Feasibility of Pulmonary Ventilation Visualization With Aerosolized Magnetic Resonance Contrast Media

Magnetic Resonance Imaging of Aerosol Deposition

Nuclear magnetic resonance imaging (MRI) uses non-ionizing radiation and offers a host of contrast mechanisms with the potential to quantify aerosol deposition. This chapter introduces the physics of MRI, its use in lung imaging, and more specifically, the methods that are used for the detection of regional distributions of inhaled particles. The most common implementation of MRI is based on imaging of hydrogen atoms (1H) in water. The regional deposition of aerosol particles can be measured by the perturbation of the acquired 1H signals via labeling of the aerosol with contrast agents. Existing in vitro human and in vivo animal model measurements of regional aerosol deposition in the respiratory tract are described, demonstrating the capability of MRI to assess aerosol deposition in the lung.

Imaging drug delivery to the lungs: Methods and applications in oncology

Direct delivery to the lung via inhalation is arguably one of the most logical approaches to treat lung cancer using drugs. However, despite significant efforts and investment in this area, this strategy has not progressed in clinical trials. Imaging drug delivery is a powerful tool to understand and develop novel drug delivery strategies. In this review we focus on imaging studies of drug delivery by the inhalation route, to provide a broad overview of the field to date and attempt to better understand the complexities of this route of administration and the significant barriers that it faces, as well as its advantages. We start with a discussion of the specific challenges for drug delivery to the lung via inhalation. We focus on the barriers that have prevented progress of this approach in oncology, as well as the most recent developments in this area. This is followed by a comprehensive overview of the different imaging modalities that are relevant to lung drug delivery, including nuclear imaging, X-ray imaging, magnetic resonance imaging, optical imaging and mass spectrometry imaging. For each of these modalities, examples from the literature where these techniques have been explored are provided. Finally the different applications of these technologies in oncology are discussed, focusing separately on small molecules and nanomedicines. We hope that this comprehensive review will be informative to the field and will guide the future preclinical and clinical development of this promising drug delivery strategy to maximise its therapeutic potential.

Three-dimensional quantitative MRI of aerosolized gadolinium-based nanoparticles and contrast agents in isolated ventilated porcine lungs

PURPOSE

The objective of this study is to evaluate the suitability and performance of ultra-short echo time (UTE) sequences for imaging and quantifying the deposition of nebulized MRI contrast agents in human-sized lungs.

METHODS

Nebulization of clinically used contrast agent or gadolinium-based nanoparticles were performed using a commercial jet nebulizer in isolated and ventilated porcine lungs connected to a 3D-printed human upper airways replica. MR images of isolated lungs were acquired on a 3T clinical MR scanner using 3D UTE sequences at different flip angles.

RESULTS

3D acquisitions with isotropic millimetric resolution were obtained in less than 4 min. Images exhibit homogeneous and large MR signal enhancement (above 200%) following nebulization of both types of aerosols. Deposition of aerosol down to the level of the bronchi of secondary lobules was visualized. T₁ values and the concentration of nanoparticles obtained by MRI were found to correlate with the amount of nebulized gadolinium³⁺ ions.

CONCLUSION

The distribution of aerosolized gadolinium-based contrast agent or nanoparticles can be visualized and quantified using UTE MRI in large animal ventilated lung model on a clinical MRI scanner. This protocol can be used for assessing and quantifying aerosol regional deposition with high spatial resolution (1 mm 3D isotropic) without ionizing radiation and could be applied in the future for diagnostic or therapeutic applications in patients.

Orotracheal manganese-enhanced MRI (MEMRI): An effective approach for lung tumor detection

Lung cancer is a primary cause of cancer deaths worldwide. Timely detection of this pathology is necessary to delay or interrupt lung cancer progression, ultimately resulting in a possible better prognosis for the patient. In this context, magnetic resonance imaging (MRI) is especially promising. Ultra-short echo time (UTE) MRI sequences, in combination with gadolinium-based contrast agents, have indeed shown to be especially adapted to the detection of lung neoplastic lesions at submillimeter precision. Manganese-enhanced MRI (MEMRI) increasingly appears to be a possible effective alternative to gadolinium-enhanced MRI. In this work, we investigated whether low-dose MEMRI can effectively target non-small-cell lung cancer in rodents, whilst minimizing the potential toxic effect of manganese. Both systemic and orotracheal administration modalities allowed the identification of tumors of submillimeter size, as confirmed by bioluminescence imaging and histology. Equivalent tumor signal enhancements and contrast-to-noise ratios were observed with orotracheal administration using 20 times lower doses compared with the more conventional systemic route. This finding is of crucial importance as it supports the observation that higher performances of contrast agents can be obtained using an orotracheal administration route when targeting lung diseases. As a consequence, lower concentrations of contrast media can be employed, reducing the dose and potential safety issues. The non-detectable accumulation of ionic manganese in the brain and liver following orotracheal administration observed in vivo is extremely encouraging with regard to the safety of the orotracheal protocol with low-dose Mn²⁺ administration. To our knowledge, this is the first time that a study has clearly allowed the high-precision detection of lung tumor and its contours via the synergic employment of a strongly T₁ -weighted MRI UTE sequence and ionic manganese, an inexpensive contrast agent. Overall, these results support the growing interest in drug and contrast agent delivery via the airways to target and diagnose several diseases of the lungs.

Management of COPD: Is there a role for quantitative imaging?

While the recent development of quantitative imaging methods have led to their increased use in the diagnosis and management of many chronic diseases, medical imaging still plays a limited role in the management of chronic obstructive pulmonary disease (COPD). In this review we highlight three pulmonary imaging modalities: computed tomography (CT), magnetic resonance imaging (MRI) and optical coherence tomography (OCT) imaging and the COPD biomarkers that may be helpful for managing COPD patients. We discussed the current role imaging plays in COPD management as well as the potential role quantitative imaging will play by identifying imaging phenotypes to enable more effective COPD management and improved outcomes.

Orotracheal administration of contrast agents: a new protocol for brain tumor targeting

The development of new non-invasive diagnostic and therapeutic approaches is of paramount importance in order to improve the outcome of patients with glioblastoma (GBM). In this work we investigated a completely non-invasive pre-clinical protocol to effectively target and detect brain tumors through the orotracheal route, using ultra-small nanoparticles (USRPs) and MRI. A mouse model of GBM was developed. In vivo MRI acquisitions were performed before and after intravenous or orotracheal administration of the nanoparticles to identify and segment the tumor. The accumulation of the nanoparticles in neoplastic lesions was assessed ex vivo through fluorescence microscopy. Before the administration of contrast agents, MR images allowed the identification of the presence of abnormal brain tissue in 73% of animals. After orotracheal or intravenous administration of USRPs, in all the mice an excellent co-localization of the position of the tumor with MRI and histology was observed. The elimination time of the USRPs from the tumor after the orotracheal administration was approximately 70% longer compared with intravenous injection. MRI and USRPs were shown to be powerful imaging tools able to detect, quantify and longitudinally monitor the development of GBMs. The absence of ionizing radiation and high resolution of MRI, along with the complete non-invasiveness and good reproducibility of the proposed protocol, make this technique potentially translatable to humans. To our knowledge, this is the first time that the advantages of a needle-free orotracheal administration route have been demonstrated for the investigation of the pathomorphological changes due to GBMs.

Magnetic resonance imaging of cystic fibrosis lung disease

Lung involvement in cystic fibrosis (CF) disease continues to be a major life-limiting factor of this autosomal recessive genetic disorder. Efforts made toward early diagnosis and advances in therapy have led to sustained survival of affected patients, and many are now of adult age. Because imaging provides detailed information on regional distribution of CF lung disease, repetitive imaging is required for severity assessment and therapy monitoring not only in clinical routine but also for interventional trials. Computed tomography has long succeeded chest radiograph because it provides the highest morphologic detail of airway and parenchymal changes. This is inseparably accompanied by an increase in radiation exposure to CF individuals, who are critically susceptible to, and may accumulate, relevant doses during their lifetime. Magnetic resonance imaging (MRI) as an ionizing radiation-free cross-sectional imaging modality is capable of depicting anatomic hallmarks of CF lung disease at lower spatial resolution but with enhanced tissue characterization. Comprehensive functional lung imaging (imaging of respiratory mechanics, ventilation, and lung perfusion) provides valuable additional information that cannot or can hardly be obtained by any other single diagnostic procedure. The present review article strives to present the current state of lung MRI in CF, as well as its future perspectives. Functional MRI of the CF lung is at the threshold of being considered a routine application, which, supporting early diagnosis, may help to further improve the survival of CF patients.

Manganese: a new contrast agent for lung imaging?

Lung parenchyma remains one of the most difficult tissues to be imaged by means of magnetic resonance imaging (MRI). Several MRI techniques are routinely used for lung imaging. However, manganese-enhancement MRI (MEMRI) technique has not been associated with pulmonary MRI. Here, we evaluated T(1) -enhancement in the rat lung after a manganese instillation, using a 4.7 T magnet with a radial ultrashort echo time sequence. Our data showed that the signal intensity was increased in lungs receiving a manganese solution compared with a control solution to the lungs. MR signal enhancements above 30% were measured in lung parenchyma following 200 µl instillation of a 1 mm manganese chloride solution. MEMRI, therefore, may be a useful novel tool for enhancing signal intensity and image contrast in lung tissue.

Regional distribution of aerosol deposition in rat lungs using magnetic resonance imaging

The toxic or therapeutic effect of an inhaled aerosol is highly dependent upon the site and extent of deposition in the lung. A novel MRI-based method was used to quantify the spatial distribution of particles in the rat lung. Rats were exposed to 0.95 μm-diameter iron oxide particles in a controlled manner (N = 6) or to particle-free air (N = 6). Lungs were fixed in 3% glutaraldehyde by vascular perfusion, excised and imaged in a 3T scanner using a gradient-echo imaging protocol. The signal decay rate, R2*, was measured in each voxel of the entire left lung (1 mm thick slices). R2* was significantly higher in exposed animals (0.0065 ± 0.0006 ms(-1)) than in controls (0.0050 ± 0.0003 ms(-1), p < 0.001). A calibration curve between R2* and concentration of deposited particles (C(part)) was obtained by imaging gel samples with known particle concentrations. Regional deposition was assessed by comparing C(part) between the outer (C(part,peripheral)) and inner (C(part,central)) areas on each transaxial slice, and expressed as the c/p ratio. C(part,peripheral) (1.54 ± 0.70 μg/mL) was significantly higher than C(part,central) (1.00 ± 0.39 μg/mL, p<0.05), resulting in a c/p ratio of 0.65. This method may be used in future studies to quantify spatial distribution of deposited particles in healthy and diseased lungs.

The importance of imaging and physiology measurements in assessing the delivery of peripherally targeted aerosolized drugs

Considerable recent effort has been directed towards developing new aerosol formulations and delivery devices that can target drugs to the lung periphery. In order to determine the efficacy of targeted drug therapy, it is essential that the peripheral lung region be adequately assessed. Imaging of the airways structure and pathology has greatly advanced in the last decade and this rate of growth is accelerating as new technologies become available. Lung imaging continues to play an important role in the study of the peripheral airways and, when combined with state-of-the-art lung function measurements and computational modeling, can be a powerful tool for investigating the effects of inhaled medication. This article focuses on recent strategies in imaging and physiological measurements of the lungs that allow the assessment of inhaled medication delivered to the periphery and discusses how these methods may help to further optimize and refine future aerosol delivery technology.

Nebulized liposomal gadobenate dimeglumine contrast formulation for magnetic resonance imaging of larynx and trachea

Background

To develop a lipid-stabilized contrast formulation containing gadobenate dimeglumine for clear visualization of the mucosal surfaces of the larynx and trachea for early diagnosis of disease by magnetic resonance imaging.

Methods

The contrast formulation was prepared by loading gadobenate dimeglumine into egg phosphotidylcholine, cholesterol, and sterylamine nanoliposomes using the dehydration-rehydration method. The liposomal contrast formulation was ultrasonically nebulized, and the deposition and coating pattern on explanted pig laryngeal and tracheal segments was examined by inductively coupled plasma atomic emission spectroscopy. The sizes of the nebulized droplets were characterized by photon correlation spectroscopy. The contrast-enhanced mucosal surface images of the larynx and trachea were obtained in a 3.0T magnetic resonance scanner using a T1-weighted spectral presaturation inversion recovery sequence.

Results

Various cationic liposome formulations were compared for their stabilization effects on the droplets containing gadobenate dimeglumine. The liposomes composed of egg phosphotidylcholine, cholesterol, and sterylamine in a molar ratio of 1:1:1 were found to enable the most efficient nebulization and the resulting droplet sizes were narrowly distributed. They also resulted in the most even coating on the laryngeal and tracheal lumen surfaces and produced significant contrast enhancement along the mucosal surface. Such contrast enhancement could help clearer visualization of several disease states, such as intraluminal protrusions, submucosal nodules, and craters.

Conclusion

This lipid-stabilized magnetic resonance imaging contrast formulation may be useful for improving mucosal surface visualization and early diagnosis of disease originating in the mucosal surfaces of the larynx and trachea.

Magnetic resonance methods and applications in pharmaceutical research

This review presents an overview of some recent magnetic resonance (MR) techniques for pharmaceutical research. MR is noninvasive, and does not expose subjects to ionizing radiation. Some methods that have been used in pharmaceutical research MR include magnetic resonance spectroscopy (MRS) and magnetic resonance imaging (MRI) methods, among them, diffusion-weighted MRI, perfusion-weighted MRI, functional MRI, molecular imaging and contrast-enhance MRI. Some applications of MR in pharmaceutical research include MR in metabonomics, in vivo MRS, studies in cerebral ischemia and infarction, degenerative joint diseases, oncology, cardiovascular disorders, respiratory diseases and skin diseases. Some of these techniques, such as cardiac and joint imaging, or brain fMRI are standard, and are providing relevant data routinely. Skin MR and hyperpolarized gas lung MRI are still experimental. In conclusion, considering the importance of finding and characterizing biomarkers for improved drug evaluation, it can be expected that the use of MR techniques in pharmaceutical research is going to increase in the near future.

Visualizing water clearance in the lung with MRI

Current indirect measurements of alveolar fluid clearance (AFC) suggest that the rate of fluid clearance correlates with morbidity and mortality in patients with pulmonary edema. In a traditional AFC-measurement, fluid laced with a tracer macromolecule is instilled into the lung and thereafter repeated samples of the instilled fluid are extracted from the lung's fluid-filled airspaces. The change in concentration of the tracer molecule indicates the AFC-rate. In this work, a new MRI technique was developed to image lung water clearance by adding Gadolinium-DTPA to the instilled fluid. As fluid is absorbed by the animal, the concentration of gadolinium will increase, reducing the T(1) relaxation time. By repeatedly measuring the T(1) relaxation time, the AFC can be tracked over time with high spatial resolution. The new technique was tested both in phantoms and 10 Yorkshire piglets.

Detectability of regional lung ventilation with flat-panel detector-based dynamic radiography

This study was performed to investigate the ability of breathing chest radiography using flat-panel detector (FPD) to quantify relative local ventilation. Dynamic chest radiographs during respiration were obtained using a modified FPD system. Imaging was performed in three different positions, ie, standing and right and left decubitus positions, to change the distribution of local ventilation. We measured the average pixel value in the local lung area. Subsequently, the interframe differences, as well as difference values between maximum inspiratory and expiratory phases, were calculated. The results were visualized as images in the form of a color display to show more or less x-ray translucency. Temporal changes and spatial distribution of the results were then compared to lung physiology. In the results, the average pixel value in each lung was associated with respiratory phase. In all positions, respiratory changes of pixel value in the lower area were greater than those in the upper area (P < 0.01), which was the same tendency as the regional differences in ventilation determined by respiratory physiology. In addition, in the decubitus position, it was observed that areas with large respiratory changes in pixel value moved up in the vertical direction during expiration, which was considered to be airway closure. In conclusion, breathing chest radiography using FPD was shown to be capable of quantifying relative ventilation in local lung area and detecting regional differences in ventilation and timing of airway closure. This method is expected to be useful as a new diagnostic imaging modality for evaluating relative local ventilation.

Oxygen-enhanced magnetic resonance imaging: influence of different gas delivery methods on the T1-changes of the lungs

OBJECTIVE

The clinical feasibility of oxygen-enhanced magnetic resonance imaging (MRI) of the lung may benefit from the use of a simple gas delivery method. In this study, the oxygen-induced T1 change of the lung obtained using a closed O(2) delivery system was compared with that obtained by a conventional nontight face mask.

MATERIAL AND METHODS

Twenty-three healthy subjects (15 men, 8 women, mean age = 25 years, age range = 20-35 years) underwent oxygen-enhanced MRI of the lung using a closed O(2) delivery system composed by a tightly fitting face mask and a 60-L reservoir bag (equipment type A: n = 13, 9 men, 4 women, mean age = 24.4 years, age range = 20-32 years), or a clinically available nontight face mask (equipment type B: n = 10; 6 men, 4 women, mean age = 25.8 years, age range = 20-35 years). The effect of 100%-oxygen inhalation was assessed using a Snapshot FLASH T1-mapping technique (repetition time/echo time = 1.5-1.6/0.56 milliseconds; matrix = 128 x 90; acquisition time = 3.3-3.7 seconds; slice thickness = 15-20 mm; number of images = 40). By nonlinear curve fitting, the mean T1 values of the left and right lung at room air and 100%-oxygen ventilation were calculated (T1(room air, right); T1(oxygen, right); T1(room air, left); T1(oxygen, left)). The average T1 differences (DeltaT1 = T1(room air) - T1(oxygen)) of the 2 volunteer groups were compared (Wilcoxon signed rank test, Mann-Whitney U test).

RESULTS

The mean T1 values obtained using the 2 respiratory equipments at room air or oxygen ventilation were not significantly different (A vs. B at room air ventilation: P = 0.85 for the right lung, P = 0.27 for the left lung; A vs. B at oxygen ventilation: P = 0.55 for the left lung, P = 0.29 for the right lung). With both systems, the mean T1 values decreased significantly after oxygen inhalation (P = 0.03-0.0002). For both lungs, the DeltaT1 obtained using the equipment type A was statistically equivalent to that obtained using the equipment type B: DeltaT1A, right = 96 +/- 19 milliseconds versus DeltaT1B, right = 97 +/- 34 milliseconds (P = 0.82); DeltaT1A, left = 74 +/- 47 milliseconds versus DeltaT1B, left = 68 +/- 63 milliseconds (P = 0.85).

CONCLUSION

Gas delivery in oxygen-enhanced MRI of the lung can be performed with a clinically available standard face mask, without the need for closed sophisticated equipments.

Aerosol delivery in ventilated newborn pigs: an MRI evaluation

Pulmonary deposition of inhaled drugs in ventilated neonates has not been studied in vivo. The objective of this study was to evaluate pulmonary delivery of gadopentetate dimeglumine (Gd-DTPA) following nebulization in ventilated piglets using magnetic resonance imaging. Seven ventilated piglets (5 +/- 2 d old, weight 1.8 +/- 0.5 kg) were scanned in the Bruker/Siemens 4T magnetic resonance scanner using T1 weighted spin-echo sequence. Aerosols of Gd-DTPA were generated continuously using the MiniHeart jet nebulizer. Breath-hold coronal images were obtained before and every 10 min during aerosolized Gd-DTPA for 90 min. Signal intensity (SI) changes over the lungs, kidneys, liver, skeletal muscle, and heart were evaluated. A significant increase in SI was observed in the lungs, kidney, and liver at 10, 20, and 40 min respectively after start of aerosol. At the end of 90 min, the SI increased by 95%, 101%, and 426% over the right lung, left lung, and kidney, respectively. A much smaller increase in SI was observed over the liver. In conclusion, we have demonstrated effective pulmonary aerosol delivery within 10 min of contrast nebulization in ventilated piglets. Contrast visualization in the kidneys within 20 min of aerosol initiation reflects alveolar absorption, glomerular filtration and renal concentration.

Evaluation of a Reduced Dose Protocol for Respiratory Gated Lung Computed Tomography in an Animal Model

OBJECTIVE

We sought to evaluate and validate a low-dose protocol for respiratory-gated multislice computed tomography (CT) for volume calculations in small ventilated neonatal animals as a model for the ventilated human neonatal lung.

MATERIALS AND METHODS

Five mechanically ventilated newborn piglets were imaged in a multislice CT scanner (0.5-mm slice thickness, 4:16 pitch, 0.5 seconds rotation time, 120 kV) using a normal (100 mAs) and a reduced (10 mAs) dose protocol. All animals were scanned twice (at 100 and 10 mAs) at each of 3 different ventilator settings. Complete volume datasets were reconstructed throughout the respiratory cycle in increments of 10% using retrospective half-scan reconstruction. End-inspiratory volumes and volumes during maximal expiration (functional residual capacity) were calculated by a customized software and values for normal and reduced dose protocols were compared using Kolmogorov-Smirnov test and Bland-Altman plots.

RESULTS

Two volume datasets (one normal and one reduced dose protocol) showed artifacts on the axial images, which could not be analyzed by the software. Those values were determined after manual segmentation and excluded from final analysis. The mean (+/-SD) end-inspiratory volumes and functional residual capacity were 34.3 +/- 10.1 mL and 25.3 +/- 8.0 mL for the normal-dose protocol versus 33.1 +/- 10.0 mL and 24.7 +/- 8.1 mL for the reduced-dose protocol, respectively. There was no statistically significant difference between normal and reduced dose protocol (KS-Test: D = 0.14 < Dmax).

CONCLUSION

Lung volume calculation in ventilated newborn piglets (end-inspiratory volumes and functional residual capacity) can be performed using respiratory-gated multislice CT even at a substantially reduced dose (eg, to 10 mAs). This makes the technique a candidate for future pediatric use.

Toxicological aspects and applications of nanoparticles in paediatric respiratory disease

Most research in the area of micro- and nano-particles as applied to respiratory disease has been on potential toxic effects. Particulate emissions from industrial processes, coal burning and diesel exhaust have been shown to cause a variety of adverse effects both in vitro and in vivo. However, the vast majority of these studies has focused on larger, micron-sized particles. It is only within the last few years that the emphasis has shifted to nanoparticles as nanotechnology research and its applications have increased. Investigations have also begun into how nanoparticles may be used for therapeutic and imaging purposes in pulmonary diseases such as tuberculosis and cystic fibrosis. Some of these applications, along with recent studies on the toxic effects of nanoparticulate emissions will be reviewed in this article.

Rapid Lung Volumetry Using Ultrafast Dynamic Magnetic Resonance Imaging During Forced Vital Capacity Maneuver

INTRODUCTION

Dynamic magnetic resonance imaging (MRI) has the potential for rapid noninvasive evaluation of changes in lung volume. The aim of this study was to perform rapid lung volumetry using ultrafast dynamic MRI to capture a forced vital capacity (FVC) maneuver.

MATERIALS AND METHODS

Nine healthy volunteers underwent 2-dimensional spoiled gradient echo imaging in coronal and sagittal planes during FVC maneuvers. An elliptical model of the axial cross section of the lungs was used to generate rapid volume-time curves. Spirometric indices were correlated with MR volumetry findings.

RESULTS

Total lung volume calculated from static MRI correlated well with the dynamic MR scans (r = 0.83; P < 0.01). Spirometric indices (first second of forced expiration and FVC) calculated from our MR volumetry technique correlated well with conventional spirometry (P < 0.01).

CONCLUSION

The technique provides a means of sampling lung volume change during the rapid subsecond movements that take place during a FVC maneuver.

High-Resolution Three-Dimensional Magnetic Resonance Imaging of Mouse Lung In Situ

OBJECTIVES

This study establishes a method for high-resolution isotropic magnetic resonance (MR) imaging of mouse lungs using tracheal liquid-instillation to remove MR susceptibility artifacts.

METHODS

C57BL/6J mice were instilled sequentially with perfluorocarbon and phosphate-buffered saline to an airway pressure of 10, 20, or 30 cm H2O. Imaging was performed in a 7T MR scanner using a 2.5-cm Quadrature volume coil and a 3-dimensional (3D) FLASH imaging sequence.

RESULTS

Liquid-instillation removed magnetic susceptibility artifacts and allowed lung structure to be viewed at an isotropic resolution of 78-90 microm. Instilled liquid and modeled lung volumes were well correlated (R = 0.92; P < 0.05) and differed by a constant tissue volume (220 +/- 92 microL). 3D image renderings allowed differences in structural dimensions (volumes and areas) to be accurately measured at each inflation pressure.

CONCLUSION

These data demonstrate the efficacy of pulmonary liquid instillation for in situ high-resolution MR imaging of mouse lungs for accurate measurement of pulmonary airway, parenchymal, and vascular structures.

Evaluation of pulmonary function using breathing chest radiography with a dynamic flat panel detector: primary results in pulmonary diseases

OBJECTIVES

Dynamic flat panel detectors (FPD) permit acquisition of distortion-free radiographs with a large field of view and high image quality. The present study was performed to evaluate pulmonary function using breathing chest radiography with a dynamic FPD. We report primary results of a clinical study and computer algorithm for quantifying and visualizing relative local pulmonary airflow.

MATERIALS AND METHODS

Dynamic chest radiographs of 18 subjects (1 emphysema, 2 asthma, 4 interstitial pneumonia, 1 pulmonary nodule, and 10 normal controls) were obtained during respiration using an FPD system. We measured respiratory changes in distance from the lung apex to the diaphragm (DLD) and pixel values in each lung area. Subsequently, the interframe differences (D-frame) and difference values between maximum inspiratory and expiratory phases (D-max) were calculated. D-max in each lung represents relative vital capacity (VC) and regional D-frames represent pulmonary airflow in each local area. D-frames were superimposed on dynamic chest radiographs in the form of color display (fusion images). The results obtained using our methods were compared with findings on computed tomography (CT) images and pulmonary functional test (PFT), which were examined before inclusion in the study.

RESULTS

In normal subjects, the D-frames were distributed symmetrically in both lungs throughout all respiratory phases. However, subjects with pulmonary diseases showed D-frame distribution patterns that differed from the normal pattern. In subjects with air trapping, there were some areas with D-frames near zero indicated as colorless areas on fusion images. These areas also corresponded to the areas showing air trapping on computed tomography images. In asthma, obstructive abnormality was indicated by areas continuously showing D-frame near zero in the upper lung. Patients with interstitial pneumonia commonly showed fusion images with an uneven color distribution accompanied by increased D-frames in the area identified as normal on computed tomography images. Furthermore, measurement of DLD was very effective for evaluating diaphragmatic kinetics.

CONCLUSIONS

This is a rapid and simple method for evaluation of respiratory kinetics for pulmonary diseases, which can reveal abnormalities in diaphragmatic kinetics and regional lung ventilation. Furthermore, quantification and visualization of respiratory kinetics is useful as an aid in interpreting dynamic chest radiographs.

Advances in magnetic resonance imaging of lung physiology

This review presents an overview of some recent magnetic resonance imaging (MRI) techniques for measuring aspects of local physiology in the lung. MRI is noninvasive, relatively high resolution, and does not expose subjects to ionizing radiation. Conventional MRI of the lung suffers from low signal intensity caused by the low proton density and the large degree of microscopic field inhomogeneity that degrades the magnetic resonance signal and interferes with image acquisition. However, in recent years, there have been rapid advances in both hardware and software design, allowing these difficulties to be minimized. This review focuses on some newer techniques that measure regional perfusion, ventilation, gas diffusion, ventilation-to-perfusion ratio, partial pressure of oxygen, and lung water. These techniques include contrast-enhanced and arterial spin-labeling techniques for measuring perfusion, hyperpolarized gas techniques for measuring regional ventilation, and apparent diffusion coefficient and multiecho and gradient echo techniques for measuring proton density and lung water. Some of the major advantages and disadvantages of each technique are discussed. In addition, some of the physiological issues associated with making measurements are discussed, along with strategies for understanding large and complex data sets.

Advances in Magnetic Resonance (2006)

Advances in the field of magnetic resonance (MR) as it pertains to clinical diagnostic radiology are examined in this review on the basis of publications in Investigative Radiology over the past 2 years (2005-2006). The articles published during that timeframe are discussed, organizationally wise, by anatomic region with an additional focus on studies involving MR contrast media.

Simultaneous Cardiac and Respiratory Synchronization in Oxygen-Enhanced Magnetic Resonance Imaging of the Lung Using a Pneumotachograph for Respiratory Monitoring

OBJECTIVES

We sought to evaluate an optimized method for oxygen-enhanced magnetic resonance imaging of the lung, using electrocardiogram-trigger and a pneumotachograph for simultaneous cardiac and respiratory synchronization.

MATERIALS AND METHODS

Five series of IR-SSFSE images (echo time = 28.2 milliseconds; inversion time = 1,200 milliseconds) were obtained in 6 volunteers during the ventilation-paradigm room-air/oxygen/room-air: series 1, respiratory-triggered; series 2, cardiac-triggered; series 3, cardiac-triggered and respiratory-synchronized using the signal of the pneumatic belt; series 4, cardiac-triggered and respiratory-synchronized using the external signal of the pneumotachograph; and series 5, not cardiac-triggered and respiratory-synchronized using the signal of the pneumotachograph. Standard deviations of the lung (SI(var)) and diaphragm mismatch (DM) were measured. The relative SI change (DeltaSI) was computed from room-air and oxygen-enhanced images. Parametric maps were obtained from cross-correlation analysis of the ventilation paradigm. Mean correlation coefficients (cc) and the percentage of activated pixels over the lung (Act%) were calculated from these maps. All 5 parameters were compared among the 5 series (Friedman-analysis of variance, Dunn's posthoc test).

RESULTS

In series 4, DM and SI(var) were significantly lower than in respiratory and cardiac-triggered series (DM = 4.7 vs. 14.3 and 18.4; SI(var) = 4.9 vs. 10 and 11). In the same series cc and Act% also were significantly higher than in series 1 and 2 (cc = 0.86 vs. 0.7 and 0.6; Act% = 71.3 vs. 44.7 and 41.2). DeltaSI was not significantly different among all series.

CONCLUSIONS

Effective respiratory and cardiac synchronization can be achieved in oxygen-enhanced magnetic resonance imaging of the lung, using a pneumotachograph for real-time targeting of end-expiration.

Monitoring of Lung Motion in Patients With Malignant Pleural Mesothelioma Using Two-Dimensional and Three-Dimensional Dynamic Magnetic Resonance Imaging

PURPOSE

To monitor lung motion in patients with malignant pleural mesothelioma (MPM) before and after chemotherapy (CHT) using 2-dimensional (2D) and 3-dimensional (3D) dynamic MRI (dMRI) in comparison with spirometry.

METHODS AND MATERIALS

Twenty-two patients with MPM were examined before CHT, as well as after 3 and 6 CHT cycles (3 months and 6 months) using 2D dMRI (trueFISP; 3 images/s) and 3D dMRI (FLASH 3D, 1 slab (52 slices)/s) using parallel imaging in combination with view-sharing technique. Maximum craniocaudal lung dimensions (2D) and lung volumes (3D) were monitored, separated into the tumor-bearing and nontumor-bearing hemithorax. Vital capacity (VC) was measured for comparison using spirometry.

RESULTS

Using 2D technique, there was a significant difference between the tumor-bearing and the nontumor-bearing hemithorax before CHT (P < 0.01) and after 3 CHT cycles (P < 0.05), whereas difference was not significant in the second control. In the tumor-bearing hemithorax, mobility increased significantly from the status before versus after 3 CHT cycles (4.1 +/- 1.1 cm vs. 4.8 +/- 1.4 cm, P < 0.05). Using 3D technique, at maximum inspiration, the volume of the tumor-bearing hemithorax was 0.6 +/- 0.4 L and of the nontumor-bearing hemithorax 1.25 +/- 0.4 L before CHT. In the follow-up exams, these volumes changed to 1.05 +/- 0.4 L (P < 0.05) and 1.4 +/- 0.5 L, respectively. Using spirometry, there was no significant change in VC (1.9 +/- 0.4 L vs. 2.2 +/- 0.7 L vs. 2.2 +/- 0.9 L).

CONCLUSION

dMRI is capable of monitoring changes in lung motion and volumetry in patients with MPM not detected by global spirometry. Thus, dMRI is proposed for use as a further measure of therapy response.

Dynamic computed tomography of the neonatal lung: volume calculations and validation in an animal model

PURPOSE

The purpose of this study was to evaluate and validate dynamic volume calculation by respiratory-gated multislice computed tomography (CT) in small neonatal animals.

MATERIALS AND METHODS

Six mechanically ventilated newborn piglets were imaged in a multislice CT with 0.5-mm slice thickness (4:16 pitch, 0.5-second rotation time, 120 kV). The respirator was connected to the CT unit for recording the respiratory signal. Simultaneously, tidal volume was measured by the respirator and functional residual capacity (FRC) using a multiple-breath washin-washout technique (MBW) with heptafluoropropane (HFP) as tracer gas. Complete volume datasets were reconstructed throughout the respiratory cycle in increments of 10% using retrospective half-scan gating. All animals were scanned in 3 different ventilator settings. Dynamic lung volumes (tidal volumes) were calculated by means of segmentation of the lung parenchyma during the respiratory cycle using work-in-progress software.

RESULTS

The mean (+/-standard deviation) FRC determined by CT was 24.7+/-8.6 mL versus 24.8+/-7.3 mL for the MBW technique. There was no statistically significant difference (P=0.555). Pearson's correlation coefficient showed a strong correlation between the data obtained with CT and that obtained with the MBW technique (r=0.886). After exclusion of one outlier, tidal volumes showed a similar correlation (r=0.837) without significant differences in the mean values (CT: 8.9+/-2.4 mL and respirator: 8.7+/-2.4 mL, P=0.566).

CONCLUSION

Dynamic multislice CT with respiratory gating allows for calculation of lung volumes and may be useful for future CT applications in human neonatal lung imaging.

Future Horizons in MR Imaging

In this article, we defined the major areas of active research in clinical MR imaging. Further increases in the number of parallel coils within an imaging array and in advances in parallel imaging pulse sequences and postprocessing will lead to further reductions in imaging time analogous to the impact of multidetector CT on helical CT. The synergism between parallel and high-field imaging will aid the development of high-field imaging. The combined dynamic and hepatic parenchymal enhancement of new contrast agents that have or may soon receive FDA approval will enable improved detection and characterization of liver lesions. The lymphotropic SPIO agents will remain an active area of clinical research to further assess their role in oncologic staging. Molecular imaging contrast research using magnetic particles and MR microscopy will continue to flourish. Screening examinations by MR imaging will re-main an area of research for the short- and intermediate term, with the final outcome dependent more on socioeconomic costs than the underlying capability of achieving high-quality screening studies.

Future directions in body magnetic resonance imaging

Technologic innovations in instrumentation and contrast agents naturally lead to new clinical and research applications in body MRI. Although long-range predictions of innovation are an uncertain process, short-term trends in development are more readily discernable. This review will provide examples of recent developments in magnetic resonance spectroscopic imaging, contrast agent development and molecular imaging, instrumentation, post-processing, and screening in an attempt to describe areas of active research.