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Bi S, Yuan Q, Dai Z, Sun X, Wan Sohaimi WFB, Bin Yusoff AL. Advances in CT-based lung function imaging for thoracic radiotherapy. Front Oncol 2024; 14:1414337. [PMID: 39286020 PMCID: PMC11403405 DOI: 10.3389/fonc.2024.1414337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/14/2024] [Indexed: 09/19/2024] Open
Abstract
The objective of this review is to examine the potential benefits and challenges of CT-based lung function imaging in radiotherapy over recent decades. This includes reviewing background information, defining related concepts, classifying and reviewing existing studies, and proposing directions for further investigation. The lung function imaging techniques reviewed herein encompass CT-based methods, specifically utilizing phase-resolved four-dimensional CT (4D-CT) or end-inspiratory and end-expiratory CT scans, to delineate distinct functional regions within the lungs. These methods extract crucial functional parameters, including lung volume and ventilation distribution, pivotal for assessing and characterizing the functional capacity of the lungs. CT-based lung ventilation imaging offers numerous advantages, notably in the realm of thoracic radiotherapy. By utilizing routine CT scans, additional radiation exposure and financial burdens on patients can be avoided. This imaging technique also enables the identification of different functional areas of the lung, which is crucial for minimizing radiation exposure to healthy lung tissue and predicting and detecting lung injury during treatment. In conclusion, CT-based lung function imaging holds significant promise for improving the effectiveness and safety of thoracic radiotherapy. Nevertheless, challenges persist, necessitating further research to address limitations and optimize clinical utilization. Overall, this review highlights the importance of CT-based lung function imaging as a valuable tool in radiotherapy planning and lung injury monitoring.
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Affiliation(s)
- Suyan Bi
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Qingqing Yuan
- National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Zhitao Dai
- National Cancer Center/National Clinical Research Center for Cancer/ Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xingru Sun
- Huizhou Third People's Hospital, Guangzhou Medical University, Huizhou, Guangdong, China
| | - Wan Fatihah Binti Wan Sohaimi
- Department of Nuclear Medicine Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Ahmad Lutfi Bin Yusoff
- Department of Nuclear Medicine Radiotherapy and Oncology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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2
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Ohno Y, Hanamatsu S, Obama Y, Ueda T, Ikeda H, Hattori H, Murayama K, Toyama H. Overview of MRI for pulmonary functional imaging. Br J Radiol 2021; 95:20201053. [PMID: 33529053 DOI: 10.1259/bjr.20201053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Morphological evaluation of the lung is important in the clinical evaluation of pulmonary diseases. However, the disease process, especially in its early phases, may primarily result in changes in pulmonary function without changing the pulmonary structure. In such cases, the traditional imaging approaches to pulmonary morphology may not provide sufficient insight into the underlying pathophysiology. Pulmonary imaging community has therefore tried to assess pulmonary diseases and functions utilizing not only nuclear medicine, but also CT and MR imaging with various technical approaches. In this review, we overview state-of-the art MR methods and the future direction of: (1) ventilation imaging, (2) perfusion imaging and (3) biomechanical evaluation for pulmonary functional imaging.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan.,Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan
| | - Satomu Hanamatsu
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yuki Obama
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hidekazu Hattori
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
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3
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Buzan MT, Wetscherek A, Rank CM, Kreuter M, Heussel CP, Kachelrieß M, Dinkel J. Delayed contrast dynamics as marker of regional impairment in pulmonary fibrosis using 5D MRI - a pilot study. Br J Radiol 2020; 93:20190121. [PMID: 32584606 DOI: 10.1259/bjr.20190121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyse delayed contrast dynamics of fibrotic lesions in interstitial lung disease (ILD) using five dimensional (5D) MRI and to correlate contrast dynamics with disease severity. METHODS 20 patients (mean age: 71 years; M:F, 13:7), with chronic fibrosing ILD: n = 12 idiopathic pulmonary fibrosis (IPF) and n = 8 non-IPF, underwent thin-section multislice CT as part of the standard diagnostic workup and additionally MRI of the lung. 2 min after contrast injection, a radial gradient echo sequence with golden-angle spacing was acquired during 5 min of free-breathing, followed by 5D image reconstruction. Disease was categorized as severe or non-severe according to CT morphological regional severity. For each patient, 10 lesions were analysed. RESULTS IPF lesions showed later peak enhancement compared to non-IPF (severe: p = 0.01, non-severe: p = 0.003). Severe lesions showed later peak enhancement compared to non-severe lesions, in non-IPF (p = 0.04), but not in IPF (p = 0.35). There was a tendency towards higher accumulation and washout rates in IPF compared to non-IPF in non-severe disease. Severe lesions had lower washout rate than non-severe ones in both IPF (p = 0.003) and non-IPF (p = 0.005). Continuous contrast agent accumulation, without washout, was found only in IPF lesions. CONCLUSIONS Contrast agent dynamics are influenced by type and severity of pulmonary fibrosis, which might enable a more thorough characterisation of disease burden. The regional impairment is of particular interest in the context of antifibrotic treatments and was characterised using a non-invasive, non-irradiating, free-breathing method. ADVANCES IN KNOWLEDGE Delayed contrast enhancement patterns allow the assessment of regional lung impairment which could represent different disease stages or phenotypes in ILD.
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Affiliation(s)
- Maria Ta Buzan
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Andreas Wetscherek
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Christopher M Rank
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Kreuter
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Center for Rare and Interstitial Lung Diseases, Pneumology and respiratory critical care medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Claus Peter Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.,Center for Rare and Interstitial Lung Diseases, Pneumology and respiratory critical care medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julien Dinkel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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4
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Boucneau T, Fernandez B, Larson P, Darrasse L, Maître X. 3D Magnetic Resonance Spirometry. Sci Rep 2020; 10:9649. [PMID: 32541799 PMCID: PMC7295793 DOI: 10.1038/s41598-020-66202-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/21/2020] [Indexed: 01/23/2023] Open
Abstract
Spirometry is today the gold standard technique for assessing pulmonary ventilatory function in humans. From the shape of a flow-volume loop measured while the patient is performing forced respiratory cycles, the Forced Vital Capacity (FVC) and the Forced Expiratory Volume in one second (FEV1) can be inferred, and the pulmonologist is able to detect and characterize common respiratory afflictions. This technique is non-invasive, simple, widely available, robust, repeatable and reproducible. Yet, its outcomes rely on the patient's cooperation and provide only global information over the lung. With 3D Magnetic Resonance (MR) Spirometry, local ventilation can be assessed by MRI anywhere in the lung while the patient is freely breathing. The larger dimensionality of 3D MR Spirometry advantageously allows the extraction of original metrics that characterize the anisotropic and hysteretic regional mechanical behavior of the lung. Here, we demonstrated the potential of this technique on a healthy human volunteer breathing along different respiratory patterns during the MR acquisition. These new results are discussed with lung physiology and recent pulmonary CT data. As respiratory mechanics inherently support lung ventilation, 3D MR Spirometry may open a new way to non-invasively explore lung function while providing improved diagnosis of localized pulmonary diseases.
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Affiliation(s)
- Tanguy Boucneau
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Orsay, France
| | | | - Peder Larson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Luc Darrasse
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Orsay, France
| | - Xavier Maître
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, Orsay, France.
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5
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Affiliation(s)
- Juergen Biederer
- From the Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany; Christian-Albrechts University of Kiel, Faculty of Medicine, Kiel, Germany; and University of Latvia, Faculty of Medicine, Riga, Latvia
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6
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Pozin N, Montesantos S, Katz I, Pichelin M, Vignon-Clementel I, Grandmont C. Predicted airway obstruction distribution based on dynamical lung ventilation data: A coupled modeling-machine learning methodology. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3108. [PMID: 29799665 DOI: 10.1002/cnm.3108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/16/2018] [Accepted: 05/18/2018] [Indexed: 06/08/2023]
Abstract
In asthma and chronic obstructive pulmonary disease, some airways of the tracheobronchial tree can be constricted, from moderate narrowing up to closure. Those pathological patterns of obstructions affect the lung ventilation distribution. While some imaging techniques enable visualization and quantification of constrictions in proximal generations, no noninvasive technique exists to provide the airway morphology and obstruction distribution in distal areas. In this work, we propose a method that exploits lung ventilation measures to access positions of airway obstructions (restrictions and closures) in the tree. This identification approach combines a lung ventilation model, in which a 0D tree is strongly coupled to a 3D parenchyma description, along with a machine learning approach. On the basis of synthetic data generated with typical temporal and spatial resolutions as well as reconstruction errors, we obtain very encouraging results of the obstruction distribution, with a detection rate higher than 85%.
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Affiliation(s)
- N Pozin
- INRIA Paris, 2 Rue Simone IFF, Paris, 75012, France
- Laboratoire Jacques-Louis Lions, Sorbonne Université, UPMC, Paris, 75252, France
- Medical R&D, WBL Healthcare, Air Liquide Santé International, 1 Chemin de la Porte des Loges, Les Loges-en-Josas, 78350, France
| | - S Montesantos
- Medical R&D, WBL Healthcare, Air Liquide Santé International, 1 Chemin de la Porte des Loges, Les Loges-en-Josas, 78350, France
| | - I Katz
- Medical R&D, WBL Healthcare, Air Liquide Santé International, 1 Chemin de la Porte des Loges, Les Loges-en-Josas, 78350, France
- Department of Mechanical Engineering, Lafayette College, Easton, PA, 18042, USA
| | - M Pichelin
- Medical R&D, WBL Healthcare, Air Liquide Santé International, 1 Chemin de la Porte des Loges, Les Loges-en-Josas, 78350, France
| | - I Vignon-Clementel
- INRIA Paris, 2 Rue Simone IFF, Paris, 75012, France
- Laboratoire Jacques-Louis Lions, Sorbonne Université, UPMC, Paris, 75252, France
| | - C Grandmont
- INRIA Paris, 2 Rue Simone IFF, Paris, 75012, France
- Laboratoire Jacques-Louis Lions, Sorbonne Université, UPMC, Paris, 75252, France
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Kovacs W, Hsieh N, Roth H, Nnamdi-Emeratom C, Bandettini WP, Arai A, Mankodi A, Summers RM, Yao J. Holistic segmentation of the lung in cine MRI. J Med Imaging (Bellingham) 2017; 4:041310. [PMID: 29226176 DOI: 10.1117/1.jmi.4.4.041310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/06/2017] [Indexed: 01/01/2023] Open
Abstract
Duchenne muscular dystrophy (DMD) is a childhood-onset neuromuscular disease that results in the degeneration of muscle, starting in the extremities, before progressing to more vital areas, such as the lungs. Respiratory failure and pneumonia due to respiratory muscle weakness lead to hospitalization and early mortality. However, tracking the disease in this region can be difficult, as current methods are based on breathing tests and are incapable of distinguishing between muscle involvements. Cine MRI scans give insight into respiratory muscle movements, but the images suffer due to low spatial resolution and poor signal-to-noise ratio. Thus, a robust lung segmentation method is required for accurate analysis of the lung and respiratory muscle movement. We deployed a deep learning approach that utilizes sequence-specific prior information to assist the segmentation of lung in cine MRI. More specifically, we adopt a holistically nested network to conduct image-to-image holistic training and prediction. One frame of the cine MRI is used in the training and applied to the remainder of the sequence ([Formula: see text] frames). We applied this method to cine MRIs of the lung in the axial, sagittal, and coronal planes. Characteristic lung motion patterns during the breathing cycle were then derived from the segmentations and used for diagnosis. Our data set consisted of 31 young boys, age [Formula: see text] years, 15 of whom suffered from DMD. The remaining 16 subjects were age-matched healthy volunteers. For validation, slices from inspiratory and expiratory cycles were manually segmented and compared with results obtained from our method. The Dice similarity coefficient for the deep learning-based method was [Formula: see text] for the sagittal view, [Formula: see text] for the axial view, and [Formula: see text] for the coronal view. The holistic neural network approach was compared with an approach using Demon's registration and showed superior performance. These results suggest that the deep learning-based method reliably and accurately segments the lung across the breathing cycle.
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Affiliation(s)
- William Kovacs
- National Institutes of Health, Radiology and Imaging Sciences, Clinical Center, Clinical Image Processing Services, Bethesda, Maryland, United States
| | - Nathan Hsieh
- National Institutes of Health, Radiology and Imaging Sciences, Clinical Center, Clinical Image Processing Services, Bethesda, Maryland, United States
| | - Holger Roth
- National Institutes of Health, Radiology and Imaging Sciences, Clinical Center, Clinical Image Processing Services, Bethesda, Maryland, United States
| | - Chioma Nnamdi-Emeratom
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Neurogenetics Branch, Bethesda, Maryland, United States
| | - W Patricia Bandettini
- National Institutes of Health, National Heart, Lung and Blood Institute, Advanced Cardiovascular Imaging, Bethesda, Maryland, United States
| | - Andrew Arai
- National Institutes of Health, National Heart, Lung and Blood Institute, Advanced Cardiovascular Imaging, Bethesda, Maryland, United States
| | - Ami Mankodi
- National Institutes of Health, National Institute of Neurological Disorders and Stroke, Neurogenetics Branch, Bethesda, Maryland, United States
| | - Ronald M Summers
- National Institutes of Health, Radiology and Imaging Sciences, Clinical Center, Clinical Image Processing Services, Bethesda, Maryland, United States
| | - Jianhua Yao
- National Institutes of Health, Radiology and Imaging Sciences, Clinical Center, Clinical Image Processing Services, Bethesda, Maryland, United States
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