventilation. In obstructive airway diseases such as asthma, chronic-obstructive pulmonary disease (COPD), cystic fibrosis (CF), and asthma, HPV downregulates pulmonary perfusion in order to redistribute blood flow to functional lung areas in order to conserve optimal oxygenation. Imaging of lung perfusion can be seen as a reflection of lung ventilation in obstructive airway diseases. Other conditions that primarily affect lung perfusion are pulmonary vascular diseases, pulmonary hypertension, or (chronic) pulmonary embolism, which also lead to inhomogeneity in pulmonary capillary blood distribution. Several magnetic resonance imaging (MRI) techniques either dependent on exogenous contrast materials, exploiting periodical lung signal variations with cardiac action, or relying on intrinsic lung voxel attributes have been demonstrated to visualize lung perfusion. Additional post-processing may add temporal information and provide quantitative information related to blood flow. The most widely used and robust technique, dynamic-contrast enhanced MRI, is available in clinical routine assessment of COPD, CF, and pulmonary vascular disease. Non-contrast techniques are important research tools currently requiring clinical validation and cross-correlation in the absence of a viable standard of reference. First data on many of these techniques in the context of observational studies assessing therapy effects have just become available. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Simon M F Triphan
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philip Konietzke
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Marilisa Konietzke
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
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Kay FU, Madhuranthakam AJ. MR Perfusion Imaging of the Lung. Magn Reson Imaging Clin N Am 2024; 32:111-123. [PMID: 38007274 DOI: 10.1016/j.mric.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Lung perfusion assessment is critical for diagnosing and monitoring a variety of respiratory conditions. MRI perfusion provides a radiation-free technique, making it an ideal choice for longitudinal imaging in younger populations. This review focuses on the techniques and applications of MRI perfusion, including contrast-enhanced (CE) MRI and non-CE methods such as arterial spin labeling (ASL), fourier decomposition (FD), and hyperpolarized 129-Xenon (129-Xe) MRI. ASL leverages endogenous water protons as tracers for a non-invasive measure of lung perfusion, while FD offers simultaneous measurements of lung perfusion and ventilation, enabling the generation of ventilation/perfusion mapsHyperpolarized 129-Xe MRI emerges as a novel tool for assessing regional gas exchange in the lungs. Despite the promise of MRI perfusion techniques, challenges persist, including competition with other imaging techniques and the need for additional validation and standardization. In conditions such as cystic fibrosis and lung cancer, MRI has displayed encouraging results, whereas in diseases like chronic obstructive pulmonary disease, further validation remains necessary. In conclusion, while MRI perfusion techniques hold immense potential for a comprehensive, non-invasive assessment of lung function and perfusion, their broader clinical adoption hinges on technological advancements, collaborative research, and rigorous validation.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Ananth J Madhuranthakam
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, North Campus 2201 Inwood Road, Dallas, TX 75390-8568, USA
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3
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Lacharie M, Villa A, Milidonis X, Hasaneen H, Chiribiri A, Benedetti G. Role of pulmonary perfusion magnetic resonance imaging for the diagnosis of pulmonary hypertension: A review. World J Radiol 2023; 15:256-273. [PMID: 37823020 PMCID: PMC10563854 DOI: 10.4329/wjr.v15.i9.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023] Open
Abstract
Among five types of pulmonary hypertension, chronic thromboembolic pulmonary hypertension (CTEPH) is the only curable form, but prompt and accurate diagnosis can be challenging. Computed tomography and nuclear medicine-based techniques are standard imaging modalities to non-invasively diagnose CTEPH, however these are limited by radiation exposure, subjective qualitative bias, and lack of cardiac functional assessment. This review aims to assess the methodology, diagnostic accuracy of pulmonary perfusion imaging in the current literature and discuss its advantages, limitations and future research scope.
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Affiliation(s)
- Miriam Lacharie
- Oxford Centre of Magnetic Resonance Imaging, University of Oxford, Oxford OX3 9DU, United Kingdom
| | - Adriana Villa
- Department of Diagnostic and Interventional Radiology, German Oncology Centre, Limassol 4108, Cyprus
| | - Xenios Milidonis
- Deep Camera MRG, CYENS Centre of Excellence, Nicosia, Cyprus, Nicosia 1016, Cyprus
| | - Hadeer Hasaneen
- School of Biomedical Engineering & Imaging Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Kings Coll London, Div Imaging Sci, St Thomas Hospital, London WC2R 2LS, United Kingdom
| | - Giulia Benedetti
- Department of Cardiovascular Imaging and Biomedical Engineering, King’s College London, London WC2R 2LS, United Kingdom
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Torres LA, Lee KE, Barton GP, Hahn AD, Sandbo N, Schiebler ML, Fain SB. Dynamic contrast enhanced MRI for the evaluation of lung perfusion in idiopathic pulmonary fibrosis. Eur Respir J 2022; 60:2102058. [PMID: 35273033 PMCID: PMC10015995 DOI: 10.1183/13993003.02058-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 02/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of this work was to apply quantitative and semiquantitative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) methods to evaluate lung perfusion in idiopathic pulmonary fibrosis (IPF). METHODS In this prospective trial 41 subjects, including healthy control and IPF subjects, were studied using DCE-MRI at baseline. IPF subjects were then followed for 1 year; progressive IPF (IPFprog) subjects were distinguished from stable IPF (IPFstable) subjects based on a decline in percent predicted forced vital capacity (FVC % pred) or diffusing capacity of the lung for carbon monoxide (D LCO % pred) measured during follow-up visits. 35 out of 41 subjects were retained for final baseline analysis (control: n=15; IPFstable: n=14; IPFprog: n=6). Seven measures and their coefficients of variation (CV) were derived using temporally resolved DCE-MRI. Two sets of global and regional comparisons were made: control versus IPF groups and control versus IPFstable versus IPFprog groups, using linear regression analysis. Each measure was compared with FVC % pred, D LCO % pred and the lung clearance index (LCI % pred) using a Spearman rank correlation. RESULTS DCE-MRI identified regional perfusion differences between control and IPF subjects using first moment transit time (FMTT), contrast uptake slope and pulmonary blood flow (PBF) (p≤0.05), while global averages did not. FMTT was shorter for IPFprog compared with both IPFstable (p=0.004) and control groups (p=0.023). Correlations were observed between PBF CV and D LCO % pred (rs= -0.48, p=0.022) and LCI % pred (rs= +0.47, p=0.015). Significant group differences were detected in age (p<0.001), D LCO % pred (p<0.001), FVC % pred (p=0.001) and LCI % pred (p=0.007). CONCLUSIONS Global analysis obscures regional changes in pulmonary haemodynamics in IPF using DCE-MRI in IPF. Decreased FMTT may be a candidate marker for IPF progression.
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Affiliation(s)
- Luis A Torres
- Dept of Medical Physics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Kristine E Lee
- Dept of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Gregory P Barton
- Dept of Medical Physics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Andrew D Hahn
- Dept of Medical Physics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Nathan Sandbo
- Dept of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Mark L Schiebler
- Dept of Medicine, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Dept of Radiology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
| | - Sean B Fain
- Dept of Medical Physics, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Dept of Radiology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI, USA
- Dept of Biomedical Engineering, College of Engineering, University of Wisconsin - Madison, Madison, WI, USA
- Dept of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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MR lung perfusion measurements in adolescents after congenital diaphragmatic hernia: correlation with spirometric lung function tests. Eur Radiol 2021; 32:2572-2580. [PMID: 34741621 PMCID: PMC8921025 DOI: 10.1007/s00330-021-08315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/01/2021] [Accepted: 09/01/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVES To evaluate whether lung perfusion continues to be reduced in 10-year-old children after congenital diaphragmatic hernia (CDH) and whether lung perfusion values correlate with spirometric lung function measurements. METHODS Fifty-four patients after CDH repair received dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI)-based lung perfusion measurements at the age of 10 years (10.2 ± 1.0 years). Additionally, a control group of 10 children has been examined according to the same protocol. Lung spirometry was additionally available in 43 patients of the CDH group. A comparison of ipsilateral and contralateral parameters was performed. RESULTS Pulmonary blood flow (PBF) was reduced on the ipsilateral side in CDH patients (60.4 ± 23.8 vs. 93.3 ± 16.09 mL/100 mL/min; p < 0.0001). In comparison to the control group, especially the ratio of ipsilateral to contralateral, PBF was reduced in CDH patients (0.669 ± 0.152 vs. 0.975 ± 0.091; p < 0.0001). There is a positive correlation between ipsilateral pulmonary blood flow, and spirometric forced 1-s volume (r = 0.45; p = 0.0024). CONCLUSIONS Pulmonary blood flow impairment persists during childhood and correlates with spirometric measurements. Without the need for ionizing radiation, MRI measurements seem promising as follow-up parameters after CDH. KEY POINTS • Ten-year-old children after congenital diaphragmatic hernia continue to show reduced perfusion of ipsilateral lung. • Lung perfusion values correlate with lung function tests after congenital diaphragmatic hernia.
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Imaging of congenital lung diseases presenting in the adulthood: a pictorial review. Insights Imaging 2021; 12:153. [PMID: 34716817 PMCID: PMC8557233 DOI: 10.1186/s13244-021-01095-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022] Open
Abstract
Congenital lung diseases in adults are rare diseases that can present with symptoms or be detected incidentally. Familiarity with the imaging features of different types of congenital lung diseases helps both in correct diagnosis and management of these diseases. Congenital lung diseases in adults are classified into three main categories as bronchopulmonary anomalies, vascular anomalies, and combined bronchopulmonary and vascular anomalies. Contrast-enhanced computed tomography, especially 3D reconstructions, CT, or MR angiography, can show vascular anomalies in detail. The tracheobronchial tree, parenchymal changes, and possible complications can also be defined on chest CT, and new applications such as quantitative 3D reconstruction CT images, dual-energy CT (DECT) can be helpful in imaging parenchymal changes. In addition to the morphological assessment of the lungs, novel MRI techniques such as ultra-short echo time (UTE), arterial spin labeling (ASL), and phase-resolved functional lung (PREFUL) can provide functional information. This pictorial review aims to comprehensively define the radiological characteristics of each congenital lung disease in adults and to highlight differential diagnoses and possible complications of these diseases.
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Weatherley ND, Eaden JA, Hughes PJC, Austin M, Smith L, Bray J, Marshall H, Renshaw S, Bianchi SM, Wild JM. Quantification of pulmonary perfusion in idiopathic pulmonary fibrosis with first pass dynamic contrast-enhanced perfusion MRI. Thorax 2020; 76:144-151. [PMID: 33273022 PMCID: PMC7815896 DOI: 10.1136/thoraxjnl-2019-214375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 01/07/2023]
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) is a fatal disease of lung scarring. Many patients later develop raised pulmonary vascular pressures, sometimes disproportionate to the interstitial disease. Previous therapeutic approaches that have targeted pulmonary vascular changes have not demonstrated clinical efficacy, and quantitative assessment of regional pulmonary vascular involvement using perfusion imaging may provide a biomarker for further therapeutic insights. Methods We studied 23 participants with IPF, using dynamic contrast-enhanced MRI (DCE-MRI) and pulmonary function tests, including forced vital capacity (FVC), transfer factor (TLCO) and coefficient (KCO) of the lungs for carbon monoxide. DCE-MRI parametric maps were generated including the full width at half maximum (FWHM) of the bolus transit time through the lungs. Key metrics used were mean (FWHMmean) and heterogeneity (FWHMIQR). Nineteen participants returned at 6 months for repeat assessment. Results Spearman correlation coefficients were identified between TLCO and FWHMIQR (r=−0.46; p=0.026), KCO and FWHMmean (r=−0.42; p=0.047) and KCO and FWHMIQR (r=−0.51; p=0.013) at baseline. No statistically significant correlations were seen between FVC and DCE-MRI metrics. Follow-up at 6 months demonstrated statistically significant decline in FVC (p=0.040) and KCO (p=0.014), with an increase in FWHMmean (p=0.040), but no significant changes in TLCO (p=0.090) nor FWHMIQR (p=0.821). Conclusions DCE-MRI first pass perfusion demonstrates correlations with existing physiological gas exchange metrics, suggesting that capillary perfusion deficit (as well as impaired interstitial diffusion) may contribute to gas exchange limitation in IPF. FWHMmean showed a significant increase over a 6-month period and has potential as a quantitative biomarker of pulmonary vascular disease progression in IPF.
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Affiliation(s)
- Nicholas D Weatherley
- Polaris, Imaging group, Dept IICD, University of Sheffield, Sheffield, UK.,Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
| | - James A Eaden
- Polaris, Imaging group, Dept IICD, University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- Polaris, Imaging group, Dept IICD, University of Sheffield, Sheffield, UK
| | - Matthew Austin
- Polaris, Imaging group, Dept IICD, University of Sheffield, Sheffield, UK
| | - Laurie Smith
- Polaris, Imaging group, Dept IICD, University of Sheffield, Sheffield, UK
| | - Jody Bray
- Polaris, Imaging group, Dept IICD, University of Sheffield, Sheffield, UK
| | - Helen Marshall
- Polaris, Imaging group, Dept IICD, University of Sheffield, Sheffield, UK
| | - Stephen Renshaw
- Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
| | - Stephen M Bianchi
- Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
| | - Jim M Wild
- Polaris, Imaging group, Dept IICD, University of Sheffield, Sheffield, UK
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Campbell-Washburn AE. 2019 American Thoracic Society BEAR Cage Winning Proposal: Lung Imaging Using High-Performance Low-Field Magnetic Resonance Imaging. Am J Respir Crit Care Med 2020; 201:1333-1336. [PMID: 32298594 PMCID: PMC7258650 DOI: 10.1164/rccm.201912-2505ed] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Velasco C, Mota-Cobián A, Mota RA, Pellico J, Herranz F, Galán-Arriola C, Ibáñez B, Ruiz-Cabello J, Mateo J, España S. Quantitative assessment of myocardial blood flow and extracellular volume fraction using 68Ga-DOTA-PET: A feasibility and validation study in large animals. J Nucl Cardiol 2020; 27:1249-1260. [PMID: 30927149 DOI: 10.1007/s12350-019-01694-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Here we evaluated the feasibility of PET with Gallium-68 (68Ga)-labeled DOTA for non-invasive assessment of myocardial blood flow (MBF) and extracellular volume fraction (ECV) in a pig model of myocardial infarction. We also aimed to validate MBF measurements using microspheres as a gold standard in healthy pigs. METHODS 8 healthy pigs underwent three sequential 68Ga-DOTA-PET/CT scans at rest and during pharmacological stress with simultaneous injection of fluorescent microspheres to validate MBF measurements. Myocardial infarction was induced in 5 additional pigs, which underwent 68Ga-DOTA-PET/CT examinations 7-days after reperfusion. Dynamic PET images were reconstructed and fitted to obtain MBF and ECV parametric maps. RESULTS MBF assessed with 68Ga-DOTA-PET showed good correlation (y = 0.96x + 0.11, r = 0.91) with that measured with microspheres. MBF values obtained with 68Ga-DOTA-PET in the infarcted area (LAD, left anterior descendant) were significantly reduced in comparison to remote ones LCX (left circumflex artery, P < 0.0001) and RCA (right coronary artery, P < 0.0001). ECV increased in the infarcted area (P < 0.0001). CONCLUSION 68Ga-DOTA-PET allowed non-invasive assessment of MBF and ECV in pigs with myocardial infarction and under rest-stress conditions. This technique could provide wide access to quantitative measurement of both MBF and ECV with PET imaging.
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Affiliation(s)
- Carlos Velasco
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Adriana Mota-Cobián
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Rubén A Mota
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- Charles River Laboratories España, Cerdanyola, Spain
| | - Juan Pellico
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Fernando Herranz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Carlos Galán-Arriola
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- CIBER de enfermedades Cardiovasculares, Madrid, Spain
| | - Borja Ibáñez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- CIBER de enfermedades Cardiovasculares, Madrid, Spain
- Cardiology Department, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Jesús Ruiz-Cabello
- Universidad Complutense de Madrid, Madrid, Spain
- CIC biomaGUNE, San Sebastian-Donostia, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Jesús Mateo
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain.
| | - Samuel España
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, 28029, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Voskrebenzev A, Vogel-Claussen J. Proton MRI of the Lung: How to Tame Scarce Protons and Fast Signal Decay. J Magn Reson Imaging 2020; 53:1344-1357. [PMID: 32166832 DOI: 10.1002/jmri.27122] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022] Open
Abstract
Pulmonary proton MRI techniques offer the unique possibility of assessing lung function and structure without the requirement for hyperpolarization or dedicated hardware, which is mandatory for multinuclear acquisition. Five popular approaches are presented and discussed in this review: 1) oxygen enhanced (OE)-MRI; 2) arterial spin labeling (ASL); 3) Fourier decomposition (FD) MRI and other related methods including self-gated noncontrast-enhanced functional lung (SENCEFUL) MR and phase-resolved functional lung (PREFUL) imaging; 4) dynamic contrast-enhanced (DCE) MRI; and 5) ultrashort TE (UTE) MRI. While DCE MRI is the most established and well-studied perfusion measurement, FD MRI offers a free-breathing test without any contrast agent and is predestined for application in patients with renal failure or with low compliance. Additionally, FD MRI and related methods like PREFUL and SENCEFUL can act as an ionizing radiation-free V/Q scan, since ventilation and perfusion information is acquired simultaneously during one scan. For OE-MRI, different concentrations of oxygen are applied via a facemask to assess the regional change in T1 , which is caused by the paramagnetic property of oxygen. Since this change is governed by a combination of ventilation, diffusion, and perfusion, a compound functional measurement can be achieved with OE-MRI. The known problem of fast T2 * decay of the lung parenchyma leading to a low signal-to-noise ratio is bypassed by the UTE acquisition strategy. Computed tomography (CT)-like images allow the assessment of lung structure with high spatial resolution without ionizing radiation. Despite these different branches of proton MRI, common trends are evident among pulmonary proton MRI: 1) free-breathing acquisition with self-gating; 2) application of UTE to preserve a stronger parenchymal signal; and 3) transition from 2D to 3D acquisition. On that note, there is a visible convergence of the different methods and it is not difficult to imagine that future methods will combine different aspects of the presented methods.
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Affiliation(s)
- Andreas Voskrebenzev
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
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11
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Winther HB, Gutberlet M, Hundt C, Kaireit TF, Alsady TM, Schmidt B, Wacker F, Sun Y, Dettmer S, Maschke SK, Hinrichs JB, Jambawalikar S, Prince MR, Barr RG, Vogel-Claussen J. Deep semantic lung segmentation for tracking potential pulmonary perfusion biomarkers in chronic obstructive pulmonary disease (COPD): The multi-ethnic study of atherosclerosis COPD study. J Magn Reson Imaging 2019; 51:571-579. [PMID: 31276264 DOI: 10.1002/jmri.26853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/19/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with high morbidity and mortality. Identification of imaging biomarkers for phenotyping is necessary for future treatment and therapy monitoring. However, translation of visual analytic pipelines into clinics or their use in large-scale studies is significantly slowed by time-consuming postprocessing steps. PURPOSE To implement an automated tool chain for regional quantification of pulmonary microvascular blood flow in order to reduce analysis time and user variability. STUDY TYPE Prospective. POPULATION In all, 90 MRI scans of 63 patients, of which 31 had a COPD with a mean Global Initiative for Chronic Obstructive Lung Disease status of 1.9 ± 0.64 (μ ± σ). FIELD STRENGTH/SEQUENCE 1.5T dynamic gadolinium-enhanced MRI measurement using 4D dynamic contrast material-enhanced (DCE) time-resolved angiography acquired in a single breath-hold in inspiration. [Correction added on August 20, 2019, after first online publication: The field strength in the preceding sentence was corrected.] ASSESSMENT: We built a 3D convolutional neural network for semantic segmentation using 29 manually segmented perfusion maps. All five lobes of the lung are denoted, including the middle lobe. Evaluation was performed on 61 independent cases from two sites of the Multi-Ethnic Study of Arteriosclerosis (MESA)-COPD study. We publish our implementation of a model-free deconvolution filter according to Sourbron et al for 4D DCE MRI scans as open source. STATISTICAL TEST Cross-validation 29/61 (# training / # testing), intraclass correlation coefficient (ICC), Spearman ρ, Pearson r, Sørensen-Dice coefficient, and overlap. RESULTS Segmentations and derived clinical parameters were processed in ~90 seconds per case on a Xeon E5-2637v4 workstation with Tesla P40 GPUs. Clinical parameters and predicted segmentations exhibit high concordance with the ground truth regarding median perfusion for all lobes with an ICC of 0.99 and a Sørensen-Dice coefficient of 93.4 ± 2.8 (μ ± σ). DATA CONCLUSION We present a robust end-to-end pipeline that allows for the extraction of perfusion-based biomarkers for all lung lobes in 4D DCE MRI scans by combining model-free deconvolution with deep learning. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:571-579.
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Affiliation(s)
- Hinrich B Winther
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - Till F Kaireit
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Tawfik Moher Alsady
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bertil Schmidt
- Institute for Computer Science, Johannes Gutenberg University, Mainz, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Yanping Sun
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Sabine Dettmer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Sabine K Maschke
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Sachin Jambawalikar
- Department of Radiology, Columbia University Medical Center, New York, New York, USA
| | - Martin R Prince
- Cornell Cardiovascular Magnetic Resonance Imaging Laboratory, Radiology Department, Weill Medical College of Cornell University, New York, New York, USA
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
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12
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Update on MR imaging of the pulmonary vasculature. Int J Cardiovasc Imaging 2019; 35:1483-1497. [PMID: 31030315 DOI: 10.1007/s10554-019-01603-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/11/2019] [Indexed: 01/01/2023]
Abstract
Magnetic resonance imaging (MRI) plays an increasingly important role in the non-invasive evaluation of the pulmonary vasculature. MR angiographic (MRA) techniques provide morphological information, while MR perfusion techniques provide functional information of the pulmonary vasculature. Contrast-enhanced MRA can be performed at high spatial resolution using 3D T1-weighted spoiled gradient echo sequence or at high temporal resolution using time-resolved techniques. Non-contrast MRA can be performed using 3D steady state free precession, double inversion fast spin echo, time of flight or phase contrast sequences. MR perfusion can be done using dynamic contrast-enhanced technique or using non-contrast techniques such as arterial spin labelling and time-resolved imaging of lungs during free breathing with Fourier decomposition analysis. MRI is used in the evaluation of acute and chronic pulmonary embolism, pulmonary hypertension and other vascular abnormalities, congenital anomalies and neoplasms. In this article, we review the different MR techniques used in the evaluation of pulmonary vasculature and its clinical applications.
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13
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A decade of lung expansion: A review of ventilation-weighted 1 H lung MRI. Z Med Phys 2017; 27:172-179. [DOI: 10.1016/j.zemedi.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/10/2016] [Accepted: 07/26/2016] [Indexed: 11/30/2022]
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14
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Ohno Y, Koyama H, Lee HY, Miura S, Yoshikawa T, Sugimura K. Contrast-enhanced CT- and MRI-based perfusion assessment for pulmonary diseases: basics and clinical applications. Diagn Interv Radiol 2017; 22:407-21. [PMID: 27523813 DOI: 10.5152/dir.2016.16123] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Assessment of regional pulmonary perfusion as well as nodule and tumor perfusions in various pulmonary diseases are currently performed by means of nuclear medicine studies requiring radioactive macroaggregates, dual-energy computed tomography (CT), and dynamic first-pass contrast-enhanced perfusion CT techniques and unenhanced and dynamic first-pass contrast enhanced perfusion magnetic resonance imaging (MRI), as well as time-resolved three-dimensional or four-dimensional contrast-enhanced magnetic resonance angiography (MRA). Perfusion scintigraphy, single-photon emission tomography (SPECT) and SPECT fused with CT have been established as clinically available scintigraphic methods; however, they are limited by perfusion information with poor spatial resolution and other shortcomings. Although positron emission tomography with 15O water can measure absolute pulmonary perfusion, it requires a cyclotron for generation of a tracer with an extremely short half-life (2 min), and can only be performed for academic purposes. Therefore, clinicians are concentrating their efforts on the application of CT-based and MRI-based quantitative and qualitative perfusion assessment to various pulmonary diseases. This review article covers 1) the basics of dual-energy CT and dynamic first-pass contrast-enhanced perfusion CT techniques, 2) the basics of time-resolved contrast-enhanced MRA and dynamic first-pass contrast-enhanced perfusion MRI, and 3) clinical applications of contrast-enhanced CT- and MRI-based perfusion assessment for patients with pulmonary nodule, lung cancer, and pulmonary vascular diseases. We believe that these new techniques can be useful in routine clinical practice for not only thoracic oncology patients, but also patients with different pulmonary vascular diseases.
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Affiliation(s)
- Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology and Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
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15
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Velasco C, Mateo J, Santos A, Mota-Cobian A, Herranz F, Pellico J, Mota RA, España S, Ruiz-Cabello J. Assessment of regional pulmonary blood flow using 68Ga-DOTA PET. EJNMMI Res 2017; 7:7. [PMID: 28101850 PMCID: PMC5241570 DOI: 10.1186/s13550-017-0259-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/11/2017] [Indexed: 11/19/2022] Open
Abstract
Background In vivo determination of regional pulmonary blood flow (PBF) is a valuable tool for the evaluation of many lung diseases. In this study, the use of 68Ga-DOTA PET for the in vivo quantitative determination of regional PBF is proposed. This methodology was implemented and tested in healthy pigs and validated using fluorescent microspheres. The study was performed on young large white pigs (n = 4). To assess the reproducibility and consistency of the method, three PET scans were obtained for each animal. Each radiotracer injection was performed simultaneously to the injection of fluorescent microspheres. PBF images were generated applying a two-compartment exchange model over the dynamic PET images. PET and microspheres values were compared by regression analysis and Bland–Altman plot. Results The capability of the proposed technique to produce 3D regional PBF images was demonstrated. The correlation evaluation between 68Ga-DOTA PET and microspheres showed a good and significant correlation (r = 0.74, P < 0.001). Conclusions Assessment of PBF with the proposed technique allows combining the high quantitative accuracy of PET imaging with the use of 68Ga/68Ge generators. Thus, 68Ga-DOTA PET emerges as a potential inexpensive method for measuring PBF in clinical settings with an extended use. Electronic supplementary material The online version of this article (doi:10.1186/s13550-017-0259-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos Velasco
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Jesus Mateo
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Arnoldo Santos
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain.,Department of Anesthesia, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, 02114, Boston, MA, USA
| | - Adriana Mota-Cobian
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Fernando Herranz
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Juan Pellico
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
| | - Ruben A Mota
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,Charles River, Carrer dels Argenters, 7, 08290, Barcelona, Spain
| | - Samuel España
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain. .,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain.
| | - Jesus Ruiz-Cabello
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, C/Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), C/Monforte de Lemos 3-5, 28029, Madrid, Spain
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16
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Johns CS, Swift AJ, Hughes PJ, Ohno Y, Schiebler M, Wild JM. Pulmonary MR angiography and perfusion imaging—A review of methods and applications. Eur J Radiol 2017; 86:361-370. [DOI: 10.1016/j.ejrad.2016.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
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17
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Abstract
CLINICAL/METHODICAL ISSUE Separate assessment of respiratory mechanics, gas exchange and pulmonary circulation is essential for the diagnosis and therapy of pulmonary diseases. Due to the global character of the information obtained clinical lung function tests are often not sufficiently specific in the differential diagnosis or have a limited sensitivity in the detection of early pathological changes. STANDARD RADIOLOGICAL METHODS The standard procedures of pulmonary imaging are computed tomography (CT) for depiction of the morphology as well as perfusion/ventilation scintigraphy and single photon emission computed tomography (SPECT) for functional assessment. METHODICAL INNOVATIONS Magnetic resonance imaging (MRI) with hyperpolarized gases, O2-enhanced MRI, MRI with fluorinated gases and Fourier decomposition MRI (FD-MRI) are available for assessment of pulmonary ventilation. For assessment of pulmonary perfusion dynamic contrast-enhanced MRI (DCE-MRI), arterial spin labeling (ASL) and FD-MRI can be used. PERFORMANCE Imaging provides a more precise insight into the pathophysiology of pulmonary function on a regional level. The advantages of MRI are a lack of ionizing radiation, which allows a protective acquisition of dynamic data as well as the high number of available contrasts and therefore accessible lung function parameters. ACHIEVEMENTS Sufficient clinical data exist only for certain applications of DCE-MRI. For the other techniques, only feasibility studies and case series of different sizes are available. The clinical applicability of hyperpolarized gases is limited for technical reasons. PRACTICAL RECOMMENDATIONS The clinical application of the techniques described, except for DCE-MRI, should be restricted to scientific studies.
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Affiliation(s)
- G Sommer
- Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
| | - G Bauman
- Klinik für Radiologie und Nuklearmedizin - Radiologische Physik, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
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18
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Region of interest-based versus whole-lung segmentation-based approach for MR lung perfusion quantification in 2-year-old children after congenital diaphragmatic hernia repair. Eur Radiol 2016; 26:4231-4238. [DOI: 10.1007/s00330-016-4330-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Revised: 02/16/2016] [Accepted: 03/11/2016] [Indexed: 10/22/2022]
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19
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Baldi S, Hartley R, Brightling C, Gupta S. Asthma. IMAGING 2016. [DOI: 10.1183/2312508x.10002815] [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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20
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Bauman G, Bieri O. Matrix pencil decomposition of time-resolved proton MRI for robust and improved assessment of pulmonary ventilation and perfusion. Magn Reson Med 2016; 77:336-342. [PMID: 26757102 DOI: 10.1002/mrm.26096] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/04/2015] [Accepted: 11/27/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE To present an improved and robust method of pulmonary function assessment from time-resolved proton MRI using a matrix pencil (MP) method in combination with a linear least squares analysis. METHODS Simulations of the signal time course in lung parenchyma were performed to compare the accuracy of Fourier decomposition (FD) and MP methods for the estimation of respiratory and cardiac amplitudes. Series of two-dimensional time-resolved lung images were acquired in healthy volunteers at 1.5 T using ultra-fast steady-state free precession. Qualitative lung ventilation- and perfusion-weighted images as well as a quantitative map of fractional ventilation, perfusion, and blood arrival time were calculated using the proposed MP method and compared with the contemporary FD technique. A region-of-interest analysis was performed on the quantitative data. RESULTS The signal analysis performed using MP decomposition resulted in reduced variability of the estimated respiratory and cardiac amplitudes in comparison with FD for both simulated and in vivo data. CONCLUSION MP decomposition provides an automatic, robust, and more accurate estimation of amplitudes of respiratory and cardiac signal modulations in the lung parenchyma than the contemporary FD technique. Magn Reson Med 77:336-342, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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21
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Zöllner FG, Daab M, Weidner M, Sommer V, Zahn K, Schaible T, Weisser G, Schoenberg SO, Neff KW, Schad LR. Semi-automatic lung segmentation of DCE-MRI data sets of 2-year old children after congenital diaphragmatic hernia repair: Initial results. Magn Reson Imaging 2015; 33:1345-1349. [DOI: 10.1016/j.mri.2015.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 08/08/2015] [Indexed: 11/17/2022]
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22
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Comparison of models and contrast agents for improved signal and signal linearity in dynamic contrast-enhanced pulmonary magnetic resonance imaging. Invest Radiol 2015; 50:174-8. [PMID: 25501016 DOI: 10.1097/rli.0000000000000122] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objectives of this study were to compare pulmonary blood flow (PBF) measurements acquired with 3 previously published models (low-dose "single bolus," "dual bolus" and a "nonlinear correction" algorithm) for addressing the nonlinear relationship between contrast agent concentration and magnetic resonance signal in the arterial input function (AIF) and to compare both lung signal and PBF measurements obtained using gadopentetate dimeglumine (Gd-DTPA, Magnevist) with those obtained using the high-relaxivity agent gadobenate dimeglumine (Gd-BOPTA, Multihance). MATERIALS AND METHODS Ten of 12 healthy humans were successfully scanned on 2 consecutive days at 1.5 T. Contrast-enhanced pulmonary perfusion scans were acquired with a 3-dimensional spoiled gradient echo pulse sequence and interleaved variable density k-space sampling with a 1-second frame rate and 4 × 4 × 4-mm resolution. Each day, 2 perfusion scans were acquired with either Gd-DTPA or Gd-BOPTA; the order of the administered contrast agent was randomized. Region of interest analysis was used to determine PBF on the basis of the indicator dilution theory. Linear mixed-effects modeling was used to compare the AIF models and contrast agents. RESULTS With Gd-DTPA, no significant differences were observed between the mean PBF calculated for the single bolus (323 ± 110 mL/100mL/min), dual bolus (315 ± 177 mL/100mL/min), and nonlinear correction (298 ± 100 mL/100mL/min) approach. With Gd-BOPTA, the mean PBF using the dual bolus approach (245 ± 103 mL/100mL/min) was lower than with the single bolus (345 ± 130 mL/100mL/min P < 0.01) and nonlinear correction (321 ± 115 mL/100mL/min; P = 0.02). Peak lung enhancement was significantly higher in all regions with Gd-BOPTA than with Gd-DTPA (P << 0.01). CONCLUSIONS The dual bolus approach with Gd-BOPTA resulted in a significantly lower PBF than did the other combinations of contrast agent and AIF model. No other statistically significant differences were found. Given the much higher signal in the lung parenchyma using Gd-BOPTA, the use of Gd-BOPTA with either single bolus or the nonlinear correction method appears most promising for voxelwise perfusion quantification using 3-dimensional dynamic contrast-enhanced pulmonary perfusion magnetic resonance imaging.
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23
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Hartley R, Baldi S, Brightling C, Gupta S. Novel imaging approaches in adult asthma and their clinical potential. Expert Rev Clin Immunol 2015; 11:1147-62. [PMID: 26289375 DOI: 10.1586/1744666x.2015.1072049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Currently, imaging in asthma is confined to chest radiography and CT. The emergence of new imaging techniques and tremendous improvement of existing imaging methods, primarily due to technological advancement, has completely changed its research and clinical prospects. In research, imaging in asthma is now being employed to provide quantitative assessment of morphology, function and pathogenic processes at the molecular level. The unique ability of imaging for non-invasive, repeated, quantitative, and in vivo assessment of structure and function in asthma could lead to identification of 'imaging biomarkers' with potential as outcome measures in future clinical trials. Emerging imaging techniques and their utility in the research and clinical setting is discussed in this review.
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Affiliation(s)
- Ruth Hartley
- a 1 Department of Infection, Inflammation and Immunity, Institute for Lung Health, University of Leicester, Leicester, LE3 9QP, UK
| | - Simonetta Baldi
- a 1 Department of Infection, Inflammation and Immunity, Institute for Lung Health, University of Leicester, Leicester, LE3 9QP, UK
| | - Chris Brightling
- a 1 Department of Infection, Inflammation and Immunity, Institute for Lung Health, University of Leicester, Leicester, LE3 9QP, UK
| | - Sumit Gupta
- a 1 Department of Infection, Inflammation and Immunity, Institute for Lung Health, University of Leicester, Leicester, LE3 9QP, UK.,b 2 Radiology Department, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, LE3 9QP, UK
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24
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Xia Y, Guan Y, Fan L, Liu SY, Yu H, Zhao LM, Li B. Dynamic contrast enhanced magnetic resonance perfusion imaging in high-risk smokers and smoking-related COPD: correlations with pulmonary function tests and quantitative computed tomography. COPD 2015; 11:510-20. [PMID: 25211632 DOI: 10.3109/15412555.2014.948990] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study aimed to prospectively evaluate correlations between dynamic contrast-enhanced (DCE) MR perfusion imaging, pulmonary function tests (PFT) and volume quantitative CT in smokers with or without chronic obstructive pulmonary disease (COPD) and to determine the value of DCE-MR perfusion imaging and CT volumetric imaging on the assessment of smokers. According to the ATS/ERS guidelines, 51 male smokers were categorized into five groups: At risk for COPD (n = 8), mild COPD (n = 9), moderate COPD (n = 12), severe COPD (n = 10), and very severe COPD (n = 12). Maximum slope of increase (MSI), positive enhancement integral (PEI), etc. were obtained from MR perfusion data. The signal intensity ratio (RSI) of the PDs and normal lung was calculated (RSI = SIPD/SInormal). Total lung volume (TLV), total emphysema volume (TEV) and emphysema index (EI) were obtained from volumetric CT data. For "at risk for COPD," the positive rate of PDs on MR perfusion images was higher than that of abnormal changes on non-enhanced CT images (p < 0.05). Moderate-to-strong positive correlations were found between all the PFT parameters and SIPD, or RSI (r range 0.445∼0.683, p ≤ 0.001). TEV and EI were negatively correlated better with FEV1/FVC than other PFT parameters (r range -0.48 --0.63, p < 0.001). There were significant differences in RSI and SIPD between "at risk for COPD" and "very severe COPD," and between "mild COPD" and "very severe COPD". Thus, MR perfusion imaging may be a good approach to identify early evidence of COPD and may have potential to assist in classification of COPD.
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Affiliation(s)
- Yi Xia
- 1Department of Radiology, Changzheng Hospital of the Second Military Medical University , Shanghai , China
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25
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Bauman G, Pusterla O, Bieri O. Ultra-fast Steady-State Free Precession Pulse Sequence for Fourier Decomposition Pulmonary MRI. Magn Reson Med 2015; 75:1647-53. [DOI: 10.1002/mrm.25697] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology; University of Basel Hospital; Basel Switzerland
| | - Orso Pusterla
- Division of Radiological Physics, Department of Radiology; University of Basel Hospital; Basel Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology; University of Basel Hospital; Basel Switzerland
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26
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Ciet P, Tiddens HAWM, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH. Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging. Pediatr Radiol 2015; 45:1901-15. [PMID: 26342643 PMCID: PMC4666905 DOI: 10.1007/s00247-015-3420-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/20/2015] [Accepted: 06/17/2015] [Indexed: 11/11/2022]
Abstract
Pediatric chest MRI is challenging. High-resolution scans of the lungs and airways are compromised by long imaging times, low lung proton density and motion. Low signal is a problem of normal lung. Lung abnormalities commonly cause increased signal intenstities. Among the most important factors for a successful MRI is patient cooperation, so the long acquisition times make patient preparation crucial. Children usually have problems with long breath-holds and with the concept of quiet breathing. Young children are even more challenging because of higher cardiac and respiratory rates giving motion blurring. For these reasons, CT has often been preferred over MRI for chest pediatric imaging. Despite its drawbacks, MRI also has advantages over CT, which justifies its further development and clinical use. The most important advantage is the absence of ionizing radiation, which allows frequent scanning for short- and long-term follow-up studies of chronic diseases. Moreover, MRI allows assessment of functional aspects of the chest, such as lung perfusion and ventilation, or airways and diaphragm mechanics. In this review, we describe the most common MRI acquisition techniques on the verge of clinical translation, their problems and the possible solutions to make chest MRI feasible in children.
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Affiliation(s)
- Pierluigi Ciet
- Department of Radiology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands ,Department of Pediatric Pulmonology and Allergology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Harm A. W. M. Tiddens
- Department of Radiology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands ,Department of Pediatric Pulmonology and Allergology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Piotr A. Wielopolski
- Department of Radiology, Sophia Children’s Hospital, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jim M. Wild
- Academic Radiology, University of Sheffield, Sheffield, UK
| | - Edward Y. Lee
- Departments of Radiology and Medicine, Pulmonary Divisions, Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - Giovanni Morana
- Department of Radiology, Ca’ Foncello Regional Hospital, Treviso, Italy
| | - Maarten H. Lequin
- Department of Radiology, Wilhelmina Children’s Hospital, University Medical Center, Wilhelmina Kinderziekenhuis (WKZ) Lundlaan 6, 3584 EA Utrecht, The Netherlands
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27
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Weidner M, Zöllner FG, Hagelstein C, Zahn K, Schaible T, Schoenberg SO, Schad LR, Neff KW. High temporal versus high spatial resolution in MR quantitative pulmonary perfusion imaging of two-year old children after congenital diaphragmatic hernia repair. Eur Radiol 2014; 24:2427-34. [PMID: 25038855 DOI: 10.1007/s00330-014-3304-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 05/15/2014] [Accepted: 06/30/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Congenital diaphragmatic hernia (CDH) leads to lung hypoplasia. Using dynamic contrast-enhanced (DCE) MR imaging, lung perfusion can be quantified. As MR perfusion values depend on temporal resolution, we compared two protocols to investigate whether ipsilateral lung perfusion is impaired after CDH, whether there are protocol-dependent differences, and which protocol is preferred. METHODS DCE-MRI was performed in 36 2-year old children after CDH on a 3 T MRI system; protocol A (n = 18) based on a high spatial (3.0 s; voxel: 1.25 mm(3)) and protocol B (n = 18) on a high temporal resolution (1.5 s; voxel: 2 mm(3)). Pulmonary blood flow (PBF), pulmonary blood volume (PBV), mean transit time (MTT), and peak-contrast-to-noise-ratio (PCNR) were quantified. RESULTS PBF was reduced ipsilaterally, with ipsilateral PBF of 45 ± 26 ml/100 ml/min to contralateral PBF of 63 ± 28 ml/100 ml/min (p = 0.0016) for protocol A; and for protocol B, side differences were equivalent (ipsilateral PBF = 62 ± 24 vs. contralateral PBF = 85 ± 30 ml/100 ml/min; p = 0.0034). PCNR was higher for protocol B (30 ± 18 vs. 20 ± 9; p = 0.0294). Protocol B showed higher values of PBF in comparison to protocol A (p always <0.05). CONCLUSIONS Ipsilateral lung perfusion is reduced in 2-year old children following CDH repair. Higher temporal resolution and increased voxel size show a gain in PCNR and lead to higher perfusion values. Protocol B is therefore preferred. KEY POINTS • Quantitative lung perfusion parameters depend on temporal and spatial resolution. • Reduction of lung perfusion in CDH can be measured with different MR protocols. • Temporal resolution of 1.5 s with spatial resolution of 2 mm (3) is suitable.
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Affiliation(s)
- M Weidner
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1-3, 68167, Mannheim, Germany,
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Kohlmann P, Strehlow J, Jobst B, Krass S, Kuhnigk JM, Anjorin A, Sedlaczek O, Ley S, Kauczor HU, Wielpütz MO. Automatic lung segmentation method for MRI-based lung perfusion studies of patients with chronic obstructive pulmonary disease. Int J Comput Assist Radiol Surg 2014; 10:403-17. [PMID: 24989967 DOI: 10.1007/s11548-014-1090-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/04/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE A novel fully automatic lung segmentation method for magnetic resonance (MR) images of patients with chronic obstructive pulmonary disease (COPD) is presented. The main goal of this work was to ease the tedious and time-consuming task of manual lung segmentation, which is required for region-based volumetric analysis of four-dimensional MR perfusion studies which goes beyond the analysis of small regions of interest. METHODS The first step in the automatic algorithm is the segmentation of the lungs in morphological MR images with higher spatial resolution than corresponding perfusion MR images. Subsequently, the segmentation mask of the lungs is transferred to the perfusion images via nonlinear registration. Finally, the masks for left and right lungs are subdivided into a user-defined number of partitions. Fourteen patients with two time points resulting in 28 perfusion data sets were available for the preliminary evaluation of the developed methods. RESULTS Resulting lung segmentation masks are compared with reference segmentations from experienced chest radiologists, as well as with total lung capacity (TLC) acquired by full-body plethysmography. TLC results were available for thirteen patients. The relevance of the presented method is indicated by an evaluation, which shows high correlation between automatically generated lung masks with corresponding ground-truth estimates. CONCLUSION The evaluation of the developed methods indicates good accuracy and shows that automatically generated lung masks differ from expert segmentations about as much as segmentations from different experts.
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Liszewski MC, Hersman FW, Altes TA, Ohno Y, Ciet P, Warfield SK, Lee EY. Magnetic resonance imaging of pediatric lung parenchyma, airways, vasculature, ventilation, and perfusion: state of the art. Radiol Clin North Am 2013; 51:555-82. [PMID: 23830786 DOI: 10.1016/j.rcl.2013.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Magnetic resonance (MR) imaging is a noninvasive imaging modality, particularly attractive for pediatric patients given its lack of ionizing radiation. Despite many advantages, the physical properties of the lung (inherent low signal-to-noise ratio, magnetic susceptibility differences at lung-air interfaces, and respiratory and cardiac motion) have posed technical challenges that have limited the use of MR imaging in the evaluation of thoracic disease in the past. However, recent advances in MR imaging techniques have overcome many of these challenges. This article discusses these advances in MR imaging techniques and their potential role in the evaluation of thoracic disorders in pediatric patients.
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Affiliation(s)
- Mark C Liszewski
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA
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Alexander M, McTaggart R, Santarelli J, Fischbein N, Marks M, Zaharchuk G, Do H. Multimodality Evaluation of Dural Arteriovenous Fistula with CT Angiography, MR with Arterial Spin Labeling, and Digital Subtraction Angiography: Case Report. J Neuroimaging 2013; 24:520-3. [DOI: 10.1111/jon.12032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/24/2013] [Accepted: 02/03/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Ryan McTaggart
- Stanford University Medical Center; Department of Radiology; Stanford CA
| | - Justin Santarelli
- Stanford University Medical Center; Department of Radiology; Stanford CA
- Stanford University Medical Center; Department of Neurosurgery; Stanford CA
| | - Nancy Fischbein
- Stanford University Medical Center; Department of Radiology; Stanford CA
- Stanford University Medical Center; Department of Neurosurgery; Stanford CA
- Stanford University Medical Center; Department of Otolaryngology; Stanford CA
| | - Michael Marks
- Stanford University Medical Center; Department of Radiology; Stanford CA
- Stanford University Medical Center; Department of Neurosurgery; Stanford CA
| | - Greg Zaharchuk
- Stanford University Medical Center; Department of Radiology; Stanford CA
| | - Huy Do
- Stanford University Medical Center; Department of Radiology; Stanford CA
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