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Lazarinis N, Fouka E, Linden A, Bossios A. Small airways disease in chronic obstructive pulmonary disease. Expert Rev Respir Med 2024; 18:539-552. [PMID: 39046133 DOI: 10.1080/17476348.2024.2380070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Small airway disease (SAD) represents a common and critical feature of Chronic Obstructive Pulmonary Disease (COPD). Introduced in the '60s, SAD has gradually gained increasing interest as assessment methodologies have improved. Chronic exposure to smoking and noxious particles or gases induces inflammation and remodeling, leading to airway obstruction and SAD, eventually resulting in complete airway loss. AREAS COVERED A literature search up to June 2024 was performed in PubMed to identify articles on SAD and airway diseases mainly COPD, but also to the extent that it seemed relevant in the uncontrolled/severe asthma field, where SAD is better studied. We provide clinicians and translational scientists with a comprehensive analysis of the existing literature on SAD in COPD, concentrating on the underlying pathophysiological mechanisms, diagnostic techniques, and current pharmacological approaches targeting airflow obstruction in small airways. EXPERT OPINION Small airways are the primary site for the onset and progression of airflow obstruction in patients with COPD, with significant clinical consequences associated with poor lung function, hyperinflation, and impaired quality of life. The early identification of individuals with subclinical SAD may allow us to prevent its further progress from airway loss and potential development of emphysema and choose the appropriate therapeutic approach.
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Affiliation(s)
- Nikolaos Lazarinis
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska Severe COPD Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Evangelia Fouka
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Pulmonary Department, Medical School, Aristotle University of Thessaloniki, 'G. Papanikolaou'' General Hospital, Exohi, Thessaloniki, Greece
| | - Anders Linden
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska Severe COPD Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | - Apostolos Bossios
- Division of Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Karolinska Severe Asthma Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
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Leblanc M, Tessier M, Ollenberger G, O'Brien C, Zuckier LS. Guidelines for ventilation/perfusion (V/P SPECT) in pulmonary embolism. J Med Imaging Radiat Sci 2024; 55:158-162. [PMID: 37996383 DOI: 10.1016/j.jmir.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 11/25/2023]
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Jabbarpour A, Ghassel S, Lang J, Leung E, Le Gal G, Klein R, Moulton E. The Past, Present, and Future Role of Artificial Intelligence in Ventilation/Perfusion Scintigraphy: A Systematic Review. Semin Nucl Med 2023; 53:752-765. [PMID: 37080822 DOI: 10.1053/j.semnuclmed.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/22/2023]
Abstract
Ventilation-perfusion (V/Q) lung scans constitute one of the oldest nuclear medicine procedures, remain one of the few studies performed in the acute setting, and are amongst the few performed in the emergency setting. V/Q studies have witnessed a long fluctuation in adoption rates in parallel to continuous advances in image processing and computer vision techniques. This review provides an overview on the status of artificial intelligence (AI) in V/Q scintigraphy. To clearly assess the past, current, and future role of AI in V/Q scans, we conducted a systematic Ovid MEDLINE(R) literature search from 1946 to August 5, 2022 in addition to a manual search. The literature was reviewed and summarized in terms of methodologies and results for the various applications of AI to V/Q scans. The PRISMA guidelines were followed. Thirty-one publications fulfilled our search criteria and were grouped into two distinct categories: (1) disease diagnosis/detection (N = 22, 71.0%) and (2) cross-modality image translation into V/Q images (N = 9, 29.0%). Studies on disease diagnosis and detection relied heavily on shallow artificial neural networks for acute pulmonary embolism (PE) diagnosis and were primarily published between the mid-1990s and early 2000s. Recent applications almost exclusively regard image translation tasks from CT to ventilation or perfusion images with modern algorithms, such as convolutional neural networks, and were published between 2019 and 2022. AI research in V/Q scintigraphy for acute PE diagnosis in the mid-90s to early 2000s yielded promising results but has since been largely neglected and thus have yet to benefit from today's state-of-the art machine-learning techniques, such as deep neural networks. Recently, the main application of AI for V/Q has shifted towards generating synthetic ventilation and perfusion images from CT. There is therefore considerable potential to expand and modernize the use of real V/Q studies with state-of-the-art deep learning approaches, especially for workflow optimization and PE detection at both acute and chronic stages. We discuss future challenges and potential directions to compensate for the lag in this domain and enhance the value of this traditional nuclear medicine scan.
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Affiliation(s)
- Amir Jabbarpour
- Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - Siraj Ghassel
- Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ontario, Canada
| | - Jochen Lang
- Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ontario, Canada
| | - Eugene Leung
- Division of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Grégoire Le Gal
- Division of Hematology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ran Klein
- Department of Physics, Carleton University, Ottawa, Ontario, Canada; Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ontario, Canada; Division of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Nuclear Medicine and Molecular Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - Eric Moulton
- Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Ontario, Canada; Jubilant DraxImage Inc., Kirkland, Quebec, Canada
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Xie H, Zhao Z, Zhang W, Li L. Quantitative analysis of lung function and airway remodeling using ventilation/perfusion single photon emission tomography/computed tomography and HRCT in patients with chronic obstructive pulmonary disease and asthma. Ann Nucl Med 2023; 37:504-516. [PMID: 37268867 DOI: 10.1007/s12149-023-01848-7] [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: 02/01/2023] [Accepted: 05/20/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the role of V/P SPECT/CT and HRCT quantitative parameters in evaluating COPD and asthma disease severity, airway obstructivity-grade, ventilation and perfusion distribution patterns, airway remodeling, and lung parenchymal changes. METHOD Fifty-three subjects who underwent V/P SPECT/CT, HRCT, and pulmonary function tests (PFTs) were included. Preserved lung ventilation (PLVF), perfusion function (PLPF), airway obstructivity-grade (OG), proportion of anatomical volume, ventilation and perfusion contribution of each lobe, and V/P distribution patterns were evaluated using V/P SPECT/CT. The quantitative parameters of HRCT included CT bronchial and CT pulmonary function parameters. In addition, the correlation and difference of V/P SPECT/CT-, HRCT-, and PFT-related parameters were compared. RESULTS There was a statistically significant difference between severe asthma and severe-very severe COPD in CT bronchial parameters, like WA, LA and AA, in the lung segment airways (P < 0.05). CT bronchial parameters, like as WT and WA, were statistically significant (p < 0.05) among asthma patients. The EI of severe-very severe COPD was different from that of the disease severity groups in asthma patients (P < 0.05). The airway obstructivity-grade, PLVF and PLPF differed significantly among the severe-very severe COPD and mild-moderate asthma patients (P < 0.05). And the PLPF was statistically significant among the disease severity groups in asthma and COPD (P < 0.05). OG and PLVF, PLPF, and PFT parameters were significantly correlated, with the FEV1 correlation being the most significant (r = - 0.901, r = 0.915, and r = 0.836, respectively; P < 0.01). There was a strong negative correlation between OG and PLVF (r = - 0.945) and OG and PLPF (r = - 0.853) and a strong positive correlation between PLPF and PLVF (r = 0.872). In addition, OG, PLVF, and PLPF were moderately to strongly correlated with CT lung function parameters (r = - 0.673 to - 0.839; P < 0.01), while lowly to moderately correlated with most CT bronchial parameters (r = - 0.366 to - 0.663, P < 0.01). There were three different V/P distribution patterns, including matched, mismatched, and reverse mismatched patterns. Last, the CT volume overestimated the contribution in the upper lobes and underestimated the lower lobes' contribution to overall function. CONCLUSIONS Quantitative assessment of ventilation and perfusion abnormalities and the degree of pulmonary functional loss by V/P SPECT/CT shows promise as an objective measure to assess the severity of disease and lung function to guide localized treatments. There are differences between HRCT parameters and SPECT/CT parameters among the disease severity groups in asthma and COPD, which may enhance, to some extent, the understanding of complex physiological mechanisms in asthma and COPD.
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Affiliation(s)
- Hangyu Xie
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhen Zhao
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
| | - Wenjie Zhang
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Lin Li
- Department of Nuclear Medicine, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Radadia N, Friedlander Y, Priel E, Konyer NB, Huang C, Jamal M, Farncombe T, Marriott C, Finley C, Agzarian J, Dolovich M, Noseworthy MD, Nair P, Shargall Y, Svenningsen S. Comparison of ventilation defects quantified by Technegas SPECT and hyperpolarized 129Xe MRI. Front Physiol 2023; 14:1133334. [PMID: 37234422 PMCID: PMC10206636 DOI: 10.3389/fphys.2023.1133334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/03/2023] [Indexed: 05/28/2023] Open
Abstract
Introduction: The ideal contrast agents for ventilation SPECT and MRI are Technegas and 129Xe gas, respectively. Despite increasing interest in the clinical utility of ventilation imaging, these modalities have not been directly compared. Therefore, our objective was to compare the ventilation defect percent (VDP) assessed by Technegas SPECT and hyperpolarized 129Xe MRI in patients scheduled to undergo lung cancer resection with and without pre-existing obstructive lung disease. Methods: Forty-one adults scheduled to undergo lung cancer resection performed same-day Technegas SPECT, hyperpolarized 129Xe MRI, spirometry, and diffusing capacity of the lung for carbon monoxide (DLCO). Ventilation abnormalities were quantified as the VDP using two different methods: adaptive thresholding (VDPT) and k-means clustering (VDPK). Correlation and agreement between VDP quantified by Technegas SPECT and 129Xe MRI were determined by Spearman correlation and Bland-Altman analysis, respectively. Results: VDP measured by Technegas SPECT and 129Xe MRI were correlated (VDPT: r = 0.48, p = 0.001; VDPK: r = 0.63, p < 0.0001). A 2.0% and 1.6% bias towards higher Technegas SPECT VDP was measured using the adaptive threshold method (VDPT: 23.0% ± 14.0% vs. 21.0% ± 5.2%, p = 0.81) and k-means method (VDPK: 9.4% ± 9.4% vs. 7.8% ± 10.0%, p = 0.02), respectively. For both modalities, higher VDP was correlated with lower FEV1/FVC (SPECT VDPT: r = -0.38, p = 0.01; MRI VDPK: r = -0.46, p = 0.002) and DLCO (SPECT VDPT: r = -0.61, p < 0.0001; MRI VDPK: r = -0.68, p < 0.0001). Subgroup analysis revealed that VDP measured by both modalities was significantly higher for participants with COPD (n = 13) than those with asthma (n = 6; SPECT VDPT: p = 0.007, MRI VDPK: p = 0.006) and those with no history of obstructive lung disease (n = 21; SPECT VDPT: p = 0.0003, MRI VDPK: p = 0.0003). Discussion: The burden of ventilation defects quantified by Technegas SPECT and 129Xe MRI VDP was correlated and greater in participants with COPD when compared to those without. Our observations indicate that, despite substantial differences between the imaging modalities, quantitative assessment of ventilation defects by Technegas SPECT and 129Xe MRI is comparable.
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Affiliation(s)
- Nisarg Radadia
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Yonni Friedlander
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Eldar Priel
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Norman B. Konyer
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Chynna Huang
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Mobin Jamal
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Troy Farncombe
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Nuclear Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Christopher Marriott
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Nuclear Medicine, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Christian Finley
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - John Agzarian
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Myrna Dolovich
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Michael D. Noseworthy
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Parameswaran Nair
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Yaron Shargall
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Sarah Svenningsen
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Firestone Institute for Respiratory Health, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
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Tanguay J, Basharat F. Xenon-enhanced dual-energy tomosynthesis for functional imaging of respiratory disease-Concept and phantom study. Med Phys 2023; 50:719-736. [PMID: 36419344 DOI: 10.1002/mp.16101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Xenon-enhanced dual-energy (DE) computed tomography (CT) and hyperpolarized noble-gas magnetic resonance imaging (MRI) provide maps of lung ventilation that can be used to detect chronic obstructive pulmonary disease (COPD) early in its development and predict respiratory exacerbations. However, xenon-enhanced DE-CT requires high radiation doses and hyper-polarized noble-gas MRI is expensive and only available at a handful of institutions globally. PURPOSE To present xenon-enhanced dual-energy tomosynthesis (XeDET) for low-dose, low-cost functional imaging of respiratory disease in an experimental phantom study. METHODS We propose using digital tomosynthesis to produce Xe-enhanced low-energy (LE) and high-energy (HE) coronal images. DE subtraction of the LE and HE images is used to suppress soft tissues. We used an imaging phantom to investigate image quality in terms of the area under the reciever operating characteristic curve (AUC) for the Non-PreWhitening model observer with an Eye filter and internal noise (NPWEi). The phantom simulated anatomic clutter due to lung parenchyma and attenuation due to soft tissue and lung tissue. Aluminum slats were used to simulate rib structures. A stepwedge consisting of an acrylic casing with sealed cylindrical air-filled cavities was used to simulate ventilation defects with step thicknesses of 0.5, 1, and 2 cm and cylindrical radii of 0.5, 0.75, and 1 cm. The phantom was ventilated with Xe and projection data were acquired using a flat-panel detector, a tube-voltage combination of 60/140 kV with 1.2 mm of copper filtration on the HE spectrum and an angular range of ± 15 ∘ $\pm 15^{\circ}$ in 1° increments. The AUC of a NPWEi observer that has access only to a single coronal slice was calculated from measurements of the three-dimensional noise power spectrum and signal template. The AUC was calculated as a function of ventilation defect thickness and radius for total patient entrance air kermas ranging from 1.42 to 2.84 mGy with and without rib-simulating Al slats. For the AUC analysis, the observer internal noise level was obtained from an ad hoc calibration to a high-dose data set. RESULTS XeDET was able to suppress parenchyma-simulating clutter in coronal images enabling visualization of the simulated ventilation defects, but the limited angle acquisition resulted in residual clutter due to out-of-plane bone-mimmicking structures. The signal power of the defects increased linearly with defect radius and showed a ten-fold to fifteen-fold increase in signal power when the defect thickness increased from 0.5 to 2 cm. These trends agreed with theoretical predictions. Along the depth dimension, the power of the defects decreased exponentially with distance from the center of the defects with full-width half maxima that varied from 1.85 to 2.85 cm depending on the defect thickness and radius. The AUCs of the 1-cm-radius defect that was 2 cm in thickness ranged from good (0.8-0.9) to excellent (0.9-1.0) over the range of air kermas considered. CONCLUSIONS Xenon-enhanced DE tomosynthesis has the potential to enable functional imaging of respiratory disease and should be further investigated as a low-cost alternative to MRI-based approaches and a low-dose alternative to CT-based approaches.
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Affiliation(s)
- Jesse Tanguay
- Department of Physics, Toronto Metropoliton University (formerly Ryerson University), Toronto, ON, Canada
| | - Fateen Basharat
- Department of Physics, Toronto Metropoliton University (formerly Ryerson University), Toronto, ON, Canada
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Tan TH, Ismail R. Utility of Lung Perfusion SPECT/CT in Detection of Pulmonary Thromboembolic Disease: Outcome Analysis. Nucl Med Mol Imaging 2023; 57:1-8. [PMID: 35013684 PMCID: PMC8731677 DOI: 10.1007/s13139-021-00726-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose To evaluate the clinical outcome of Q-SPECT/CT in pulmonary thromboembolic disease. Methods From Jan 2020 to Jan 2021, 30 consecutive patients (M:F = 8:22; median age = 52 year (21-89)) suspected of having acute pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH) were referred for non-contrasted Q-SPECT/CT. All patients were COVID-19 PCR negative. MSKCC Q-SPECT/CT and/or PISAPED criteria were used to determine the presence of thromboembolic disease in Q-SPECT/CT. Final diagnosis was made based on composite reference standards that included at least 2-month clinical cardiorespiratory assessment and follow-up imaging. Results Q-SPECT/CT was positive in 19 patients: indeterminate in 1 and 10 were negative. Three false positive cases were observed during follow-up. Of the remaining 16 true positives, all patients' cardiorespiratory symptom were improved or stabilised after treatment with anticoagulants. The overall sensitivity, specificity, PPV, NPV and accuracy of Q-SPECT/CT were 100% (95% CI, 79.41-100%), 78.57% (95% CI, 49.20-95.34%), 84.21% (95% CI, 66.41-93.57%), 100% and 90.00% (95% CI, 73.47-97.89%) respectively. Conclusions In the current COVID-19 pandemic, Q-SPECT/CT can be an alternative modality to detect pulmonary thromboembolic disease. Normal Q-SPECT/CT excludes pulmonary thromboembolic disease with high degree of certainty. However, false positive has been observed.
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Affiliation(s)
- Teik Hin Tan
- Nuclear Medicine, Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Selangor Malaysia
| | - Rosmadi Ismail
- Internal Medicine, Sunway Medical Centre, 5, Jalan Lagoon Selatan, Bandar Sunway, 47500 Petaling Jaya, Selangor Malaysia
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Basharat F, Tanguay J. Experimental feasibility of xenon-enhanced dual-energy radiography for imaging of lung function. Phys Med Biol 2022; 67. [PMID: 36395522 DOI: 10.1088/1361-6560/aca3f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. We experimentally investigated the feasibility of two-dimensional xenon-enhanced dual-energy (XeDE) radiography for imaging of lung function. We optimized image quality under quantum-noise-limited conditions using a chest phantom consisting of a rectangular chamber representing the thoracic volume and PMMA slabs simulating x-ray attenuation by soft tissue. A sealed, air-filled cavity with thin PMMA walls was positioned inside the chamber to simulate a 2 cm thick ventilation defect. The chamber was ventilated with xenon and dual-energy imaging was performed using a diagnostic x-ray tube and a flat-panel detector. The contrast-to-noise ratio of ventilation defects normalized by patient x-ray exposure maximized at a kV-pair of approximately 60/140-kV and when approximately one third of the total exposure was allocated to the HE image. We used the optimized technique to image a second phantom that contained lung-parenchyma-mimicking PMMA clutter, rib-mimicking aluminum slats and an insert that simulated ventilation defects with thicknesses ranging from 0.5 cm to 2 cm and diameters ranging from 1 cm to 2 cm. From the resulting images we computed the area under the receiver operating characteristic curve (AUC) of the non-prewhitening model observer with an eye filter and internal noise. For a xenon concentration of 75%, good AUCs (i.e. 0.8-0.9) to excellent AUCs (i.e. >0.9) were obtained when the defect diameter is greater than 1.3 cm and defect thickness is 1 cm. When the xenon concentration was reduced to 50%, the AUC was ∼0.9 for defects 1.2 cm in diameter and ∼1.5 cm in thickness. Two-dimensional XeDE radiography may therefore enable detection of functional abnormalities associated with early-stage COPD, for which xenon ventilation defects can occupy up to 20% of the lung volume, and should be further developed as a low-cost alternative to MRI-based approaches and a low-dose alternative to CT-based approaches.
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Affiliation(s)
- Fateen Basharat
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Jesse Tanguay
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
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Maincent C, Perrin C, Chironi G, Baqué-Juston M, Berthier F, Paulmier B, Hugonnet F, Dittlot C, Farhad RL, Renvoise J, Serrano B, Nataf V, Mocquot F, Keita-Perse O, Claessens YE, Faraggi M. Microvascular injuries, secondary edema, and inconsistencies in lung vascularization between affected and nonaffected pulmonary segments of non-critically ill hospitalized COVID-19 patients presenting with clinical deterioration. Ther Adv Respir Dis 2022; 16:17534666221096040. [PMID: 35485327 PMCID: PMC9058452 DOI: 10.1177/17534666221096040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: We aimed to better understand the pathophysiology of SARS-CoV-2 pneumonia in non-critically ill hospitalized patients secondarily presenting with clinical deterioration and increase in oxygen requirement without any identified worsening factors. Methods: We consecutively enrolled patients without clinical or biological evidence for superinfection, without left ventricular dysfunction and for whom a pulmonary embolism was discarded by computed tomography (CT) pulmonary angiography. We investigated lung ventilation and perfusion (LVP) by LVP scintigraphy, and, 24 h later, left and right ventricular function by Tc-99m-labeled albumin-gated blood-pool scintigraphy with late (60 mn) tomographic albumin images on the lungs to evaluate lung albumin retention that could indicate microvascular injuries with secondary edema. Results: We included 20 patients with confirmed SARS-CoV-2 pneumonia. All had CT evidence of organizing pneumonia and normal left ventricular ejection fraction. No patient demonstrated preserved ventilation with perfusion defect (mismatch), which may discard a distal lung thrombosis. Patterns of ventilation and perfusion were heterogeneous in seven patients (35%) with healthy lung segments presenting a relative paradoxical hypoperfusion and hypoventilation compared with segments with organizing pneumonia presenting a relative enhancement in perfusion and preserved ventilation. Lung albumin retention in area of organizing pneumonia was observed in 12 patients (60%), indicating microvascular injuries, increase in vessel permeability, and secondary edema. Conclusion: In hospitalized non-critically ill patients without evidence of superinfection, pulmonary embolism, or cardiac dysfunction, various types of damage may contribute to clinical deterioration including microvascular injuries and secondary edema, inconsistencies in lung segments vascularization suggesting a dysregulation of the balance in perfusion between segments affected by COVID-19 and others. Summary Statement Microvascular injuries and dysregulation of the balance in perfusion between segments affected by COVID-19 and others are present in non-critically ill patients without other known aggravating factors. Key Results In non-critically ill patients without evidence of superinfection, pulmonary embolism, macroscopic distal thrombosis or cardiac dysfunction, various types of damage may contribute to clinical deterioration including 1/ microvascular injuries and secondary edema, 2/ inconsistencies in lung segments vascularization with hypervascularization of consolidated segments contrasting with hypoperfusion of not affected segments, suggesting a dysregulation of the balance in perfusion between segments affected by COVID-19 and others.
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Affiliation(s)
- Cécile Maincent
- Pulmonary Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Christophe Perrin
- Pulmonary Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Gilles Chironi
- Check-up Unit, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Marie Baqué-Juston
- Radiology Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Frédéric Berthier
- Department of Biostatistics, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Benoît Paulmier
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Florent Hugonnet
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Claire Dittlot
- Pulmonary Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Ryan Lukas Farhad
- Pulmonary Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Julien Renvoise
- Pulmonary Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Benjamin Serrano
- Medical Physics Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Valérie Nataf
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - François Mocquot
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Olivia Keita-Perse
- Department of Infectious disease, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Yann-Erik Claessens
- Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Monaco, Monaco
| | - Marc Faraggi
- Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Avenue Pasteur, BP 480, 98012 Monaco, Monaco
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McDonald VM, Urroz PD, Bajc M, Rutherford N, Brooker B, Gibson PG. Imaging for precision medicine: can V-P SPECT measure mepolizumab response in asthma? Respirol Case Rep 2021; 9:e00717. [PMID: 33552524 PMCID: PMC7848709 DOI: 10.1002/rcr2.717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/27/2022] Open
Abstract
Monoclonal antibody therapies are effective for many but not all people with severe asthma. Precision medicine guides treatment selection using biomarkers to select patients most likely to respond according to their inflammatory endotypes. However, when assessing response to treatment, greater precision is required. We report a case series describing treatment response to mepolizumab in four severe asthma patients, assessed by traditional methods and with objective ventilation/perfusion single photon emission computed tomography (V-P SPECT). In this series, patients with severe asthma received mepolizumab treatment with clinical outcomes recorded at commencement and at approximately 16 weeks post-treatment initiation. V-P SPECT imaging was performed before and after treatment to determine ventilation heterogeneity and perfusion, and its ability to assess treatment responsiveness. V-P SPECT shows promise as an objective measure to assess lung ventilation and perfusion to observe and assess responsiveness to mepolizumab. With quantification, this measure may allow better precision in determining treatment improvements.
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Affiliation(s)
- Vanessa M. McDonald
- Centre of Research Excellence in Severe Asthma and Priority Research Centre for Healthy LungsUniversity of NewcastleCallaghanNSWAustralia
- Department of Respiratory and Sleep MedicineJohn Hunter HospitalNew Lambton HeightsNSWAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
| | - Paola D. Urroz
- Centre of Research Excellence in Severe Asthma and Priority Research Centre for Healthy LungsUniversity of NewcastleCallaghanNSWAustralia
| | - Marika Bajc
- Skåne University Hospital, Department of Clinical SciencesUniversity Hospital LundLundSweden
| | - Natalie Rutherford
- Department of Nuclear MedicineJohn Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Bree Brooker
- Department of Nuclear MedicineJohn Hunter HospitalNew Lambton HeightsNSWAustralia
| | - Peter G. Gibson
- Centre of Research Excellence in Severe Asthma and Priority Research Centre for Healthy LungsUniversity of NewcastleCallaghanNSWAustralia
- Department of Respiratory and Sleep MedicineJohn Hunter HospitalNew Lambton HeightsNSWAustralia
- Hunter Medical Research InstituteNew Lambton HeightsNSWAustralia
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11
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Owen DR, Sun Y, Boonstra PS, McFarlane M, Viglianti BL, Balter JM, El Naqa I, Schipper MJ, Schonewolf CA, Ten Haken RK, Kong FMS, Jolly S, Matuszak MM. Investigating the SPECT Dose-Function Metrics Associated With Radiation-Induced Lung Toxicity Risk in Patients With Non-small Cell Lung Cancer Undergoing Radiation Therapy. Adv Radiat Oncol 2021; 6:100666. [PMID: 33817412 PMCID: PMC8010578 DOI: 10.1016/j.adro.2021.100666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Dose to normal lung has commonly been linked with radiation-induced lung toxicity (RILT) risk, but incorporating functional lung metrics in treatment planning may help further optimize dose delivery and reduce RILT incidence. The purpose of this study was to investigate the impact of the dose delivered to functional lung regions by analyzing perfusion (Q), ventilation (V), and combined V/Q single-photon-emission computed tomography (SPECT) dose-function metrics with regard to RILT risk in patients with non-small cell lung cancer (NSCLC) patients who received radiation therapy (RT). Methods and Materials SPECT images acquired from 88 patients with locally advanced NSCLC before undergoing conventionally fractionated RT were retrospectively analyzed. Dose was converted to the nominal dose equivalent per 2 Gy fraction, and SPECT intensities were normalized. Regional lung segments were defined, and the average dose delivered to each lung region was quantified. Three functional categorizations were defined to represent low-, normal-, and high-functioning lungs. The percent of functional lung category receiving ≥20 Gy and mean functional intensity receiving ≥20 Gy (iV20) were calculated. RILT was defined as grade 2+ radiation pneumonitis and/or clinical radiation fibrosis. A logistic regression was used to evaluate the association between dose-function metrics and risk of RILT. Results By analyzing V/Q normalized intensities and functional distributions across the population, a wide range in functional capability (especially in the ipsilateral lung) was observed in patients with NSCLC before RT. Through multivariable regression models, global lung average dose to the lower lung was found to be significantly associated with RILT, and Q and V iV20 were correlated with RILT when using ipsilateral lung metrics. Through a receiver operating characteristic analysis, combined V/Q low-function receiving ≥20 Gy (low-functioning V/Q20) in the ipsilateral lung was found to be the best predictor (area under the curce: 0.79) of RILT risk. Conclusions Irradiation of the inferior lung appears to be a locational sensitivity for RILT risk. The multivariable correlation between ipsilateral lung iV20 and RILT, as well as the association of low-functioning V/Q20 and RILT, suggest that irradiating low-functioning regions in the lung may lead to higher toxicity rates.
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Affiliation(s)
- Daniel R Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Yilun Sun
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Philip S Boonstra
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Matthew McFarlane
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Benjamin L Viglianti
- Department of Radiology, University of Michigan, Ann Arbor, Michigan.,Veterans Administration, Nuclear Medicine Service, Ann Arbor Michigan
| | - James M Balter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Feng-Ming S Kong
- Hong Kong University Shenzhen Hospital and Queen Mary Hospital, Hong Kong University Li Ka Shing Medical School, Department of Clinical Oncology, Hong Kong.,Department of Radiation Oncology, Case Western Reserve University, Cleveland, Ohio
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Martha M Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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12
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Barnes PJ, Anderson GP, Fagerås M, Belvisi MG. Chronic lung diseases: prospects for regeneration and repair. Eur Respir Rev 2021; 30:30/159/200213. [PMID: 33408088 PMCID: PMC9488945 DOI: 10.1183/16000617.0213-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022] Open
Abstract
COPD and idiopathic pulmonary fibrosis (IPF) together represent a considerable unmet medical need, and advances in their treatment lag well behind those of other chronic conditions. Both diseases involve maladaptive repair mechanisms leading to progressive and irreversible damage. However, our understanding of the complex underlying disease mechanisms is incomplete; with current diagnostic approaches, COPD and IPF are often discovered at an advanced stage and existing definitions of COPD and IPF can be misleading. To halt or reverse disease progression and achieve lung regeneration, there is a need for earlier identification and treatment of these diseases. A precision medicine approach to treatment is also important, involving the recognition of disease subtypes, or endotypes, according to underlying disease mechanisms, rather than the current “one-size-fits-all” approach. This review is based on discussions at a meeting involving 38 leading global experts in chronic lung disease mechanisms, and describes advances in the understanding of the pathology and molecular mechanisms of COPD and IPF to identify potential targets for reversing disease degeneration and promoting tissue repair and lung regeneration. We also discuss limitations of existing disease measures, technical advances in understanding disease pathology, and novel methods for targeted drug delivery. Treatment outcomes with COPD and IPF are suboptimal. Better understanding of the diseases, such as targetable repair mechanisms, may generate novel therapies, and earlier diagnosis and treatment is needed to stop or even reverse disease progression.https://bit.ly/2Ga8J1g
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Affiliation(s)
- Peter J Barnes
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Gary P Anderson
- Lung Health Research Centre, University of Melbourne, Melbourne, Australia
| | | | - Maria G Belvisi
- National Heart & Lung Institute, Imperial College London, London, UK.,Respiratory and Immunology, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
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13
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Kim M, Doganay O, Hwang HJ, Seo JB, Gleeson FV. Lobar Ventilation in Patients with COPD Assessed with the Full-Scale Airway Network Flow Model and Xenon-enhanced Dual-Energy CT. Radiology 2020; 298:201-209. [PMID: 33231530 DOI: 10.1148/radiol.2020202485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background The full-scale airway network (FAN) flow model shows excellent agreement with limited functional imaging data but requires further validation prior to clinical use. Purpose To validate the ventilation distributions computed with the FAN flow model with xenon ventilation from xenon-enhanced dual-energy (DE) CT in participants with chronic obstructive pulmonary disease (COPD). Materials and Methods In this prospective study, the FAN model extracted structural data from xenon-enhanced DE CT images of men with COPD scanned between June 2012 and July 2013 to compute gas ventilation dynamics. The ventilation distributions on the middle cross-section plane, percentage lobar ventilation, and ventilation heterogeneity quantified by the coefficient of variation (CV) were compared between xenon-enhanced DE CT imaging and the FAN model. The relationship between the ventilation parameters with the densitometry and pulmonary function test results was demonstrated. The agreements and correlations between the parameters were measured using the concordance correlation coefficient and the Pearson correlation coefficient. Results Twenty-two men with COPD (mean age, 67 years ± 7 [standard deviation]) were evaluated. The percentage lobar ventilation computed with FAN showed a strong positive correlation with xenon-enhanced DE CT data (r = 0.7, P < .001). Ninety-five percent of lobar ventilation CV differences lay within 95% confidence intervals. Correlations of the percentage lobar ventilation were negative for percentage emphysema (xenon-enhanced DE CT: r = -0.38, P < .001; FAN: r = -0.23, P = .02) but were positive for percentage normal tissue volume (xenon-enhanced DE CT: r = 0.78, P < .001; FAN: r = 0.45, P < .001). Lung CVs of FAN revealed negative correlations with the spirometry results (CVFAN vs percentage predicted forced expiratory volume in 1 second: r = -0.75, P < .001; CVFAN vs ratio of forced expiratory volume in 1 second to forced vital capacity: r = -0.67, P < .001). Conclusion The full-scale airway network modeled lobar ventilation in patients with chronic obstructive pulmonary disease correlated with the xenon-enhanced dual-energy CT imaging data. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Parraga and Eddy in this issue.
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Affiliation(s)
- Minsuok Kim
- From the School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, England (M.K.); Healthy Science Institute, Ege University, Izmir, Turkey (O.D.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (H.J.H., J.B.S.); Department of Oncology, University of Oxford, Oxford, England (F.V.G.); and Department of Radiology, The Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, England (F.V.G.)
| | - Ozkan Doganay
- From the School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, England (M.K.); Healthy Science Institute, Ege University, Izmir, Turkey (O.D.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (H.J.H., J.B.S.); Department of Oncology, University of Oxford, Oxford, England (F.V.G.); and Department of Radiology, The Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, England (F.V.G.)
| | - Hye Jeon Hwang
- From the School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, England (M.K.); Healthy Science Institute, Ege University, Izmir, Turkey (O.D.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (H.J.H., J.B.S.); Department of Oncology, University of Oxford, Oxford, England (F.V.G.); and Department of Radiology, The Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, England (F.V.G.)
| | - Joon Beom Seo
- From the School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, England (M.K.); Healthy Science Institute, Ege University, Izmir, Turkey (O.D.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (H.J.H., J.B.S.); Department of Oncology, University of Oxford, Oxford, England (F.V.G.); and Department of Radiology, The Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, England (F.V.G.)
| | - Fergus V Gleeson
- From the School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough LE11 3TU, England (M.K.); Healthy Science Institute, Ege University, Izmir, Turkey (O.D.); Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (H.J.H., J.B.S.); Department of Oncology, University of Oxford, Oxford, England (F.V.G.); and Department of Radiology, The Churchill Hospital, Oxford University Hospitals NHS Trust, Headington, England (F.V.G.)
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14
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Giraudo C, Evangelista L, Fraia AS, Lupi A, Quaia E, Cecchin D, Casali M. Molecular Imaging of Pulmonary Inflammation and Infection. Int J Mol Sci 2020; 21:ijms21030894. [PMID: 32019142 PMCID: PMC7037834 DOI: 10.3390/ijms21030894] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Infectious and inflammatory pulmonary diseases are a leading cause of morbidity and mortality worldwide. Although infrequently used in this setting, molecular imaging may significantly contribute to their diagnosis using techniques like single photon emission tomography (SPET), positron emission tomography (PET) with computed tomography (CT) or magnetic resonance imaging (MRI) with the support of specific or unspecific radiopharmaceutical agents. 18F-Fluorodeoxyglucose (18F-FDG), mostly applied in oncological imaging, can also detect cells actively involved in infectious and inflammatory conditions, even if with a low specificity. SPET with nonspecific (e.g., 67Gallium-citrate (67Ga citrate)) and specific tracers (e.g., white blood cells radiolabeled with 111Indium-oxine (111In) or 99mTechnetium (99mTc)) showed interesting results for many inflammatory lung diseases. However, 67Ga citrate is unfavorable by a radioprotection point of view while radiolabeled white blood cells scan implies complex laboratory settings and labeling procedures. Radiolabeled antibiotics (e.g., ciprofloxacin) have been recently tested, although they seem to be quite unspecific and cause antibiotic resistance. New radiolabeled agents like antimicrobic peptides, binding to bacterial cell membranes, seem very promising. Thus, the aim of this narrative review is to provide a comprehensive overview about techniques, including PET/MRI, and tracers that can guide the clinicians in the appropriate diagnostic pathway of infectious and inflammatory pulmonary diseases.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
- Correspondence: ; Tel.: +39-049-821-2357; Fax: +39-049-821-1878
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (L.E.); (D.C.)
| | - Anna Sara Fraia
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Amalia Lupi
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Emilio Quaia
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (L.E.); (D.C.)
- Padova Neuroscience Center (PNC), University of Padova, 35131 Padova, Italy
| | - Massimiliano Casali
- Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy;
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15
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Bajc M, Lindqvist A. Ventilation/Perfusion SPECT Imaging Diagnosing PE and Other Cardiopulmonary Diseases. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Bajc M, Schümichen C, Grüning T, Lindqvist A, Le Roux PY, Alatri A, Bauer RW, Dilic M, Neilly B, Verberne HJ, Delgado Bolton RC, Jonson B. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 2019; 46:2429-2451. [PMID: 31410539 PMCID: PMC6813289 DOI: 10.1007/s00259-019-04450-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022]
Abstract
These guidelines update the previous EANM 2009 guidelines on the diagnosis of pulmonary embolism (PE). Relevant new aspects are related to (a) quantification of PE and other ventilation/perfusion defects; (b) follow-up of patients with PE; (c) chronic PE; and (d) description of additional pulmonary physiological changes leading to diagnoses of left ventricular heart failure (HF), chronic obstructive pulmonary disease (COPD) and pneumonia. The diagnosis of PE should be reported when a mismatch of one segment or two subsegments is found. For ventilation, Technegas or krypton gas is preferred over diethylene triamine pentaacetic acid (DTPA) in patients with COPD. Tomographic imaging with V/PSPECT has higher sensitivity and specificity for PE compared with planar imaging. Absence of contraindications makes V/PSPECT an essential method for the diagnosis of PE. When V/PSPECT is combined with a low-dose CT, the specificity of the test can be further improved, especially in patients with other lung diseases. Pitfalls in V/PSPECT interpretation are discussed. In conclusion, V/PSPECT is strongly recommended as it accurately establishes the diagnosis of PE even in the presence of diseases like COPD, HF and pneumonia and has no contraindications.
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Affiliation(s)
- Marika Bajc
- Department of Clinical Sciences, Clinical Physiology and Nuclear Medicine, University of Lund, Lund, Sweden.
| | - Carl Schümichen
- University of Rostock, Formerly Clinic for Nuclear Medicine, Rostock, Germany
| | - Thomas Grüning
- Department of Nuclear Medicine, University Hospitals Plymouth, Plymouth, UK
| | - Ari Lindqvist
- Research Unit of Pulmonary Diseases, Clinical Research Institute, HUS Helsinki University Hospital, Helsinki, Finland
| | | | - Adriano Alatri
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Ralf W Bauer
- RNS Gemeinschaftspraxis, Wiesbaden, Germany
- Department of Diagnostic and Interventional Radiology, Goethe University Frankfurt (Main), Frankfurt, Germany
| | - Mirza Dilic
- Clinic of Heart and Blood Vessel Disease, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Brian Neilly
- Department of Nuclear Medicine, Royal Infirmary, Glasgow, UK
| | - Hein J Verberne
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Bjorn Jonson
- Department of Clinical Sciences, Clinical Physiology and Nuclear Medicine, University of Lund, Lund, Sweden
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17
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Bajc M, Lindqvist A. Ventilation/Perfusion SPECT Imaging—Diagnosing Other Cardiopulmonary Diseases Beyond Pulmonary Embolism. Semin Nucl Med 2019; 49:4-10. [DOI: 10.1053/j.semnuclmed.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Doganay O, Matin T, Chen M, Kim M, McIntyre A, McGowan DR, Bradley KM, Povey T, Gleeson FV. Time-series hyperpolarized xenon-129 MRI of lobar lung ventilation of COPD in comparison to V/Q-SPECT/CT and CT. Eur Radiol 2018; 29:4058-4067. [PMID: 30552482 PMCID: PMC6610266 DOI: 10.1007/s00330-018-5888-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/08/2018] [Accepted: 11/13/2018] [Indexed: 12/23/2022]
Abstract
Purpose To derive lobar ventilation in patients with chronic obstructive pulmonary disease (COPD) using a rapid time-series hyperpolarized xenon-129 (HPX) magnetic resonance imaging (MRI) technique and compare this to ventilation/perfusion single-photon emission computed tomography (V/Q-SPECT), correlating the results with high-resolution computed tomography (CT) and pulmonary function tests (PFTs). Materials and methods Twelve COPD subjects (GOLD stages I–IV) participated in this study and underwent HPX-MRI, V/Q-SPECT/CT, high-resolution CT, and PFTs. HPX-MRI was performed using a novel time-series spiral k-space sampling approach. Relative percentage ventilations were calculated for individual lobe for comparison to the relative SPECT lobar ventilation and perfusion. The absolute HPX-MRI percentage ventilation in each lobe was compared to the absolute CT percentage emphysema score calculated using a signal threshold method. Pearson’s correlation and linear regression tests were performed to compare each imaging modality. Results Strong correlations were found between the relative lobar percentage ventilation with HPX-MRI and percentage ventilation SPECT (r = 0.644; p < 0.001) and percentage perfusion SPECT (r = 0.767; p < 0.001). The absolute CT percentage emphysema and HPX percentage ventilation correlation was also statistically significant (r = 0.695, p < 0.001). The whole lung HPX percentage ventilation correlated with the PFT measurements (FEV1 with r = − 0.886, p < 0.001*, and FEV1/FVC with r = − 0.861, p < 0.001*) better than the whole lung CT percentage emphysema score (FEV1 with r = − 0.635, p = 0.027; and FEV1/FVC with r = − 0.652, p = 0.021). Conclusion Lobar ventilation with HPX-MRI showed a strong correlation with lobar ventilation and perfusion measurements derived from SPECT/CT, and is better than the emphysema score obtained with high-resolution CT. Key Points • The ventilation hyperpolarized xenon-129 MRI correlates well with ventilation and perfusion with SPECT/CT with the advantage of higher temporal and spatial resolution. • The hyperpolarized xenon-129 MRI correlates with the PFT measurements better than the high-resolution CT with the advantage of avoiding the use of ionizing radiation. Electronic supplementary material The online version of this article (10.1007/s00330-018-5888-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ozkan Doganay
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK.
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK.
| | - Tahreema Matin
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Mitchell Chen
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Minsuok Kim
- Department of Engineering Science, University of Oxford, OX1 3PJ, Oxford, UK
| | - Anthony McIntyre
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Daniel R McGowan
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Kevin M Bradley
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Thomas Povey
- Department of Engineering Science, University of Oxford, OX1 3PJ, Oxford, UK
| | - Fergus V Gleeson
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
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19
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Abstract
Ventilation-perfusion scintigraphy is a functional imaging biomarker that has the potential of captivating the heterogeneity of chronic obstructive pulmonary disease (COPD). It specifically images the distribution of ventilation and perfusion within the lungs, which is a critical pathophysiological component of COPD. The extent of ventilation defects and ventilation inhomogeneity, as well as the ventilation-perfusion ratio distribution thus correlate with severity of disease. Furthermore, specific scintigraphic patterns, such as the "stripe sign" may detect centrilobular emphysematous lesions with a higher sensitivity than other imaging techniques. Although ventilation-perfusion scintigraphy may conceivably detect COPD before any specific changes can be detected by spirometry or high-resolution CT, it is currently mostly used in the workup of lung volume reduction treatment, and for diagnosing various complications and comorbidities of COPD when combined with low-dose CT.
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Affiliation(s)
- Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Medicine, The National Hospital, Torshavn, Faroe Islands.
| | - Ronan M G Berg
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
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