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Lin Q, Wu Z, Huang M, Dang Z, Tian L, Guan Y, Liu G, Lu Y, Tian Y. Detection of early pulmonary emphysema by multi-contrast x-ray Talbot-Lau interferometer. Med Phys 2024; 51:4133-4142. [PMID: 38578373 DOI: 10.1002/mp.17053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Pulmonary emphysema is a part of chronic obstructive pulmonary disease, which is an irreversible chronic respiratory disease. In order to avoid further damage to lung tissue, early diagnosis and treatment of pulmonary emphysema is essential. PURPOSE Early pulmonary emphysema diagnosis is difficult with conventional radiographic imaging. Recently, x-ray phase contrast imaging has proved to be an effective and promising imaging strategy for soft tissue, due to its high sensitivity and multi-contrast. The aim of this study is to diagnose pulmonary emphysema early utilizing an x-ray Talbot-Lau interferometer (TLI). METHODS We successfully established the mouse model of emphysema by porcine pancreatic elastase treatment, and then used the established x-ray TLI to perform imaging experiments on the mice with different treatment time. The traditional absorption CT and phase contrast CT were obtained simultaneously through TLI. The CT results and histopathology of mice lung in different treatment time were quantitatively analyzed. RESULTS By imaging mice lungs, it can be found that phase contrast has higher sensitivity than absorption contrast in early pulmonary emphysema. The results show that the phase contrast signal could distinguish the pulmonary emphysema earlier than the conventional attenuation signal, which can be consistent with histological images. Through the quantitative analysis of pathological section and phase contrast CT, it can be found that there is a strong linear correlation. CONCLUSIONS In this study, we quantitatively analyze mean linear intercept of histological sections and CT values of mice. The results show that the phase contrast signal has higher imaging sensitivity than the attenuation signal. X-ray TLI multi-contrast imaging is proved as a potential diagnostic method for early pulmonary emphysema in mice.
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Affiliation(s)
- Qisi Lin
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei, China
| | - Zhao Wu
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei, China
| | - Meng Huang
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei, China
- Ultrasonic Department, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zheng Dang
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei, China
| | - Lijiao Tian
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei, China
| | - Yong Guan
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei, China
| | - Gang Liu
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei, China
| | - Yalin Lu
- Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, Hefei, China
| | - Yangchao Tian
- National Synchrotron Radiation Laboratory, University of Science and Technology of China, Hefei, China
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2
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Kim M, Naish JH, Needleman SH, Tibiletti M, Taylor Y, O'Connor JPB, Parker GJM. Feasibility of dynamic T 2 *-based oxygen-enhanced lung MRI at 3T. Magn Reson Med 2024; 91:972-986. [PMID: 38013206 PMCID: PMC10952203 DOI: 10.1002/mrm.29914] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To demonstrate proof-of-concept of a T2 *-sensitized oxygen-enhanced MRI (OE-MRI) method at 3T by assessing signal characteristics, repeatability, and reproducibility of dynamic lung OE-MRI metrics in healthy volunteers. METHODS We performed sequence-specific simulations for protocol optimisation and acquired free-breathing OE-MRI data from 16 healthy subjects using a dual-echo RF-spoiled gradient echo approach at 3T across two institutions. Non-linear registration and tissue density correction were applied. Derived metrics included percent signal enhancement (PSE), ∆R2 * and wash-in time normalized for breathing rate (τ-nBR). Inter-scanner reproducibility and intra-scanner repeatability were evaluated using intra-class correlation coefficient (ICC), repeatability coefficient, reproducibility coefficient, and Bland-Altman analysis. RESULTS Simulations and experimental data show negative contrast upon oxygen inhalation, due to substantial dominance of ∆R2 * at TE > 0.2 ms. Density correction improved signal fluctuations. Density-corrected mean PSE values, aligned with simulations, display TE-dependence, and an anterior-to-posterior PSE reduction trend at TE1 . ∆R2 * maps exhibit spatial heterogeneity in oxygen delivery, featuring anterior-to-posterior R2 * increase. Mean T2 * values across 32 scans were 0.68 and 0.62 ms for pre- and post-O2 inhalation, respectively. Excellent or good agreement emerged from all intra-, inter-scanner and inter-rater variability tests for PSE and ∆R2 *. However, ICC values for τ-nBR demonstrated limited agreement between repeated measures. CONCLUSION Our results demonstrate the feasibility of a T2 *-weighted method utilizing a dual-echo RF-spoiled gradient echo approach, simultaneously capturing PSE, ∆R2 * changes, and oxygen wash-in during free-breathing. The excellent or good repeatability and reproducibility on intra- and inter-scanner PSE and ∆R2 * suggest potential utility in multi-center clinical applications.
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Affiliation(s)
- Mina Kim
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC)University College LondonLondonUK
| | - Josephine H. Naish
- Bioxydyn LimitedManchesterUK
- BHF Manchester Centre for Heart and Lung Magnetic Resonance Research (MCMR)Manchester University NHS Foundation TrustManchesterUK
| | - Sarah H. Needleman
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC)University College LondonLondonUK
| | | | - Yohn Taylor
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC)University College LondonLondonUK
| | - James P. B. O'Connor
- Division of Cancer SciencesUniversity of ManchesterManchesterUK
- Division of Radiotherapy and ImagingInstitute of Cancer ResearchLondonUK
| | - Geoff J. M. Parker
- Department of Medical Physics and Biomedical Engineering, Centre for Medical Image Computing (CMIC)University College LondonLondonUK
- Bioxydyn LimitedManchesterUK
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3
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Brooke JP, Hall IP. Novel Thoracic MRI Approaches for the Assessment of Pulmonary Physiology and Inflammation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1304:123-145. [PMID: 34019267 DOI: 10.1007/978-3-030-68748-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Excessive pulmonary inflammation can lead to damage of lung tissue, airway remodelling and established structural lung disease. Novel therapeutics that specifically target inflammatory pathways are becoming increasingly common in clinical practice, but there is yet to be a similar stepwise change in pulmonary diagnostic tools. A variety of thoracic magnetic resonance imaging (MRI) tools are currently in development, which may soon fulfil this emerging clinical need for highly sensitive assessments of lung structure and function. Given conventional MRI techniques are poorly suited to lung imaging, alternate strategies have been developed, including the use of inhaled contrast agents, intravenous contrast and specialized lung MR sequences. In this chapter, we discuss technical challenges of performing MRI of the lungs and how they may be overcome. Key thoracic MRI modalities are reviewed, namely, hyperpolarized noble gas MRI, oxygen-enhanced MRI (OE-MRI), ultrashort echo time (UTE) MRI and dynamic contrast-enhanced (DCE) MRI. Finally, we consider potential clinical applications of these techniques including phenotyping of lung disease, evaluation of novel pulmonary therapeutic efficacy and longitudinal assessment of specific patient groups.
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Affiliation(s)
- Jonathan P Brooke
- Department of Respiratory Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK.
| | - Ian P Hall
- Department of Respiratory Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK.
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4
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Ohno Y, Yui M, Yoshikawa T, Seki S, Takenaka D, Kassai Y, Hattori H, Murayama K, Toyama H. 3D Oxygen-Enhanced MRI at 3T MR System: Comparison With Thin-Section CT of Quantitative Capability for Pulmonary Functional Loss Assessment and Clinical Stage Classification of COPD in Smokers. J Magn Reson Imaging 2020; 53:1042-1051. [PMID: 33205499 DOI: 10.1002/jmri.27441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Oxygen (O2 )-enhanced MRI is mainly performed by a 2D sequence using 1.5T MR systems but trying to be obtained by a 3D sequence using a 3T MR system. PURPOSE To compare the capability of 3D O2 -enhanced MRI and that of thin-section computed tomography (CT) for pulmonary functional loss assessment and clinical stage classification of chronic obstructive pulmonary disease (COPD) in smokers. STUDY TYPE Prospective study. POPULATION Fifty six smokers were included. FIELD STRENGTH/ SEQUENCE 3T, 3D O2 -enhanced MRIs were performed with a 3D T1 -weighted fast field echo pulse sequence using the multiple flip angles. ASSESSMENTS Smokers were classified into four stages ("Without COPD," "Mild COPD," "Moderate COPD," "Severe or very severe COPD"). Maps of regional changes in T1 values were generated from O2 -enhanced MR data. Regions of interest (ROIs) were then placed over the lung on all slices and averaged to determine mean T1 value change (ΔT1 ). Quantitative CT used the percentage of low attenuation areas within the entire lung (LAA%). STATISTICAL TESTS ΔT1 and LAA% were correlated with pulmonary functional parameters, and compared for four stages using Tukey's Honestly Significant Difference test. Discrimination analyses were performed and McNemar's test was used for a comparison of the accuracy of the indexes. RESULTS There were significantly higher correlations between ΔT1 and pulmonary functional parameters (-0.83 ≤ r ≤ -0.71, P < 0.05) than between LAA% and the same pulmonary functional parameters (-0.76 ≤ r ≤ -0.69, P < 0.05). ΔT1 and LAA% of the "Mild COPD" and "Moderate COPD" groups were significantly different from those of the "Severe or Very Severe COPD" group (P < 0.05). Discriminatory accuracy of ΔT1 (62.5%) and ΔT1 with LAA% (67.9%) was significantly greater than that of LAA% (48.2%, P < 0.05). DATA CONCLUSION Compared with thin-section CT, 3D O2 -enhanced MRI has a similar capability for pulmonary functional assessment but better potential for clinical stage classification in smokers. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan.,Joint Laboratory Research of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan.,Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masao Yui
- Canon Medical Systems Corporation, Otawara, Japan
| | - Takeshi Yoshikawa
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan
| | - Shinichiro Seki
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Takenaka
- Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Japan
| | | | - Hidekazu Hattori
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuhiro Murayama
- Joint Laboratory Research 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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5
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Abstract
Lung emphysema represents a major public health burden and still accounts for five percent of all deaths worldwide. Hence, it is essential to further understand this disease in order to develop effective diagnostic and therapeutic strategies. Lung emphysema is an irreversible enlargement of the airways distal to the terminal bronchi (i.e., the alveoli) due to the destruction of the alveolar walls. The two most important causes of emphysema are (I) smoking and (II) α1-antitrypsin-deficiency. In the former lung emphysema is predominant in the upper lung parts, the latter is characterized by a predominance in the basal areas of the lungs. Since quantification and evaluation of the distribution of lung emphysema is crucial in treatment planning, imaging plays a central role. Imaging modalities in lung emphysema are manifold: computed tomography (CT) imaging is nowadays the gold standard. However, emerging imaging techniques like dynamic or functional magnetic resonance imaging (MRI), scintigraphy and lately also the implementation of radiomics and artificial intelligence are more and more diffused in the evaluation, diagnosis and quantification of lung emphysema. The aim of this review is to shortly present the different subtypes of lung emphysema, to give an overview on prediction and risk assessment in emphysematous disease and to discuss not only the traditional, but also the new imaging techniques for diagnosis, quantification and evaluation of lung emphysema.
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Affiliation(s)
- Katharina Martini
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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6
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Voskrebenzev A, Vogel-Claussen J. Proton MRI of the Lung: How to Tame Scarce Protons and Fast Signal Decay. J Magn Reson Imaging 2020; 53:1344-1357. [PMID: 32166832 DOI: 10.1002/jmri.27122] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022] Open
Abstract
Pulmonary proton MRI techniques offer the unique possibility of assessing lung function and structure without the requirement for hyperpolarization or dedicated hardware, which is mandatory for multinuclear acquisition. Five popular approaches are presented and discussed in this review: 1) oxygen enhanced (OE)-MRI; 2) arterial spin labeling (ASL); 3) Fourier decomposition (FD) MRI and other related methods including self-gated noncontrast-enhanced functional lung (SENCEFUL) MR and phase-resolved functional lung (PREFUL) imaging; 4) dynamic contrast-enhanced (DCE) MRI; and 5) ultrashort TE (UTE) MRI. While DCE MRI is the most established and well-studied perfusion measurement, FD MRI offers a free-breathing test without any contrast agent and is predestined for application in patients with renal failure or with low compliance. Additionally, FD MRI and related methods like PREFUL and SENCEFUL can act as an ionizing radiation-free V/Q scan, since ventilation and perfusion information is acquired simultaneously during one scan. For OE-MRI, different concentrations of oxygen are applied via a facemask to assess the regional change in T1 , which is caused by the paramagnetic property of oxygen. Since this change is governed by a combination of ventilation, diffusion, and perfusion, a compound functional measurement can be achieved with OE-MRI. The known problem of fast T2 * decay of the lung parenchyma leading to a low signal-to-noise ratio is bypassed by the UTE acquisition strategy. Computed tomography (CT)-like images allow the assessment of lung structure with high spatial resolution without ionizing radiation. Despite these different branches of proton MRI, common trends are evident among pulmonary proton MRI: 1) free-breathing acquisition with self-gating; 2) application of UTE to preserve a stronger parenchymal signal; and 3) transition from 2D to 3D acquisition. On that note, there is a visible convergence of the different methods and it is not difficult to imagine that future methods will combine different aspects of the presented methods.
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Affiliation(s)
- Andreas Voskrebenzev
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
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7
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Förster K, Ertl-Wagner B, Ehrhardt H, Busen H, Sass S, Pomschar A, Naehrlich L, Schulze A, Flemmer AW, Hübener C, Eickelberg O, Theis F, Dietrich O, Hilgendorff A. Altered relaxation times in MRI indicate bronchopulmonary dysplasia. Thorax 2019; 75:184-187. [PMID: 31048507 DOI: 10.1136/thoraxjnl-2018-212384] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 03/28/2019] [Accepted: 04/01/2019] [Indexed: 11/04/2022]
Abstract
We developed a MRI protocol using transverse (T2) and longitudinal (T1) mapping sequences to characterise lung structural changes in preterm infants with bronchopulmonary dysplasia (BPD). We prospectively enrolled 61 infants to perform 3-Tesla MRI of the lung in quiet sleep. Statistical analysis was performed using logistic Group Lasso regression and logistic regression. Increased lung T2 relaxation time and decreased lung T1 relaxation time indicated BPD yielding an area under the curve (AUC) of 0.80. Results were confirmed in an independent study cohort (AUC 0.75) and mirrored by lung function testing, indicating the high potential for MRI in future BPD diagnostics. TRIAL REGISTRATION: DRKS00004600.
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Affiliation(s)
- Kai Förster
- Department of Neonatology, Perinatal Center Grosshadern, Dr von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany.,Comprehensive Pneumology Center, German Lung Research Center (DZL), Helmholtz Zentrum München, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, German Lung Research Center (DZL), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany
| | - Hannah Busen
- Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany
| | - Steffen Sass
- Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany
| | - Andreas Pomschar
- Department of Radiology, German Lung Research Center (DZL), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Lutz Naehrlich
- Department of General Pediatrics and Neonatology, German Center for Lung Research (DZL), Justus-Liebig-University, Giessen, Germany
| | - Andreas Schulze
- Department of Neonatology, Perinatal Center Grosshadern, Dr von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Andreas W Flemmer
- Department of Neonatology, Perinatal Center Grosshadern, Dr von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christoph Hübener
- Department of Obstetrics and Gynecology, Perinatal Center Grosshadern, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Oliver Eickelberg
- Comprehensive Pneumology Center, German Lung Research Center (DZL), Helmholtz Zentrum München, Munich, Germany.,Division of Respiratory Sciences and Critical Care Medicine, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Fabian Theis
- Institute of Computational Biology, Helmholtz Zentrum München, Munich, Germany.,Department of Mathematics, Technical University of Munich, Munich, Germany
| | - Olaf Dietrich
- Department of Radiology, German Lung Research Center (DZL), University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Anne Hilgendorff
- Department of Neonatology, Perinatal Center Grosshadern, Dr von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany .,Comprehensive Pneumology Center, German Lung Research Center (DZL), Helmholtz Zentrum München, Munich, Germany
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8
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Torres L, Kammerman J, Hahn AD, Zha W, Nagle SK, Johnson K, Sandbo N, Meyer K, Schiebler M, Fain SB. "Structure-Function Imaging of Lung Disease Using Ultrashort Echo Time MRI". Acad Radiol 2019; 26:431-441. [PMID: 30658930 DOI: 10.1016/j.acra.2018.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this review is to acquaint the reader with recent advances in ultrashort echo time (UTE) magnetic resonance imaging (MRI) of the lung and its implications for pulmonary MRI when used in conjunction with functional MRI technique. MATERIALS AND METHODS We provide an overview of recent technical advances of UTE and explore the advantages of combined structure-function pulmonary imaging in the context of restrictive and obstructive pulmonary diseases such as idiopathic pulmonary fibrosis (IPF) and cystic fibrosis (CF). RESULTS UTE MRI clearly shows the lung parenchymal changes due to IPF and CF. The use of UTE MRI, in conjunction with established functional lung MRI in chronic lung diseases, will serve to mitigate the need for computed tomography in children. CONCLUSION Current limitations of UTE MRI include long scan times, poor delineation of thin-walled structures (e.g. cysts and reticulation) due to limited spatial resolution, low signal to noise ratio, and imperfect motion compensation. Despite these limitations, UTE MRI can now be considered as an alternative to multidetector computed tomography for the longitudinal follow-up of the morphological changes from lung diseases in neonates, children, and young adults, particularly as a complement to the unique functional capabilities of MRI.
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Romei C, Turturici L, Tavanti L, Miedema J, Fiorini S, Marletta M, Wielopolski P, Tiddens H, Falaschi F, Ciet P. The use of chest magnetic resonance imaging in interstitial lung disease: a systematic review. Eur Respir Rev 2018; 27:27/150/180062. [PMID: 30567932 DOI: 10.1183/16000617.0062-2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/23/2018] [Indexed: 01/09/2023] Open
Abstract
Thin-slices multi-detector computed tomography (MDCT) plays a key role in the differential diagnosis of interstitial lung disease (ILD). However, thin-slices MDCT has a limited ability to detect active inflammation, which is an important target of newly developed ILD drug therapy. Magnetic resonance imaging (MRI), thanks to its multi-parameter capability, provides better tissue characterisation than thin-slices MDCT.Our aim was to summarise the current status of MRI applications in ILD and to propose an ILD-MRI protocol. A systematic literature search was conducted for relevant studies on chest MRI in patients with ILD.We retrieved 1246 papers of which 55 original papers were selected for the review. We identified 24 studies comparing image quality of thin-slices MDCT and MRI using several MRI sequences. These studies described new MRI sequences to assess ILD parenchymal abnormalities, such as honeycombing, reticulation and ground-glass opacity. Thin-slices MDCT remains superior to MRI for morphological imaging. However, recent studies with ultra-short echo-time MRI showed image quality comparable to thin-slices MDCT. Several studies demonstrated the added value of chest MRI by using functional imaging, especially to detect and quantify inflammatory changes.We concluded that chest MRI could play a role in ILD patients to differentiate inflammatory and fibrotic changes and to assess efficacy of new ILD drugs.
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Affiliation(s)
- Chiara Romei
- 2nd Radiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Laura Turturici
- Radiology, Azienda USL Toscana nord ovest Sede di Viareggio, Viareggio, Italy
| | - Laura Tavanti
- Dept of Surgical, Medical, Molecular Pathology and Critical Care, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Jelle Miedema
- Dept of Respiratory Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sara Fiorini
- 1st Radiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Massimo Marletta
- 1st Radiology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Piotr Wielopolski
- Dept of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harm Tiddens
- Dept of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Pediatric Pulmonology and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Fabio Falaschi
- 2nd Radiology Unit, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Pierluigi Ciet
- Dept of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Dept of Pediatric Pulmonology and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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10
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Mendes Pereira L, Wech T, Weng AM, Kestler C, Veldhoen S, Bley TA, Köstler H. UTE-SENCEFUL: first results for 3D high-resolution lung ventilation imaging. Magn Reson Med 2018; 81:2464-2473. [PMID: 30393947 DOI: 10.1002/mrm.27576] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/27/2018] [Accepted: 10/01/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aimed to develop a 3D MRI technique to assess lung ventilation in free-breathing and without the administration of contrast agent. METHODS A 3D-UTE sequence with a koosh ball trajectory was developed for a 3 Tesla scanner. An oversampled k-space was acquired, and the direct current signal from the k-space center was used as a navigator to sort the acquired data into 8 individual breathing phases. Gradient delays were corrected, and iterative SENSE was used to reconstruct the individual timeframes. Subsequently, the signal changes caused by motion were eliminated using a 3D image registration technique, and ventilation-weighted maps were created by analyzing the signal changes in the lung tissue. Six healthy volunteers and 1 patient with lung cancer were scanned with the new 3D-UTE and the standard 2D technique. Image quality and quantitative ventilation values were compared between both methods. RESULTS UTE-based self-gated noncontrast-enhanced functional lung (SENCEFUL) MRI provided a time-resolved reconstruction of the breathing motion, with a 49% increase of the SNR. Ventilation quantification for healthy subjects was in statistical agreement with 2D-SENCEFUL and the literature, with a mean value of 0.11 ± 0.08 mL/mL for the whole lung. UTE-SENCEFUL was able to visualize and quantify ventilation deficits in a patient with lung tumor that were not properly depicted by 2D-SENCEFUL. CONCLUSION UTE-SENCEFUL represents a robust MRI method to assess both morphological and functional information of the lungs in 3D. When compared to the 2D approach, 3D-UTE offered ventilation maps with higher resolution, improved SNR, and reduced ventilation artifacts.
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Affiliation(s)
- L Mendes Pereira
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany
| | - T Wech
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany
| | - A M Weng
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany
| | - C Kestler
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany
| | - S Veldhoen
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany
| | - T A Bley
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany
| | - H Köstler
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Germany
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11
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Complementary regional heterogeneity information from COPD patients obtained using oxygen-enhanced MRI and chest CT. PLoS One 2018; 13:e0203273. [PMID: 30161221 PMCID: PMC6117056 DOI: 10.1371/journal.pone.0203273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/02/2018] [Indexed: 11/20/2022] Open
Abstract
Background The heterogeneous distribution of emphysema is a key feature of chronic obstructive pulmonary disease (COPD) patients that typically is evaluated using high-resolution chest computed tomography (HRCT). Oxygen-enhanced pulmonary magnetic resonance imaging (OEMRI) is a new method to obtain information regarding regional ventilation, diffusion, and perfusion in the lung without radiation exposure. We aimed to compare OEMRI with HRCT for the assessment of heterogeneity in COPD patients. Methods Forty patients with stable COPD underwent quantitative HRCT, OEMRI, and pulmonary function tests, including arterial blood gas analysis. OEMRI was also performed on nine healthy control subjects. We measured the severity of emphysema (percent low attenuation volume; LAV%) in whole lungs and the standard deviations (SDs) of the LAV% values of 10 isovolumetric partitions (SD-LAV) as an index of cranial-caudal heterogeneity. Similarly, relative enhancement ratios of oxygen (RERs) in whole lungs from OEMRI and SD-RER were analyzed. Results COPD patients showed a lower mean RER than control subjects (12.6% vs 22.0%, p<0.01). The regional heterogeneity of the RERs was not always consistent with the LAV distribution. Both the HRCT (LAV% and SD-LAV) and the OEMRI (RER and SD-RER) indices were significantly associated with the diffusion capacity (DLCO) and partial pressure of oxygen in arterial blood (PaO2). The PaO2 was associated only with the heterogeneity index of HRCT (SD-LAV) (R2 = 0.39); however, the PaO2 was associated with both the mean RER and heterogeneity (SD-RER) in the multivariate analysis (R2 = 0.38). Conclusions OEMRI-derived parameters were directly associated with oxygen uptake in COPD patients. Although the OEMRI-derived parameters were not identical to the HRCT-derived parameters, the cranial-caudal heterogeneity in HRCT or OEMRI was complementary to that in evaluations of oxygen uptake in the lungs. Functional imaging seems to provide new insights into COPD pathophysiology without radiation exposure.
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12
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Abstract
CLINICAL/METHODICAL ISSUE Separate assessment of respiratory mechanics, gas exchange and pulmonary circulation is essential for the diagnosis and therapy of pulmonary diseases. Due to the global character of the information obtained clinical lung function tests are often not sufficiently specific in the differential diagnosis or have a limited sensitivity in the detection of early pathological changes. STANDARD RADIOLOGICAL METHODS The standard procedures of pulmonary imaging are computed tomography (CT) for depiction of the morphology as well as perfusion/ventilation scintigraphy and single photon emission computed tomography (SPECT) for functional assessment. METHODICAL INNOVATIONS Magnetic resonance imaging (MRI) with hyperpolarized gases, O2-enhanced MRI, MRI with fluorinated gases and Fourier decomposition MRI (FD-MRI) are available for assessment of pulmonary ventilation. For assessment of pulmonary perfusion dynamic contrast-enhanced MRI (DCE-MRI), arterial spin labeling (ASL) and FD-MRI can be used. PERFORMANCE Imaging provides a more precise insight into the pathophysiology of pulmonary function on a regional level. The advantages of MRI are a lack of ionizing radiation, which allows a protective acquisition of dynamic data as well as the high number of available contrasts and therefore accessible lung function parameters. ACHIEVEMENTS Sufficient clinical data exist only for certain applications of DCE-MRI. For the other techniques, only feasibility studies and case series of different sizes are available. The clinical applicability of hyperpolarized gases is limited for technical reasons. PRACTICAL RECOMMENDATIONS The clinical application of the techniques described, except for DCE-MRI, should be restricted to scientific studies.
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Affiliation(s)
- G Sommer
- Klinik für Radiologie und Nuklearmedizin, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
| | - G Bauman
- Klinik für Radiologie und Nuklearmedizin - Radiologische Physik, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz
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13
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Zurek M, Sladen L, Johansson E, Olsson M, Jackson S, Zhang H, Mayer G, Hockings PD. Assessing the Relationship between Lung Density and Function with Oxygen-Enhanced Magnetic Resonance Imaging in a Mouse Model of Emphysema. PLoS One 2016; 11:e0151211. [PMID: 26977928 PMCID: PMC4792441 DOI: 10.1371/journal.pone.0151211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 02/23/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose A magnetic resonance imaging method is presented that allows for the simultaneous assessment of oxygen delivery, oxygen uptake, and parenchymal density. The technique is applied to a mouse model of porcine pancreatic elastase (PPE) induced lung emphysema in order to investigate how structural changes affect lung function. Method Nine-week-old female C57BL6 mice were instilled with saline or PPE at days 0 and 7. At day 19, oxygen delivery, oxygen uptake, and lung density were quantified from T1 and proton-density measurements obtained via oxygen-enhanced magnetic resonance imaging (OE-MRI) using an ultrashort echo-time imaging sequence. Subsequently, the lungs were sectioned for histological observation. Blood-gas analyses and pulmonary functional tests via FlexiVent were performed in separate cohorts. Principal Findings PPE-challenged mice had reduced density when assessed via MRI, consistent with the parenchyma loss observed in the histology sections, and an increased lung compliance was detected via FlexiVent. The oxygenation levels, as assessed via the blood-gas analysis, showed no difference between PPE-challenged animals and control. This finding was mirrored in the global MRI assessments of oxygen delivery and uptake, where the changes in relaxation time indices were matched between the groups. The heterogeneity of the same parameters however, were increased in PPE-challenged animals. When the oxygenation status was investigated in regions of varying density, a reduced oxygen-uptake was found in low-density regions of PPE-challenged mice. In high-density regions the uptake was higher than that of regions of corresponding density in control animals. The oxygen delivery was proportional to the oxygen uptake in both groups. Conclusions The proposed method allowed for the regional assessment of the relationship between lung density and two aspects of lung function, the oxygen delivery and uptake. When compared to global indices of lung function, an increased sensitivity for detecting heterogeneous lung disorders was found. This indicated that the technique has potential for early detection of lung dysfunction–before global changes occur.
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Affiliation(s)
- Magdalena Zurek
- Personalised Healthcare and Biomarkers, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
- * E-mail:
| | - Louise Sladen
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Edvin Johansson
- Personalised Healthcare and Biomarkers, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Marita Olsson
- Discovery Sciences, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Sonya Jackson
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Hui Zhang
- Drug Safety and Metabolism, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Gaell Mayer
- Respiratory, Inflammation & Autoimmunity, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
| | - Paul D. Hockings
- Personalised Healthcare and Biomarkers, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Gothenburg, Sweden
- MedTech West, Chalmers University of Technology, Gothenburg, Sweden
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14
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Alamidi DF, Kindvall SSI, Hubbard Cristinacce PL, McGrath DM, Young SS, Naish JH, Waterton JC, Wollmer P, Diaz S, Olsson M, Hockings PD, Lagerstrand KM, Parker GJM, Olsson LE. T1 Relaxation Time in Lungs of Asymptomatic Smokers. PLoS One 2016; 11:e0149760. [PMID: 26958856 PMCID: PMC4784914 DOI: 10.1371/journal.pone.0149760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/04/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose Interest in using T1 as a potential MRI biomarker of chronic obstructive pulmonary disease (COPD) has recently increased. Since tobacco smoking is the major risk factor for development of COPD, the aim for this study was to examine whether tobacco smoking, pack-years (PY), influenced T1 of the lung parenchyma in asymptomatic current smokers. Materials and Methods Lung T1 measurements from 35 subjects, 23 never smokers and 12 current smokers were retrospectively analyzed from an institutional review board approved study. All 35 subjects underwent pulmonary function test (PFT) measurements and lung T1, with similar T1 measurement protocols. A backward linear model of T1 as a function of FEV1, FVC, weight, height, age and PY was tested. Results A significant correlation between lung T1 and PY was found with a negative slope of -3.2 ms/year (95% confidence interval [CI] [-5.8, -0.6], p = 0.02), when adjusted for age and height. Lung T1 shortens with ageing among all subjects, -4.0 ms/year (95%CI [-6.3, -1.7], p = 0.001), and among the never smokers, -3.7 ms/year (95%CI [-6.0, -1.3], p = 0.003). Conclusions A correlation between lung T1 and PY when adjusted for both age and height was found, and T1 of the lung shortens with ageing. Accordingly, PY and age can be significant confounding factors when T1 is used as a biomarker in lung MRI studies that must be taken into account to detect underlying patterns of disease.
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Affiliation(s)
- Daniel F. Alamidi
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Simon S. I. Kindvall
- Department of Medical Physics, Lund University, Translational Sciences, Malmö, Sweden
| | - Penny L. Hubbard Cristinacce
- Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Deirdre M. McGrath
- Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | | | - Josephine H. Naish
- Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - John C. Waterton
- Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Per Wollmer
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Sandra Diaz
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | | | - Paul D. Hockings
- Medtech West, Chalmers University of Technology, Gothenburg, Sweden
- Antaros Medical, BioVenture Hub, Mölndal, Sweden
| | - Kerstin M. Lagerstrand
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Geoffrey J. M. Parker
- Centre for Imaging Sciences and Biomedical Imaging Institute, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- Bioxydyn Ltd, Manchester, United Kingdom
| | - Lars E. Olsson
- Department of Medical Physics, Lund University, Translational Sciences, Malmö, Sweden
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15
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Ciet P, Serra G, Andrinopoulou ER, Bertolo S, Ros M, Catalano C, Colagrande S, Tiddens HAWM, Morana G. Diffusion weighted imaging in cystic fibrosis disease: beyond morphological imaging. Eur Radiol 2016; 26:3830-3839. [PMID: 26873494 DOI: 10.1007/s00330-016-4248-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 12/22/2015] [Accepted: 01/25/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To explore the feasibility of diffusion-weighted imaging (DWI) to assess inflammatory lung changes in patients with Cystic Fibrosis (CF) METHODS: CF patients referred for their annual check-up had spirometry, chest-CT and MRI on the same day. MRI was performed in a 1.5 T scanner with BLADE and EPI-DWI sequences (b = 0-600 s/mm2). End-inspiratory and end-expiratory scans were acquired in multi-row scanners. DWI was scored with an established semi-quantitative scoring system. DWI score was correlated to CT sub-scores for bronchiectasis (CF-CTBE), mucus (CF-CTmucus), total score (CF-CTtotal-score), FEV1, and BMI. T-test was used to assess differences between patients with and without DWI-hotspots. RESULTS Thirty-three CF patients were enrolled (mean 21 years, range 6-51, 19 female). 4 % (SD 2.6, range 1.5-12.9) of total CF-CT alterations presented DWI-hotspots. DWI-hotspots coincided with mucus plugging (60 %), consolidation (30 %) and bronchiectasis (10 %). DWItotal-score correlated (all p < 0.0001) positively to CF-CTBE (r = 0.757), CF-CTmucus (r = 0.759) and CF-CTtotal-score (r = 0.79); and negatively to FEV1 (r = 0.688). FEV1 was significantly higher (p < 0.0001) in patients without DWI-hotspots. CONCLUSIONS DWI-hotspots strongly correlated with radiological and clinical parameters of lung disease severity. Future validation studies are needed to establish the exact nature of DWI-hotspots in CF patients. KEY POINTS • DWI hotspots only partly overlapped structural abnormalities on morphological imaging • DWI strongly correlated with radiological and clinical indicators of CF-disease severity • Patients with more DWI hotspots had lower lung function values • Mucus score best predicted the presence of DWI-hotspots with restricted diffusion.
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Affiliation(s)
- Pierluigi Ciet
- Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands.,Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Goffredo Serra
- Department of Radiology, University of Rome "Sapienza", Rome, Italy
| | | | - Silvia Bertolo
- Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy
| | - Mirco Ros
- Department of Pediatrics, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Catalano
- Department of Radiology, University of Rome "Sapienza", Rome, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi., Largo Brambilla 3, Florence, 50134, Italy
| | - Harm A W M Tiddens
- Department of Radiology, Erasmus Medical Center, Rotterdam, Netherlands.,Department of Paediatrics, Respiratory Medicine and Allergology, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, Wytemaweg 80, Rotterdam, 3000 CB, Zuid-Holland, Netherlands
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello - General Hospital, Piazzale Ospedale, 1, 31100, Treviso, Italy.
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16
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Kindvall SS, Diaz S, Svensson J, Wollmer P, Slusarczyk D, Olsson LE. Influence of age and sex on the longitudinal relaxation time, T1, of the lung in healthy never-smokers. J Magn Reson Imaging 2015; 43:1250-7. [DOI: 10.1002/jmri.25085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/15/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Simon S.I. Kindvall
- Medical Radiation Physics, Translational Medicine; Lund University; Malmö Sweden
| | - Sandra Diaz
- Medical Radiology, Translational Medicine; Lund University; Malmö Sweden
| | - Jonas Svensson
- Medical imaging and physiology; Skane University Hospital; Lund Sweden
| | - Per Wollmer
- Clinical Physiology, Translational Medicine; Lund University; Malmö Sweden
| | - Dariusz Slusarczyk
- Medical Radiology, Translational Medicine; Lund University; Malmö Sweden
| | - Lars E. Olsson
- Medical Radiation Physics, Translational Medicine; Lund University; Malmö Sweden
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Jobst BJ, Triphan SMF, Sedlaczek O, Anjorin A, Kauczor HU, Biederer J, Ley-Zaporozhan J, Ley S, Wielpütz MO. Functional lung MRI in chronic obstructive pulmonary disease: comparison of T1 mapping, oxygen-enhanced T1 mapping and dynamic contrast enhanced perfusion. PLoS One 2015; 10:e0121520. [PMID: 25822195 PMCID: PMC4379151 DOI: 10.1371/journal.pone.0121520] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 02/03/2015] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Monitoring of regional lung function in interventional COPD trials requires alternative endpoints beyond global parameters such as FEV1. T1 relaxation times of the lung might allow to draw conclusions on tissue composition, blood volume and oxygen fraction. The aim of this study was to evaluate the potential value of lung Magnetic resonance imaging (MRI) with native and oxygen-enhanced T1 mapping for the assessment of COPD patients in comparison with contrast enhanced perfusion MRI. MATERIALS AND METHODS 20 COPD patients (GOLD I-IV) underwent a coronal 2-dimensional inversion recovery snapshot flash sequence (8 slices/lung) at room air and during inhalation of pure oxygen, as well as dynamic contrast-enhanced first-pass perfusion imaging. Regional distribution of T1 at room air (T1), oxygen-induced T1 shortening (ΔT1) and peak enhancement were rated by 2 chest radiologists in consensus using a semi-quantitative 3-point scale in a zone-based approach. RESULTS Abnormal T1 and ΔT1 were highly prevalent in the patient cohort. T1 and ΔT1 correlated positively with perfusion abnormalities (r = 0.81 and r = 0.80; p&0.001), and with each other (r = 0.80; p<0.001). In GOLD stages I and II ΔT1 was normal in 16/29 lung zones with mildly abnormal perfusion (15/16 with abnormal T1). The extent of T1 (r = 0.45; p<0.05), ΔT1 (r = 0.52; p<0.05) and perfusion abnormalities (r = 0.52; p<0.05) showed a moderate correlation with GOLD stage. CONCLUSION Native and oxygen-enhanced T1 mapping correlated with lung perfusion deficits and severity of COPD. Under the assumption that T1 at room air correlates with the regional pulmonary blood pool and that oxygen-enhanced T1 reflects lung ventilation, both techniques in combination are principally suitable to characterize ventilation-perfusion imbalance. This appears valuable for the assessment of regional lung characteristics in COPD trials without administration of i.v. contrast.
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Affiliation(s)
- Bertram J. Jobst
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Simon M. F. Triphan
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Research Center Magnetic Resonance Bavaria (MRB), Würzburg, Germany
| | - Oliver Sedlaczek
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
| | - Angela Anjorin
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
| | - Hans Ulrich Kauczor
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Radiologie Darmstadt, Department of Radiology Hospital Gross-Gerau, Gross-Gerau, Germany
| | - Julia Ley-Zaporozhan
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Sebastian Ley
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Department of Diagnostic & Interventional Radiology, Surgical Hospital Dr. Rinecker, Munich, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
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Tiddens HAWM, Puderbach M, Venegas JG, Ratjen F, Donaldson SH, Davis SD, Rowe SM, Sagel SD, Higgins M, Waltz DA. Novel outcome measures for clinical trials in cystic fibrosis. Pediatr Pulmonol 2015; 50:302-315. [PMID: 25641878 PMCID: PMC4365726 DOI: 10.1002/ppul.23146] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/20/2014] [Accepted: 11/02/2014] [Indexed: 12/25/2022]
Abstract
Cystic fibrosis (CF) is a common inherited condition caused by mutations in the gene encoding the CF transmembrane regulator protein. With increased understanding of the molecular mechanisms underlying CF and the development of new therapies there comes the need to develop new outcome measures to assess the disease, its progression and response to treatment. As there are limitations to the current endpoints accepted for regulatory purposes, a workshop to discuss novel endpoints for clinical trials in CF was held in Anaheim, California in November 2011. The pros and cons of novel outcome measures with potential utility for evaluation of novel treatments in CF were critically evaluated. The highlights of the 2011 workshop and subsequent advances in technologies and techniques that could be used to inform the development of clinical trial endpoints are summarized in this review. Pediatr Pulmonol. © 2014 The Authors. Pediatric Pulmonology published by Wiley Periodicals, Inc.
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Affiliation(s)
- Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology, Department of Radiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Michael Puderbach
- Department for Diagnostic and Interventional Radiology, Hufeland Klinikum, Bad Langensalza, Germany
| | - Jose G Venegas
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Felix Ratjen
- Department of Pediatrics, Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Scott H Donaldson
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Stephanie D Davis
- Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Scott D Sagel
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colorado
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Zhang WJ, Niven RM, Young SS, Liu YZ, Parker GJM, Naish JH. Dynamic oxygen-enhanced magnetic resonance imaging of the lung in asthma -- initial experience. Eur J Radiol 2014; 84:318-26. [PMID: 25467640 DOI: 10.1016/j.ejrad.2014.10.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/21/2014] [Accepted: 10/25/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To prospectively estimate the feasibility and reproducibility of dynamic oxygen-enhanced magnetic resonance imaging (OE-MRI) in the assessment of regional oxygen delivery, uptake and washout in asthmatic lungs. MATERIALS AND METHODS The study was approved by the National Research Ethics Committee and written informed consent was obtained. Dynamic OE-MRI was performed twice at one month apart on four mild asthmatic patients (23±5 years old, FEV1=96±3% of predicted value) and six severe asthmatic patients (41±12 years old, FEV1=60±14% of predicted value) on a 1.5T MR scanner using a two-dimensional T1-weighted inversion-recovery turbo spin echo sequence. The enhancing fraction (EF), the maximal change in the partial pressure of oxygen in lung tissue (ΔPO2max_l) and arterial blood of the aorta (ΔPO2max_a), and the oxygen wash-in (τup_l, τup_a) and wash-out (τdown_l, τdown_a) time constants were extracted and compared between groups using the independent-samples t-test (two-tailed). Correlations between imaging readouts and clinical measurements were assessed by Pearson's correlation analysis. Bland-Altman analysis was used to estimate the levels of agreement between the repeat scans and the intra-observer agreement in the MR imaging readouts. RESULTS The severe asthmatic group had significantly smaller EF (70±16%) and median ΔPO2max_l (156±52mmHg) and significantly larger interquartile range of τup_l (0.84±0.26min) than the mild asthmatic group (95±3%, P=0.014; 281±40mmHg, P=0.004; 0.20±0.07min, P=0.001, respectively). EF, median ΔPO2max_l and τdown_l and the interquartile range of τup_l and τdown_l were significantly correlated with age and pulmonary function test parameters (r=-0.734 to -0.927, 0.676-0.905; P=0.001-0.045). Median ΔPO2max_l was significantly correlated with ΔPO2max_a (r=0.745, P=0.013). Imaging readouts showed good one-month reproducibility and good intra-observer agreement (mean bias between repeated scans and between two observations did not significantly deviate from zero). CONCLUSIONS Dynamic OE-MRI is feasible in asthma and sensitive to the severity of disease. The technique provides indices related to regional oxygen delivery, uptake and washout that show good one month reproducibility and intra-observer agreement.
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Affiliation(s)
- Wei-Juan Zhang
- Centre for Imaging Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK; Biomedical Imaging Institute, The University of Manchester, Oxford Road, Manchester M13 9PT, UK.
| | - Robert M Niven
- North West Lung Research Centre, University Hospital of South Manchester, Southmoor Road, Manchester M23 9LT, UK.
| | - Simon S Young
- Personalised Healthcare and Biomarkers, AstraZeneca R&D, Alderley Park, Macclesfield SK10 4TF, UK.
| | - Yu-Zhen Liu
- Personalised Healthcare and Biomarkers, AstraZeneca R&D, Alderley Park, Macclesfield SK10 4TF, UK.
| | - Geoffrey J M Parker
- Centre for Imaging Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK; Biomedical Imaging Institute, The University of Manchester, Oxford Road, Manchester M13 9PT, UK; Bioxydyn Limited, Rutherford House, Pencroft Way, Manchester M15 6SZ, UK.
| | - Josephine H Naish
- Centre for Imaging Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK; Biomedical Imaging Institute, The University of Manchester, Oxford Road, Manchester M13 9PT, UK.
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20
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Fujii K, Watanabe Y, Hanaoka S, Motoyoshi K, Goto M, Amemiya S, Ino K, Akahane M, Yano K, Ohtomo K. [Study on cine view of relative enhancement ratio map in O2-enhanced MRI]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2014; 70:1290-1296. [PMID: 25410336 DOI: 10.6009/jjrt.2014_jsrt_70.11.1290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Magnetic resonance imaging (MRI) enables the evaluation of organ structure and function. Oxygen-enhanced MRI (O2-enhanced MRI) is a method for evaluating the pulmonary ventilation function using oxygen as a contrast agent. We created the Cine View of Relative Enhancement Ratio Map (Cine RER map) in O2-enhanced MRI to easily observe the contrast effect for clinical use. Relative enhancement ratio (RER) was determined as the pixel values of the Cine RER map. Moreover, six healthy volunteers underwent O2-enhanced MRI to determine the appropriate scale width of the Cine RER map. We calculated each RER and set 0 to 1.27 as the scale width of the Cine RER map based on the results. The Cine RER map made it possible to observe the contrast effect over time and thus is a convenient tool for evaluating the pulmonary ventilation function in O2-enhanced MRI.
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Affiliation(s)
- Keita Fujii
- Department of Radiological Technology, Tokyo University Hospital
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Holland DV, Paul Guillerman R, Brody AS. Thoracic Manifestations of Systemic Diseases. PEDIATRIC CHEST IMAGING 2014. [DOI: 10.1007/174_2014_965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Zurek M, Johansson E, Risse F, Alamidi D, Olsson LE, Hockings PD. Accurate T
1
mapping for oxygen-enhanced MRI in the mouse lung using a segmented inversion-recovery ultrashort echo-time sequence. Magn Reson Med 2013; 71:2180-5. [DOI: 10.1002/mrm.24876] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/24/2013] [Accepted: 06/17/2013] [Indexed: 11/08/2022]
Affiliation(s)
- M. Zurek
- AstraZeneca, Personalized Healthcare and Biomarkers, In vivo Biomarkers; Mölndal Sweden
| | - E. Johansson
- AstraZeneca, Personalized Healthcare and Biomarkers, In vivo Biomarkers; Mölndal Sweden
| | - F. Risse
- AstraZeneca, Personalized Healthcare and Biomarkers, In vivo Biomarkers; Mölndal Sweden
| | - D. Alamidi
- Department of Radiation Physics; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg; Gothenburg Sweden
| | - L. E. Olsson
- Department of Medical Radiation Physics; IKVM, Lund University; Malmö Sweden
| | - P. D. Hockings
- AstraZeneca, Personalized Healthcare and Biomarkers, In vivo Biomarkers; Mölndal Sweden
- MedTech West; Chalmers University of Technology; Gothenburg Sweden
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Bauman G, Eichinger M. Ventilation and perfusion magnetic resonance imaging of the lung. Pol J Radiol 2012; 77:37-46. [PMID: 22802864 PMCID: PMC3389953 DOI: 10.12659/pjr.882579] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 01/19/2012] [Indexed: 02/02/2023] Open
Abstract
A close interaction between the respiratory pump, pulmonary parenchyma and blood circulation is essential for a normal lung function. Many pulmonary diseases present, especially in their initial phase, a variable regional impairment of ventilation and perfusion. In the last decades various techniques have been established to measure the lung function. Besides the global pulmonary function tests (PFTs) imaging techniques gained increasing importance to detect local variations in lung function, especially for ventilation and perfusion assessment. Imaging modalities allow for a deeper regional insight into pathophysiological processes and enable improved planning of invasive procedures. In contrast to computed tomography (CT) and the nuclear medicine techniques, magnetic resonance imaging (MRI), as a radiation free imaging modality gained increasing importance since the early 1990 for the assessment of pulmonary function. The major inherent problems of lung tissue, namely the low proton density and the pulmonary and cardiac motion, were overcome in the last years by a constant progress in MR technology. Some MR techniques are still under development, a process which is driven by scientific questions regarding the physiology and pathophysiology of pulmonary diseases, as well as by the need for fast and robust clinically applicable imaging techniques as safe therapy monitoring tools. MRI can be considered a promising ionizing-free alternative to techniques like CT or nuclear medicine techniques for the evaluation of lung function. The goal of this article is to provide an overview on selected MRI techniques for the assessment of pulmonary ventilation and perfusion.
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Affiliation(s)
- Grzegorz Bauman
- German Cancer Research Center, Department of Medical Physics in Radiology, Heidelberg, Germany
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Maxien D, Dietrich O, Thieme SF, Förster S, Behr J, Reiser MF, Nikolaou K. Value of oxygen-enhanced MRI of the lungs in patients with pulmonary hypertension: A qualitative and quantitative approach. J Magn Reson Imaging 2011; 35:86-94. [DOI: 10.1002/jmri.22740] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 07/14/2011] [Indexed: 11/05/2022] Open
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Togao O, Ohno Y, Dimitrov I, Hsia CC, Takahashi M. Ventilation/perfusion imaging of the lung using ultra-short echo time (UTE) MRI in an animal model of pulmonary embolism. J Magn Reson Imaging 2011; 34:539-46. [PMID: 21761465 DOI: 10.1002/jmri.22645] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 04/07/2011] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To test the feasibility of ultra-short echo time (UTE) MRI for assessment of regional pulmonary ventilation/perfusion in a standard 3 Tesla clinical MRI system. MATERIALS AND METHODS MRI of the lungs was conducted with an optimized three-dimensional UTE sequence in normal rats and in a rat model of pulmonary embolism (PE) induced by a blood clot. Changes in signal intensities (SIs) due to inhalation of molecular oxygen or intravenous (i.v.) injection of Gd, which represents the distribution of ventilation and perfusion, respectively, were assessed in the lung parenchyma. RESULTS The UTE MRI with a TE of 100 μs could detect and map the changes in SI of the lung parenchyma due to the inhalation of 100% oxygen or i.v. injection of Gd in normal rats. Reduced T1 resulting from oxygen inhalation was also quantified. These changes were not observed on the images that were obtained simultaneously with a conventional range of TE (2.3 ms). Furthermore, the method could delineate the embolized lesions where the lung ventilation and perfusion were mismatched in a rat model with PE. CONCLUSION These results show the feasibility and diagnostic potential of UTE MRI for the assessment of pulmonary ventilation and perfusion which is essential for the evaluation of a variety of lung diseases.
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Affiliation(s)
- Osamu Togao
- UT Southwestern Medical Center, Dallas, Texas 75390-8542, USA
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Magnetic Resonance Imaging of Lung Tissue: Influence of Body Positioning, Breathing and Oxygen Inhalation on Signal Decay Using Multi-Echo Gradient-Echo Sequences. Invest Radiol 2008; 43:433-8. [DOI: 10.1097/rli.0b013e3181690191] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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