[The helium-3 MRT of pulmonary ventilation: the initial clinical applications]

Redistribution of pulmonary ventilation after lung surgery detected with electrical impedance tomography

BACKGROUND

Regional ventilation of the lung can be visualized by pulmonary electrical impedance tomography (EIT). The aim of this study was to examine the post-operative redistribution of regional ventilation after lung surgery dependent on the side of surgery and its association with forced vital capacity.

METHODS

In this prospective, observational cohort study 13 patients undergoing right and 13 patients undergoing left-sided open or video-thoracoscopic procedures have been investigated. Pre-operative measurements with EIT and spirometry were compared with data obtained 3 days post-operation. The center of ventilation (COV) within a 32 × 32 pixel matrix was calculated from EIT data. The transverse axis coordinate of COV, COVx (left/right), was modified to COVx' (ipsilateral/contralateral). Thus, COVx' shows a negative change if ventilation shifts contralateral independent of the side of surgery. This enabled testing with two-way ANOVA for repeated measurements (side, time).

RESULTS

The perioperative shift of COVx' was dependent on the side of surgery (P = .007). Ventilation shifted away from the side of surgery after the right-sided surgery (COVx'-1.97 pixel matrix points, P < .001), but not after the left-sided surgery (COVx'-0.61, P = .425). The forced vital capacity (%predicted) decreased from 94 (83-109)% (median [quartiles]; [left-sided]) and 89 (80-97)% (right-sided surgery) to 61 (59-66)% and 62 (40-72)% (P < .05), respectively. The perioperative changes in forced vital capacity (%predicted) were weakly associated with the shift of COVx'.

CONCLUSION

Only after right-sided lung surgery, EIT showed reduced ventilation on the side of surgery while vital capacity was markedly reduced in both groups.

Two-dimensional and three-dimensional oxygen mapping by 3He-MRI validation in a lung phantom

The aim of this study was to validate oxygen-sensitive 3He-MRI in noninvasive determination of the regional, two- and three-dimensional distribution of oxygen partial pressure. In a gas-filled elastic silicon ventilation bag used as a lung phantom, oxygen sensitive two- and three-dimensional 3He-MRI measurements were performed at different oxygen concentrations which had been equilibrated in a range of normal and pathologic values. The oxygen partial pressure distribution was determined from 3He-MRI using newly developed software allowing for mapping of oxygen partial pressure. The reference bulk oxygen partial pressure inside the phantom was measured by conventional respiratory gas analysis. In two-dimensional measurements, image-based and gas-analysis results correlated with r=0.98; in three-dimensional measurements the between-methods correlation coefficient was r=0.89. The signal-to-noise ratio of three-dimensional measurements was about half of that of two-dimensional measurements and became critical (below 3) in some data sets. Oxygen-sensitive 3He-MRI allows for noninvasive determination of the two- and three-dimensional distribution of oxygen partial pressure in gas-filled airspaces.

Magnetic resonance imaging using hyperpolarized 3He-gas1

RATIONALE AND OBJECTIVES

Current imaging procedures of the lung concentrate on visualization of morphology. Computed tomography is the imaging method of choice for the majority of pulmonary diseases. Functional data are commonly obtained from arterial blood gas analysis, spirometry, and body plethysmography, which all suffer from lack of regional information.

MATERIALS AND METHODS

Magnetic resonance imaging (MRI) of the lung has been advanced recently by the use of hyperpolarized 3He as a new contrast mechanism. Four different image acquisition modes are performed during a typical patient study.

RESULTS

3He-MRI yields functional information about the lung with a high spatial and temporal resolution, avoiding the risks of ionizing radiation. The method is currently limited by high costs and restricted availability of the gas.

CONCLUSION

In this article, the experience obtained at the University of Mainz, being Europe's most experienced center performing 3He-MRI in humans, is reviewed against the international background.

Simulated pulmonary nodules implanted in a dedicated porcine chest phantom: sensitivity of MR imaging for detection

PURPOSE

To evaluate the diagnostic accuracy of common magnetic resonance (MR) imaging sequences for detection of small pulmonary nodules by using a chest phantom and porcine lungs containing simulated lesions.

MATERIALS AND METHODS

Fourteen porcine lungs containing 366 porcine myocardial tissue implants were inflated inside a phantom. Two-dimensional (2D) and three-dimensional (3D) gradient-echo (GRE), T2-weighted turbo spin-echo (SE), and T2-weighted single-shot SE train MR sequences were performed. Spiral computed tomography (CT) was performed for comparison. Blinded observers read the images and recorded the sizes and locations of visible nodules by consensus. The sensitivity of each imaging method for depicting single nodules of given sizes was calculated. Specificities, positive predictive values (PPVs), and negative predictive values (NPVs) for detection of one or more nodules of various sizes were calculated.

RESULTS

Sensitivities of 3D GRE, 2D GRE, T2-weighted turbo SE, and T2-weighted single-shot SE train MR imaging and of CT were 0.50, 0.40, 0.12, 0.00, and 0.55, respectively, for detection of 1.4-mm nodules and 0.88, 0.84, 0.69, 0.06, and 0.96, respectively, for detection of 4.2-mm nodules. The 95% CIs for CT and GRE MR imaging overlapped, but those for turbo SE and single-shot SE train MR imaging differed significantly (P <.05). For detection of nodules larger than 5 mm, all examinations except single-shot SE train MR imaging yielded a specificity, PPV, and NPV of 1.00 each. For detection of nodules smaller than 5 mm, diagnostic accuracy of 3D GRE MR imaging was high: Specificity, PPV, and NPV all were approximately 0.90. Two-dimensional GRE MR imaging results were influenced by false-positive findings: Specificity was 0.64; PPV, 0.74; and NPV, 1.00.

CONCLUSION

Common MR imaging sequences such as 3D GRE have high diagnostic accuracy in depicting small pulmonary nodules when artifacts from cardiac and respiratory motion are absent.

Lung morphology: fast MR imaging assessment with a volumetric interpolated breath-hold technique: initial experience with patients

PURPOSE

To prospectively evaluate the clinical feasibility of magnetic resonance (MR) imaging of the lungs with fast volumetric interpolated three-dimensional (3D) gradient-recalled-echo (GRE) sequences and to compare this examination with standard computed tomography (CT) in patients with lung abnormalities.

MATERIALS AND METHODS

Twenty-five patients with different lung abnormalities were examined with 3D GRE MR imaging. The small pulmonary nodules in seven, TNM stage of large intrapulmonary tumors in eight, and benign bronchial disease in five patients were evaluated. MR imaging-based diagnoses were compared with diagnoses made at CT and at discharge from the hospital. Contingency tables and the McNemar test were used to evaluate the significance of differences between MR imaging- and CT-based diagnoses.

RESULTS

The MR imaging- and CT-based diagnoses were identical in 24 of 25 patients. In the remaining patient, clinical findings confirmed the accuracy of the MR imaging finding of pleural empyema. Ten of 15 solid pulmonary nodules smaller than 10 mm in diameter were detected at MR imaging (P >.1). Tumor stages at MR imaging and CT were identical, but lymph node stages at the two examinations differed in two of eight patients owing to overestimation of lymph node size at MR imaging (P >.2). In the five patients with bronchiectasis, MR imaging depicted 26 of 33 affected lung segments; differences between MR imaging and CT findings of bronchial dilatation (P >.05) and bronchial wall thickening (P >.2) were not significant. Peribronchial fibrosis was overestimated at MR imaging owing to image artifacts (P <.05).

CONCLUSION

Study results confirmed the feasibility of fast breath-hold 3D GRE MR imaging of the lung.

Artificial thorax for MR imaging studies in porcine heart-lung preparations

A double-walled magnetic resonance (MR) imaging-compatible container with a flexible diaphragm was designed to hold freshly excised porcine heart-lung preparations. The saline contents simulate MR signal of an actual chest wall. Continuous evacuation keeps the lung inflated. A variety of experiments with different imaging modalities, including angiography, under close to in vivo conditions are feasible. Access to bronchial system and lung vessels allows for various studies.

CT and MR in pulmonary embolism: A changing role for nuclear medicine in diagnostic strategy

The goal of this article is to summarize current data on computed tomography (CT) and magnetic resonance (MR) in the diagnosis of acute pulmonary embolism (PE) in relation to the radionuclide ventilation perfusion scan. It is important for the nuclear medicine, CT, and MR communities to develop a shared approach to this disorder. Triage using chest radiographs appears to be a practical method for enhancing both nuclear medicine and CT/MR performance. The realization that there is no clinically available gold standard for the diagnosis of PE suggests that the imaging community should replace impractical and idealistic discussions with more realistic outcome-oriented approaches. A simplified one-step evaluation of the pulmonary arteries and the lower extremity veins for deep venous thrombus can provide a comprehensive examination for PE. CT is currently a more practical diagnostic tool, whereas MR offers a scientific probe for pulmonary physiology including the regional mapping of ventilation-perfusion relationships. Nuclear medicine, CT, and MR thus form an imaging triad for the diagnosis of acute PE.

Dynamic ventilation (3)He-magnetic resonance imaging with lung motion correction: gas flow distribution analysis

RATIONALE AND OBJECTIVES

Software was developed to correct for lung motion to improve the description of hyperpolarized (3)He gas distribution in the lung.

METHODS

Five volunteers were studied by dynamic ventilation (3)He-MRI using an ultrafast FLASH 2D sequence with a temporal resolution of 128 milliseconds. Signal kinetics were evaluated in the trachea and seven parenchymal Regions of Interest. Reference ranges for healthy subjects were defined for motion-corrected and uncorrected images.

RESULTS

Motion correction was successfully performed. Reference ranges were 0.11-1.21 seconds for tracheal transit time, 0-0.02 seconds for trachea-alveolar interval, 0.22-0.62 seconds for alveolar rise time and 0-76.6 arbitrary units for alveolar amplitude for motion corrected images, and 0-1.09 seconds, 0-0.11 seconds, 0.26-0.85 seconds, 46.4-99.8 arbitrary units for uncorrected images.

CONCLUSIONS

Evaluation of (3)He-distribution in the lung using motion correction of dynamic (3)He-ventilation imaging is feasible and gives more narrow reference ranges.

MRI in lung transplant recipients using hyperpolarized 3He: comparison with CT

PURPOSE

To elucidate the ability of 3He-MRI to detect ventilation defects in lung transplant recipients, 3He-MRI was compared to CT for concordance.

MATERIALS AND METHODS

We examined 14 lung recipients using 3He-MRI on a 1.5 T MR scanner. CT served as a reference method. Up to four representative ventilation defects were defined for each lung on 3He-MRI and compared to corresponding areas on CT.

RESULTS

Altogether, 59 representative ventilation defects were defined on 3He-MRI. Plausible CT correlates were found for 29 ventilation defects; less plausible CT correlates were found for eight defects. In 22 defects (37%) no corresponding CT changes were detected. CT demonstrated correlates for ventilation defects seen on 3He-MRI in only 63% of the cases.

CONCLUSION

3He-MRI yields a clear increase in the number of detected ventilation defects compared to CT. This may have an important impact on the early detection of bronchiolitis obliterans in lung transplant recipients.

Mechanical delivery of aerosolized gadolinium-DTPA for pulmonary ventilation assessment in MR imaging

RATIONALE AND OBJECTIVES

To evaluate a new technique with mechanical administration of aerosolized gadolinium (Gd)-DTPA for MR visualization of lung ventilation.

METHODS

Ten experimental procedures were performed in six domestic pigs. Gd-DTPA was aerosolized by a small-particle generator. The intubated animals were mechanically aerosolized with the nebulized contrast agent and studied on a 1.5-T MR imager. Respiratory gated T1-weighted turbo spin-echo images were obtained before, during, and after contrast administration. Pulmonary signal intensity (SI) changes were calculated for corresponding regions of both lungs. Homogeneity of aerosol distribution was graded independently by two radiologists.

RESULTS

To achieve a comparable SI increase as attained in previous trials that used manual aerosol ventilation, a ventilation period of 20 minutes (formerly 30 minutes) was sufficient. Mean SI changes of 116% were observed after that duration. Contrast delivery was rated evenly distributed in all cases by the reviewers.

CONCLUSIONS

The feasibility of applying Gd-DTPA as a contrast agent to demonstrate pulmonary ventilation in large animals has been described before. The results of this refined technique substantiate the potential of Gd-based ventilation MR imaging by improving aerosol distribution and shortening the nebulization duration in the healthy lung.