Distal airways in humans: dynamic hyperpolarized 3He MR imaging--feasibility

Functional lung imaging using novel and emerging MRI techniques

Respiratory diseases are leading causes of death and disability in the world. While early diagnosis is key, this has proven difficult due to the lack of sensitive and non-invasive tools. Computed tomography is regarded as the gold standard for structural lung imaging but lacks functional information and involves significant radiation exposure. Lung magnetic resonance imaging (MRI) has historically been challenging due to its short T2 and low proton density. Hyperpolarised gas MRI is an emerging technique that is able to overcome these difficulties, permitting the functional and microstructural evaluation of the lung. Other novel imaging techniques such as fluorinated gas MRI, oxygen-enhanced MRI, Fourier decomposition MRI and phase-resolved functional lung imaging can also be used to interrogate lung function though they are currently at varying stages of development. This article provides a clinically focused review of these contrast and non-contrast MR imaging techniques and their current applications in lung disease.

Brain Imaging Using Hyperpolarized 129Xe Magnetic Resonance Imaging

Hyperpolarized (HP) ¹²⁹Xe magnetic resonance imaging (MRI) is a novel iteration of traditional MRI that relies on detecting the spins of ¹H. Since ¹²⁹Xe is a gaseous signal source, it can be used for lung imaging. Additionally, ¹²⁹Xe dissolves in the blood stream and can therefore be detectable in the brain parenchyma and vasculature. In this work, we provide detailed information on the protocols that we have developed to image ¹²⁹Xe within the brains of both rodents and human subjects.

Biomedical imaging with hyperpolarized noble gases

Hyperpolarized noble gases (HNGs), polarized to approximately 50% or higher, have led to major advances in magnetic resonance (MR) imaging of porous structures and air-filled cavities in human subjects, particularly the lung. By boosting the available signal to a level about 100 000 times higher than that at thermal equilibrium, air spaces that would otherwise appear as signal voids in an MR image can be revealed for structural and functional assessments. This review discusses how HNG MR imaging differs from conventional proton MR imaging, how MR pulse sequence design is affected and how the properties of gas imaging can be exploited to obtain hitherto inaccessible information in humans and animals. Current and possible future imaging techniques, and their application in the assessment of normal lung function as well as certain lung diseases, are described.

Airway imaging in disease: gimmick or useful tool?

Airway remodeling is an important pathophysiological mechanism in a variety of chronic airway diseases. Historically investigators have had to use invasive techniques such as histological examination of excised tissue to study airway wall structure. The last several years has seen a proliferation of relatively noninvasive techniques to assess the airway branching pattern, wall thickness, and more recently, airway wall tissue components. These methods include computed tomography, magnetic resonance imaging, and optical coherence tomography. These new imaging technologies have become popular because to understand the physiology of lung disease it is important we understand the underlying anatomy. However, these new approaches are not standardized or available in all centers so a review of their validity and clinical utility is appropriate. This review documents how investigators are working hard to correct for inconsistencies between techniques so that they become more accepted and utilized in clinical settings. These new imaging techniques are very likely to play a frontline role in the study of lung disease and will, hopefully, allow clinicians and investigators to better understand disease pathogenesis and to design and assess new therapeutic interventions.

Quantitative pulmonary imaging using computed tomography and magnetic resonance imaging

Measurements of lung function, including spirometry and body plethesmography, are easy to perform and are the current clinical standard for assessing disease severity. However, these lung functional techniques do not adequately explain the observed variability in clinical manifestations of disease and offer little insight into the relationship of lung structure and function. Lung imaging and the image-based assessment of lung disease has matured to the extent that it is common for clinical, epidemiologic and genetic investigation to have a component dedicated to image analysis. There are several exciting imaging modalities currently being used for the non-invasive study of lung anatomy and function. In this review, we will focus on two of them; X-ray computed tomography and magnetic resonance imaging. Following a brief introduction of each method, we detail some of the most recent work being done to characterize smoking-related lung disease and the clinical applications of such knowledge.

Hyperpolarized 129Xe MR imaging with balanced steady-state free precession in spontaneously breathing mouse lungs

PURPOSE

We investigated the characteristics of hyperpolarized (HP) (129)Xe magnetic resonance (MR) imaging obtained from balanced steady-state free precession (SSFP) measurement of mouse lungs, especially under spontaneous breathing, and compared the results with those obtained using traditional spoiled gradient echo (SPGR) method, focusing on improved signal-to-noise ratio (SNR) and reduced total acquisition time.

METHODS

We calculated magnetization response of the HP (129)Xe gas for the balanced SSFP sequence under spontaneous breathing to derive optimal conditions for the imaging experiment. We then placed an anesthetized mouse in the magnet (9.4T) supplied with oxygen gas and a mixture of HP (129)Xe gas supplied from a continuous-flow hyperpolarizing system. We obtained an axial plane image of the lung through balanced SSFP and SPGR sequences, changing the various magnetic resonance (MR) imaging parameters, and measured the SNR of these images.

RESULTS

We demonstrated the clear dependence of image intensity on flip angle and number of shots. The SNR was higher in balanced SSFP than in SPGR and 2.3-fold higher compared at each maximum. In contrast, total acquisition time in balanced SSFP was shortened to about one-eighth that of SPGR using a one-shot acquisition mode.

CONCLUSION

In HP (129)Xe MR imaging of the lung of a spontaneously breathing mouse, balanced SSFP sequence with multi-shot and centric order acquisition provides higher SNR in a shorter acquisition time than SPGR.

Hyperpolarized noble gases as contrast agents

Hyperpolarized noble gases ((3)He and (129)Xe) can provide NMR signal enhancements of 10,000 to 100,000 times that of thermally polarized gases and have shown great potential for applications in lung magnetic resonance imaging (MRI) by greatly enhancing the sensitivity and contrast. These gases obtain a highly polarized state by employing a spin exchange optical pumping technique. In this chapter, the underlying physics of spin exchange optical pumping for production of hyperpolarized noble gases is explained and the basic components and procedures for building a polarizer are described. The storage and delivery strategies of hyperpolarized gases for in vivo imaging are discussed. Many of the problems that are likely to be encountered in practical experiments and the corresponding detailed approaches to overcome them are also discussed.

Hyperpolarized gas MR Imaging of the lung: current status as a research tool

Hyperpolarized gas magnetic resonance imaging has been explored extensively as a promising tool for the quantitative evaluation of regional pulmonary pathophysiology. This noninvasive technique is capable of providing both structural information down to the level of the alveolar microstructure and functional information, such as dynamic ventilation, intrapulmonary partial pressure of oxygen, and alveolar surface area. This study reviews the role of hyperpolarized 3-helium and 129-xenon magnetic resonance imaging in this research.

Free breathing hyperpolarized 3He lung ventilation spiral MR imaging

OBJECTIVES

Current clinical hyperpolarized He lung ventilation MR imaging protocols rely on the patient's ability to control inhalation and exhalation and hold their breath on demand. This is impractical for intensive care unit patients under ventilation or for pediatric populations under the age of 3 to 4 years. To address this problem, we propose a free-breathing protocol for hyperpolarized He lung ventilation spiral imaging. This approach was evaluated in vitro and on rabbits.

MATERIALS AND METHODS

The protocol was implemented on a clinical 1.5-T magnetic resonance imaging scanner. Ventilation images were acquired using a spiral sequence, in vitro on a lung phantom and in vivo on rabbits, the animal breathing freely from a gas reservoir. Dynamic spiral ventilation images were reconstructed using retrospective Cine synchronization. Magnetic resonance (MR) signal dynamics was modeled taking account of gas inflow and outflow, radiofrequency depolarization and oxygen-induced relaxation.

RESULTS

Cine ventilation images acquired in spontaneously breathing rabbits were reconstructed with a temporal resolution of 50 milliseconds. Gas volume variations and time-to-maximum maps were obtained. The numerical model was validated in vitro and in vivo with various gas mixtures. Ventilation parameters (functional residual capacity, tidal volume, and alveolar pO2) were extracted from the MR signal dynamics.

CONCLUSIONS

Ventilation imaging can be performed at tidal volume using a simple experimental protocol, without any ventilation device or breath-hold period. Acquisition time, SNR and pO2 decay can be optimized using the developed numerical model. Free-breathing ventilation images can be obtained without artifacts related to motion or gas flow. Lastly, parametric maps can be derived from the time-resolved ventilation images and physiological parameters extracted from the global signal dynamics.

Hyperpolarized 129Xe phase-selective imaging of mouse lung at 9.4T using a continuous-flow hyperpolarizing system

The use of hyperpolarized (HP) 129Xe magnetic resonance (MR) imaging to regionally evaluate gas diffusion and perfusion processes as well as ventilation in the lung has been expected. In this study, we used a continuous-flow hyperpolarizing (CF-HP) system to acquire gas- and dissolved-phase 129Xe images from mouse lung, employing standard gradient echo sequence equipped with chemical shift selective excitation and 90 degrees flip angle. The character of non-recoverable HP magnetization enabled the use of a phase (frequency)-selective 90 degrees pulse for direct visualization of only a given-phase 129Xe magnetization replenished into the slice during repetition time (TR). We combined gas- and dissolved-phase 129Xe images to map the ratio of dissolved- to gas-phase 129Xe replenished into the slice during TR (Mdissolved/Mgas) and found it to be approximately 0.05 to 0.08 in the peripheral regions of mouse lungs. This result suggested that replenishment of dissolved-phase 129Xe magnetization by gas diffusion and pulmonary perfusion would be faster than that of gas-phase by ventilation. The use of a CF-HP system that allows the application of relatively long TR to HP 129Xe imaging using a phase-selective 90 degrees pulse would be useful in evaluating gas transport mechanisms in the lung.

Investigation of hyperpolarized 3He magnetic resonance imaging utility in examining human airway diameter behavior in asthma through comparison with high-resolution computed tomography

RATIONALE AND OBJECTIVES

Application of a previously developed model-based algorithm on hyperpolarized (HP) (3)He magnetic resonance (MR) dynamic projection images of phantoms was extended to investigate the utility of HP (3)He MR imaging (MRI) in quantifying airway caliber changes associated with asthma.

MATERIALS AND METHODS

Airways of seven volunteers were imaged and measured using HP (3)He MRI and multidetector-row computed tomography (MDCT) before and after a methacholine (MCh) challenge. MDCT data were obtained at functional residual capacity and 1 L above functional residual capacity.

RESULTS

Comparison of the resultant data showed that HP (3)He MRI did not match MDCT in measuring the ratios of airway calibers before and after the MCh challenge in 37% to 43% of the airways from the first six generations at the two lung volumes tested. However, MDCT did yield the observation that 49% to 69% of these airways displayed bronchodilation following MCh challenge.

CONCLUSION

The current implementation of HP (3)He MRI did not match the MCh-induced postchallenge-to-prechallenge airway caliber ratios as measured with MDCT. Elevated parenchymal tethering due to bronchoconstriction-induced hyperinflation was proposed as a possible explanation for this airway dilation.

Comparison of airway diameter measurements from an anthropomorphic airway tree phantom using hyperpolarized 3He MRI and high-resolution computed tomography

An anthropomorphic airway tree phantom was imaged with both hyperpolarized (HP) 3He MRI using a dynamic projection scan and computed tomography (CT). Airway diameter measurements from the HP 3He MR images obtained using a newly developed model-based algorithm were compared against their corresponding CT values quantified with a well-established method. Of the 45 airway segments that could be evaluated with CT, only 14 airway segments (31%) could be evaluated using HP 3He MRI. No airway segments smaller than approximately 4 mm in diameter and distal to the fourth generation were adequate for analysis in MRI. For the 14 airway segments measured, only two airway segments yielded a non-equivalent comparison between the two imaging modalities, while eight more had inconclusive comparison results, leaving only four airway segments (29%) that satisfied the designed equivalence criteria. Some of the potential problems in airway diameter quantification described in the formulation of the model-based algorithm were observed in this study. These results suggest that dynamic projection HP 3He MRI may have limited utility for measuring airway segment diameters, particularly those of the central airways.

Hyperpolarized 3He Ventilation Defects and Apparent Diffusion Coefficients in Chronic Obstructive Pulmonary Disease

OBJECTIVE

Hyperpolarized 3He magnetic resonance imaging (3He MRI) at 3.0 Tesla of healthy volunteers and chronic obstructive pulmonary disease (COPD) patients was performed for quantitative evaluation of ventilation defects and apparent diffusion coefficients (ADC) and for comparison to published results acquired at 1.5 Tesla. The reproducibility of 3He ADC and ventilation defects was also assessed in subjects scanned 3 times, twice within 10 minutes, and again within 7 +/- 2 days of the first MRI visit.

MATERIALS AND METHODS

Hyperpolarized 3He MRI was performed in 6 subjects. Two interleaved images with and without additional diffusion sensitization were acquired with the first image serving as a ventilation image from which defect score and volume were measured and the combination of the 2 images used to compute ADC maps and ADC histograms.

RESULTS

He MRI at 3.0 Tesla showed increased mean ADC and ADC standard deviation for subjects with COPD compared with healthy volunteers (ADC healthy volunteer (0.24 +/- 0.12 cm2/s), mild-moderate COPD (0.34 +/- 0.14 cm2/s), and severe COPD (0.47 +/- 0.21 cm2/s), and these values were similar to previously reported results acquired at 1.5 Tesla. Reproducibility of mean ADC was high (coefficient of variation 2% in severe COPD, 3% in mild-moderate COPD, 4% in healthy volunteers) across all 3 scans. Higher same-day scan reproducibility was observed for ventilation defect volume compared with 1-week scan reproducibility in this small group of subjects.

CONCLUSIONS

ADC values for emphysematous lungs were significantly increased compared with healthy lungs in age-matched subjects, and all values were comparable to those reported previously at 1.5 Tesla. Ventilation defect score and ventilation defect volume results were also comparable to results previously reported in COPD subjects Reproducibility of ADC for same-day scan-rescan and 7-day rescan was high and similar to previously reported results.

Nonrigid 2-D/3-D registration for patient specific bronchoscopy simulation with statistical shape modeling: phantom validation

This paper presents a nonrigid registration two-dimensional/three-dimensional (2-D/3-D) framework and its phantom validation for subject-specific bronchoscope simulation. The method exploits the recent development of five degrees-of-freedom miniaturized catheter tip electromagnetic trackers such that the position and orientation of the bronchoscope can be accurately determined. This allows the effective recovery of unknown camera rotation and airway deformation, which is modelled by an active shape model (ASM). ASM captures the intrinsic variability of the tracheo-bronchial tree during breathing and it is specific to the class of motion it represents. The method reduces the number of parameters that control the deformation, and thus greatly simplifies the optimisation procedure. Subsequently, pq-based registration is performed to recover both the camera pose and parameters of the ASM. Detailed assessment of the algorithm is performed on a deformable airway phantom, with the ground truth data being provided by an additional six degrees-of-freedom electromagnetic (EM) tracker to monitor the level of simulated respiratory motion.

Measurement of the internal diameter of plastic tubes from projection MR images using a model-based least-squares fit approach

Hyperpolarized (HP) 3He MRI is an emerging tool in the diagnosis and evaluation of pulmonary diseases involving bronchoconstriction, such as asthma. Previously, airway diameters from dynamic HP 3He MR images of the lung were assessed manually and subjectively, and were thus prone to uncertainties associated with human error and partial volume effects. A model-based algorithm capable of fully utilizing pixel intensity profile information and attaining subpixel resolution has been developed to measure surrogate airway diameters from HP 3He MR static projection images of plastic tubes. This goal was achieved by fitting ideal pixel intensity profiles for various diameter (6.4 to 19.1 mm) circular tubes to actual pixel intensity data. A phantom was constructed from plastic tubes of various diameters connected in series and filled with water mixed with contrast agent. Projection MR images were then taken of the phantom. The favorable performance of the model-based algorithm compared to manual assessment demonstrates the viability of our approach. The manual and algorithm approaches yielded diameter measurements that generally stayed within 1 x the pixel dimension. However, inconsistency of the manual approach can be observed from the larger standard deviations of its measured values. The method was then extended to HP 3He MRI, producing encouraging results at tube diameters characteristic of airways beyond the second generation, thereby justifying their application to lung airway imaging and measurement. Potential obstacles when measuring airway diameters using this method are discussed.

Phase-contrast velocimetry with hyperpolarized3He for in vitro and in vivo characterization of airflow

This paper describes a technique that combines radial MRI and phase contrast (PC) to map the velocities of hyperpolarized gases ((3)He) in respiratory airways. The method was evaluated on well known geometries (straight and U-shaped pipes) before it was applied in vivo. Dynamic 2D maps of the three velocity components were obtained from a 10-mm slice with an in-plane spatial resolution of 1.6 mm within 1 s. Integration of the in vitro through-plane velocity over the slice matched the input flow within a relative precision of 6.4%. As expected for the given Reynolds number, a parabolic velocity profile was obtained in the straight pipe. In the U-shaped pipe the three velocity components were measured and compared to a fluid-dynamics simulation so the precision was evaluated as fine as 0.025 m s(-1). The technique also demonstrated its ability to visualize vortices and localize characteristic points, such as the maximum velocity and vortex-center positions. Finally, in vivo feasibility was demonstrated in the human trachea during inhalation.

Quantification of airway diameters and 3D airway tree rendering from dynamic hyperpolarized 3He magnetic resonance imaging

As another step toward extracting quantitative information from hyperpolarized 3He MRI, airway diameters in humans were measured from projection images and multislice images of the lungs. Values obtained were in good agreement with the Weibel lung morphometry model. The measurement of airway caliber can now be achieved without the use of ionizing radiation. Furthermore, it was demonstrated that 3D airway tree renderings could be constructed from the multislice data. Both the measurement of airway diameters and the rendering of 3D airway information hold promise for the clinical assessment of bronchoconstrictive diseases such as asthma and the associated evaluation of treatment effectiveness. Work is being done to address the uncertainties of the manually intensive methods we have developed.

Functional MRI of the lung using hyperpolarized 3-helium gas

Lung imaging has traditionally relied on x-ray methods, since proton MRI is limited to some extent by low proton density in the lung parenchyma and static field inhomogeneities in the chest. The relatively recent introduction of MRI of hyperpolarized noble gases has led to a rapidly evolving field of pulmonary MRI, revealing functional information of the lungs, which were hitherto unattainable. This review article briefly describes the physical background of the technology, and subsequently focuses on its clinical applications. Four different techniques that have been used in various human investigations are discussed: ventilation distribution, ventilation dynamics, and small airway evaluation using diffusion imaging and oxygen uptake assessment.