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Elbehairy AF, Marshall H, Naish JH, Wild JM, Parraga G, Horsley A, Vestbo J. Advances in COPD imaging using CT and MRI: linkage with lung physiology and clinical outcomes. Eur Respir J 2024; 63:2301010. [PMID: 38548292 DOI: 10.1183/13993003.01010-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/16/2024] [Indexed: 05/04/2024]
Abstract
Recent years have witnessed major advances in lung imaging in patients with COPD. These include significant refinements in images obtained by computed tomography (CT) scans together with the introduction of new techniques and software that aim for obtaining the best image whilst using the lowest possible radiation dose. Magnetic resonance imaging (MRI) has also emerged as a useful radiation-free tool in assessing structural and more importantly functional derangements in patients with well-established COPD and smokers without COPD, even before the existence of overt changes in resting physiological lung function tests. Together, CT and MRI now allow objective quantification and assessment of structural changes within the airways, lung parenchyma and pulmonary vessels. Furthermore, CT and MRI can now provide objective assessments of regional lung ventilation and perfusion, and multinuclear MRI provides further insight into gas exchange; this can help in structured decisions regarding treatment plans. These advances in chest imaging techniques have brought new insights into our understanding of disease pathophysiology and characterising different disease phenotypes. The present review discusses, in detail, the advances in lung imaging in patients with COPD and how structural and functional imaging are linked with common resting physiological tests and important clinical outcomes.
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Affiliation(s)
- Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Helen Marshall
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Josephine H Naish
- MCMR, Manchester University NHS Foundation Trust, Manchester, UK
- Bioxydyn Limited, Manchester, UK
| | - Jim M Wild
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in silico Medicine, Sheffield, UK
| | - Grace Parraga
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Division of Respirology, Western University, London, ON, Canada
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Astley JR, Reilly JM, Robinson S, Wild JM, Hatton MQ, Tahir BA. Explainable deep learning-based survival prediction for non-small cell lung cancer patients undergoing radical radiotherapy. Radiother Oncol 2024; 193:110084. [PMID: 38244779 DOI: 10.1016/j.radonc.2024.110084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND PURPOSE Survival is frequently assessed using Cox proportional hazards (CPH) regression; however, CPH may be too simplistic as it assumes a linear relationship between covariables and the outcome. Alternative, non-linear machine learning (ML)-based approaches, such as random survival forests (RSFs) and, more recently, deep learning (DL) have been proposed; however, these techniques are largely black-box in nature, limiting explainability. We compared CPH, RSF and DL to predict overall survival (OS) of non-small cell lung cancer (NSCLC) patients receiving radiotherapy using pre-treatment covariables. We employed explainable techniques to provide insights into the contribution of each covariable on OS prediction. MATERIALS AND METHODS The dataset contained 471 stage I-IV NSCLC patients treated with radiotherapy. We built CPH, RSF and DL OS prediction models using several baseline covariable combinations. 10-fold Monte-Carlo cross-validation was employed with a split of 70%:10%:20% for training, validation and testing, respectively. We primarily evaluated performance using the concordance index (C-index) and integrated Brier score (IBS). Local interpretable model-agnostic explanation (LIME) values, adapted for use in survival analysis, were computed for each model. RESULTS The DL method exhibited a significantly improved C-index of 0.670 compared to the CPH and a significantly improved IBS of 0.121 compared to the CPH and RSF approaches. LIME values suggested that, for the DL method, the three most important covariables in OS prediction were stage, administration of chemotherapy and oesophageal mean radiation dose. CONCLUSION We show that, using pre-treatment covariables, a DL approach demonstrates superior performance over CPH and RSF for OS prediction and use explainable techniques to provide transparency and interpretability.
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Affiliation(s)
- Joshua R Astley
- Division of Clinical Medicine, The University of Sheffield, Sheffield, UK
| | - James M Reilly
- Division of Clinical Medicine, The University of Sheffield, Sheffield, UK
| | - Stephen Robinson
- Division of Clinical Medicine, The University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Division of Clinical Medicine, The University of Sheffield, Sheffield, UK; Insigneo Institute for in Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Matthew Q Hatton
- Division of Clinical Medicine, The University of Sheffield, Sheffield, UK
| | - Bilal A Tahir
- Division of Clinical Medicine, The University of Sheffield, Sheffield, UK; Insigneo Institute for in Silico Medicine, The University of Sheffield, Sheffield, UK.
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Wild JM, Gleeson FV, Svenningsen S, Grist JT, Saunders LC, Collier GJ, Sharma M, Tcherner S, Mozaffaripour A, Matheson AM, Parraga G. Review of Hyperpolarized Pulmonary Functional 129 Xe MR for Long-COVID. J Magn Reson Imaging 2024; 59:1120-1134. [PMID: 37548112 DOI: 10.1002/jmri.28940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023] Open
Abstract
The respiratory consequences of acute COVID-19 infection and related symptoms tend to resolve 4 weeks post-infection. However, for some patients, new, recurrent, or persisting symptoms remain beyond the acute phase and persist for months, post-infection. The symptoms that remain have been referred to as long-COVID. A number of research sites employed 129 Xe magnetic resonance imaging (MRI) during the pandemic and evaluated patients post-infection, months after hospitalization or home-based care as a way to better understand the consequences of infection on 129 Xe MR gas-exchange and ventilation imaging. A systematic review and comprehensive search were employed using MEDLINE via PubMed (April 2023) using the National Library of Medicine's Medical Subject Headings and key words: post-COVID-19, MRI, 129 Xe, long-COVID, COVID pneumonia, and post-acute COVID-19 syndrome. Fifteen peer-reviewed manuscripts were identified including four editorials, a single letter to the editor, one review article, and nine original research manuscripts (2020-2023). MRI and MR spectroscopy results are summarized from these prospective, controlled studies, which involved small sample sizes ranging from 9 to 76 participants. Key findings included: 1) 129 Xe MRI gas-exchange and ventilation abnormalities, 3 months post-COVID-19 infection, and 2) a combination of MRI gas-exchange and ventilation abnormalities alongside persistent symptoms in patients hospitalized and not hospitalized for COVID-19, 1-year post-infection. The persistence of respiratory symptoms and 129 Xe MRI abnormalities in the context of normal or nearly normal pulmonary function test results and chest computed tomography (CT) was consistent. Longitudinal improvements were observed in long-term follow-up of long-COVID patients but mean 129 Xe gas-exchange, ventilation heterogeneity values and symptoms remained abnormal, 1-year post-infection. Pulmonary functional MRI using inhaled hyperpolarized 129 Xe gas has played a role in detecting gas-exchange and ventilation abnormalities providing complementary information that may help develop our understanding of the root causes of long-COVID. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Jim M Wild
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Fergus V Gleeson
- Department of Radiology, Oxford University Hospitals, Oxford, UK
| | - Sarah Svenningsen
- Department of Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - James T Grist
- Department of Radiology, Oxford University Hospitals, Oxford, UK
| | - Laura C Saunders
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Maksym Sharma
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Sam Tcherner
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Ali Mozaffaripour
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Alexander M Matheson
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
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Gupta V, Kariotis S, Rajab MD, Errington N, Alhathli E, Jammeh E, Brook M, Meardon N, Collini P, Cole J, Wild JM, Hershman S, Javed A, Thompson AAR, de Silva T, Ashley EA, Wang D, Lawrie A. Unsupervised machine learning to investigate trajectory patterns of COVID-19 symptoms and physical activity measured via the MyHeart Counts App and smart devices. NPJ Digit Med 2023; 6:239. [PMID: 38135699 PMCID: PMC10746711 DOI: 10.1038/s41746-023-00974-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Previous studies have associated COVID-19 symptoms severity with levels of physical activity. We therefore investigated longitudinal trajectories of COVID-19 symptoms in a cohort of healthcare workers (HCWs) with non-hospitalised COVID-19 and their real-world physical activity. 121 HCWs with a history of COVID-19 infection who had symptoms monitored through at least two research clinic visits, and via smartphone were examined. HCWs with a compatible smartphone were provided with an Apple Watch Series 4 and were asked to install the MyHeart Counts Study App to collect COVID-19 symptom data and multiple physical activity parameters. Unsupervised classification analysis of symptoms identified two trajectory patterns of long and short symptom duration. The prevalence for longitudinal persistence of any COVID-19 symptom was 36% with fatigue and loss of smell being the two most prevalent individual symptom trajectories (24.8% and 21.5%, respectively). 8 physical activity features obtained via the MyHeart Counts App identified two groups of trajectories for high and low activity. Of these 8 parameters only 'distance moved walking or running' was associated with COVID-19 symptom trajectories. We report a high prevalence of long-term symptoms of COVID-19 in a non-hospitalised cohort of HCWs, a method to identify physical activity trends, and investigate their association. These data highlight the importance of tracking symptoms from onset to recovery even in non-hospitalised COVID-19 individuals. The increasing ease in collecting real-world physical activity data non-invasively from wearable devices provides opportunity to investigate the association of physical activity to symptoms of COVID-19 and other cardio-respiratory diseases.
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Affiliation(s)
- Varsha Gupta
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
- Bioinformatics Institute, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
| | - Sokratis Kariotis
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
- Department of Neuroscience, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Mohammed D Rajab
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Niamh Errington
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Elham Alhathli
- Department of Neuroscience, University of Sheffield, Sheffield, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Nursing, Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Emmanuel Jammeh
- Department of Neuroscience, University of Sheffield, Sheffield, UK
| | - Martin Brook
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in-silico Medicine, University of Sheffield, Sheffield, UK
| | - Naomi Meardon
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul Collini
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Joby Cole
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in-silico Medicine, University of Sheffield, Sheffield, UK
| | - Steven Hershman
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Ali Javed
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Thushan de Silva
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Euan A Ashley
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Dennis Wang
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
- Bioinformatics Institute, Agency for Science Technology and Research (A*STAR), Singapore, Republic of Singapore
- Department of Computer Science, University of Sheffield, Sheffield, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Allan Lawrie
- National Heart and Lung Institute, Imperial College London, London, UK.
- Insigneo Institute for in-silico Medicine, University of Sheffield, Sheffield, UK.
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Stewart NJ, Higano NS, Mukthapuram S, Willmering MM, Loew W, West M, Arnsperger A, Pratt R, Rao MR, Schulte RF, Wild JM, Woods JC. Initial feasibility and challenges of hyperpolarized 129 Xe MRI in neonates with bronchopulmonary dysplasia. Magn Reson Med 2023; 90:2420-2431. [PMID: 37526031 PMCID: PMC10629838 DOI: 10.1002/mrm.29808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/14/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE The underlying functional and microstructural lung disease in neonates who are born preterm (bronchopulmonary dysplasia, BPD) remains poorly characterized. Moreover, there is a lack of suitable techniques to reliably assess lung function in this population. Here, we report our preliminary experience with hyperpolarized 129 Xe MRI in neonates with BPD. METHODS Neonatal intensive care patients with established BPD were recruited (N = 9) and imaged at a corrected gestational age of median:40.7 (range:37.1, 44.4) wk using a 1.5T neonatal scanner. 2D 129 Xe ventilation and diffusion-weighted images and dissolved phase spectroscopy were acquired, alongside 1 H 3D radial UTE. 129 Xe images were acquired during a series of short apneic breath-holds (˜3 s). 1 H UTE images were acquired during tidal breathing. Ventilation defects were manually identified and qualitatively compared to lung structures on UTE. ADCs were calculated on a voxel-wise basis. The signal ratio of the 129 Xe red blood cell (RBC) and tissue membrane (M) resonances from spectroscopy was determined. RESULTS Spiral-based 129 Xe ventilation imaging showed good image quality and sufficient sensitivity to detect mild ventilation abnormalities in patients with BPD. 129 Xe ADC values were elevated above that expected given healthy data in older children and adults (median:0.046 [range:0.041, 0.064] cm2 s-1 ); the highest value obtained from an extremely pre-term patient. 129 Xe spectroscopy revealed a low RBC/M ratio (0.14 [0.06, 0.21]). CONCLUSION We have demonstrated initial feasibility of 129 Xe lung MRI in neonates. With further data, the technique may help guide management of infant lung diseases in the neonatal period and beyond.
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Affiliation(s)
- Neil J Stewart
- Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Nara S Higano
- Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shanmukha Mukthapuram
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Matthew M Willmering
- Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Wolfgang Loew
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael West
- Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anita Arnsperger
- Division of Respiratory Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ronald Pratt
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Madhwesha R Rao
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Jim M Wild
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Pulmonary Medicine and Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Grafton-Clarke C, Matthews G, Gosling R, Swoboda P, Rothman A, Wild JM, Kiely DG, Condliffe R, Alabed S, Swift AJ, Garg P. The Left Atrial Area Derived Cardiovascular Magnetic Resonance Left Ventricular Filling Pressure Equation Shows Superiority over Integrated Echocardiography. Medicina (Kaunas) 2023; 59:1952. [PMID: 38004001 PMCID: PMC10672763 DOI: 10.3390/medicina59111952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
Background and objectives: Evaluating left ventricular filling pressure (LVFP) plays a crucial role in diagnosing and managing heart failure (HF). While traditional assessment methods involve multi-parametric transthoracic echocardiography (TTE) or right heart catheterisation (RHC), cardiovascular magnetic resonance (CMR) has emerged as a valuable diagnostic tool in HF. This study aimed to assess a simple CMR-derived model to estimate pulmonary capillary wedge pressure (PCWP) in a cohort of patients with suspected or proven heart failure and to investigate its performance in risk-stratifying patients. Materials and methods: A total of 835 patients with breathlessness were evaluated using RHC and CMR and split into derivation (85%) and validation cohorts (15%). Uni-variate and multi-variate linear regression analyses were used to derive a model for PCWP estimation using CMR. The model's performance was evaluated by comparing CMR-derived PCWP with PCWP obtained from RHC. Results: A CMR-derived PCWP incorporating left ventricular mass and the left atrial area (LAA) demonstrated good diagnostic accuracy. The model correctly reclassified 66% of participants whose TTE was 'indeterminate' or 'incorrect' in identifying raised filling pressures. On survival analysis, the CMR-derived PCWP model was predictive for mortality (HR 1.15, 95% CI 1.04-1.28, p = 0.005), which was not the case for PCWP obtained using RHC or TTE. Conclusions: The simplified CMR-derived PCWP model provides an accurate and practical tool for estimating PCWP in patients with suspected or proven heart failure. Its predictive value for mortality suggests the ability to play a valuable adjunctive role in echocardiography, especially in cases with unclear echocardiographic assessment.
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Affiliation(s)
- Ciaran Grafton-Clarke
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
| | - Gareth Matthews
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
| | - Peter Swoboda
- Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Jim M. Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - David G. Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Robin Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield S10 2TN, UK (R.C.)
- NIHR Biomedical Research Centre, Sheffield, S10 2JF, UK
| | - Pankaj Garg
- Department of Cardiology, Norfolk and Norwich University NHS Foundation Trust, Norwich NR4 7UY, UK; (C.G.-C.)
- School of Medicine, University of East Anglia, Norwich NR4 7TJ, UK
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Grist JT, Collier GJ, Walters H, Kim M, Chen M, Abu Eid G, Laws A, Matthews V, Jacob K, Cross S, Eves A, Durrant M, McIntyre A, Thompson R, Schulte RF, Raman B, Robbins PA, Wild JM, Fraser E, Gleeson F. Erratum for: Lung Abnormalities Detected with Hyperpolarized 129Xe MRI in Patients with Long COVID. Radiology 2023; 309:e239025. [PMID: 37906016 PMCID: PMC10623201 DOI: 10.1148/radiol.239025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
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Astley JR, Biancardi AM, Hughes PJC, Marshall H, Collier GJ, Chan H, Saunders LC, Smith LJ, Brook ML, Thompson R, Rowland‐Jones S, Skeoch S, Bianchi SM, Hatton MQ, Rahman NM, Ho L, Brightling CE, Wain LV, Singapuri A, Evans RA, Moss AJ, McCann GP, Neubauer S, Raman B, Wild JM, Tahir BA. Implementable Deep Learning for Multi-sequence Proton MRI Lung Segmentation: A Multi-center, Multi-vendor, and Multi-disease Study. J Magn Reson Imaging 2023; 58:1030-1044. [PMID: 36799341 PMCID: PMC10946727 DOI: 10.1002/jmri.28643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Recently, deep learning via convolutional neural networks (CNNs) has largely superseded conventional methods for proton (1 H)-MRI lung segmentation. However, previous deep learning studies have utilized single-center data and limited acquisition parameters. PURPOSE Develop a generalizable CNN for lung segmentation in 1 H-MRI, robust to pathology, acquisition protocol, vendor, and center. STUDY TYPE Retrospective. POPULATION A total of 809 1 H-MRI scans from 258 participants with various pulmonary pathologies (median age (range): 57 (6-85); 42% females) and 31 healthy participants (median age (range): 34 (23-76); 34% females) that were split into training (593 scans (74%); 157 participants (55%)), testing (50 scans (6%); 50 participants (17%)) and external validation (164 scans (20%); 82 participants (28%)) sets. FIELD STRENGTH/SEQUENCE 1.5-T and 3-T/3D spoiled-gradient recalled and ultrashort echo-time 1 H-MRI. ASSESSMENT 2D and 3D CNNs, trained on single-center, multi-sequence data, and the conventional spatial fuzzy c-means (SFCM) method were compared to manually delineated expert segmentations. Each method was validated on external data originating from several centers. Dice similarity coefficient (DSC), average boundary Hausdorff distance (Average HD), and relative error (XOR) metrics to assess segmentation performance. STATISTICAL TESTS Kruskal-Wallis tests assessed significances of differences between acquisitions in the testing set. Friedman tests with post hoc multiple comparisons assessed differences between the 2D CNN, 3D CNN, and SFCM. Bland-Altman analyses assessed agreement with manually derived lung volumes. A P value of <0.05 was considered statistically significant. RESULTS The 3D CNN significantly outperformed its 2D analog and SFCM, yielding a median (range) DSC of 0.961 (0.880-0.987), Average HD of 1.63 mm (0.65-5.45) and XOR of 0.079 (0.025-0.240) on the testing set and a DSC of 0.973 (0.866-0.987), Average HD of 1.11 mm (0.47-8.13) and XOR of 0.054 (0.026-0.255) on external validation data. DATA CONCLUSION The 3D CNN generated accurate 1 H-MRI lung segmentations on a heterogenous dataset, demonstrating robustness to disease pathology, sequence, vendor, and center. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Joshua R. Astley
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
- Department of Oncology and MetabolismThe University of SheffieldSheffieldUK
| | - Alberto M. Biancardi
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Paul J. C. Hughes
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Helen Marshall
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Guilhem J. Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Ho‐Fung Chan
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Laura C. Saunders
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Laurie J. Smith
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Martin L. Brook
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Roger Thompson
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | | | - Sarah Skeoch
- Royal National Hospital for Rheumatic DiseasesRoyal United Hospital NHS Foundation TrustBathUK
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Sciences CentreManchesterUK
| | | | | | - Najib M. Rahman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC)University of OxfordOxfordUK
| | - Ling‐Pei Ho
- MRC Human Immunology UnitUniversity of OxfordOxfordUK
| | - Chris E. Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | - Louise V. Wain
- The Institute for Lung Health, NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
- Department of Health sciencesUniversity of LeicesterLeicesterUK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
| | - Rachael A. Evans
- University Hospitals of Leicester NHS TrustUniversity of LeicesterLeicesterUK
| | - Alastair J. Moss
- The Institute for Lung Health, NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Gerry P. McCann
- The Institute for Lung Health, NIHR Leicester Biomedical Research CentreUniversity of LeicesterLeicesterUK
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC)University of OxfordOxfordUK
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC)University of OxfordOxfordUK
| | | | - Jim M. Wild
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
- Insigneo Institute for In Silico MedicineThe University of SheffieldSheffieldUK
| | - Bilal A. Tahir
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
- Department of Oncology and MetabolismThe University of SheffieldSheffieldUK
- Insigneo Institute for In Silico MedicineThe University of SheffieldSheffieldUK
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9
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Astley JR, Biancardi AM, Marshall H, Hughes PJC, Collier GJ, Hatton MQ, Wild JM, Tahir BA. A hybrid model- and deep learning-based framework for functional lung image synthesis from multi-inflation CT and hyperpolarized gas MRI. Med Phys 2023; 50:5657-5670. [PMID: 36932692 PMCID: PMC10946819 DOI: 10.1002/mp.16369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Hyperpolarized gas MRI is a functional lung imaging modality capable of visualizing regional lung ventilation with exceptional detail within a single breath. However, this modality requires specialized equipment and exogenous contrast, which limits widespread clinical adoption. CT ventilation imaging employs various metrics to model regional ventilation from non-contrast CT scans acquired at multiple inflation levels and has demonstrated moderate spatial correlation with hyperpolarized gas MRI. Recently, deep learning (DL)-based methods, utilizing convolutional neural networks (CNNs), have been leveraged for image synthesis applications. Hybrid approaches integrating computational modeling and data-driven methods have been utilized in cases where datasets are limited with the added benefit of maintaining physiological plausibility. PURPOSE To develop and evaluate a multi-channel DL-based method that combines modeling and data-driven approaches to synthesize hyperpolarized gas MRI lung ventilation scans from multi-inflation, non-contrast CT and quantitatively compare these synthetic ventilation scans to conventional CT ventilation modeling. METHODS In this study, we propose a hybrid DL configuration that integrates model- and data-driven methods to synthesize hyperpolarized gas MRI lung ventilation scans from a combination of non-contrast, multi-inflation CT and CT ventilation modeling. We used a diverse dataset comprising paired inspiratory and expiratory CT and helium-3 hyperpolarized gas MRI for 47 participants with a range of pulmonary pathologies. We performed six-fold cross-validation on the dataset and evaluated the spatial correlation between the synthetic ventilation and real hyperpolarized gas MRI scans; the proposed hybrid framework was compared to conventional CT ventilation modeling and other non-hybrid DL configurations. Synthetic ventilation scans were evaluated using voxel-wise evaluation metrics such as Spearman's correlation and mean square error (MSE), in addition to clinical biomarkers of lung function such as the ventilated lung percentage (VLP). Furthermore, regional localization of ventilated and defect lung regions was assessed via the Dice similarity coefficient (DSC). RESULTS We showed that the proposed hybrid framework is capable of accurately replicating ventilation defects seen in the real hyperpolarized gas MRI scans, achieving a voxel-wise Spearman's correlation of 0.57 ± 0.17 and an MSE of 0.017 ± 0.01. The hybrid framework significantly outperformed CT ventilation modeling alone and all other DL configurations using Spearman's correlation. The proposed framework was capable of generating clinically relevant metrics such as the VLP without manual intervention, resulting in a Bland-Altman bias of 3.04%, significantly outperforming CT ventilation modeling. Relative to CT ventilation modeling, the hybrid framework yielded significantly more accurate delineations of ventilated and defect lung regions, achieving a DSC of 0.95 and 0.48 for ventilated and defect regions, respectively. CONCLUSION The ability to generate realistic synthetic ventilation scans from CT has implications for several clinical applications, including functional lung avoidance radiotherapy and treatment response mapping. CT is an integral part of almost every clinical lung imaging workflow and hence is readily available for most patients; therefore, synthetic ventilation from non-contrast CT can provide patients with wider access to ventilation imaging worldwide.
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Affiliation(s)
- Joshua R Astley
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alberto M Biancardi
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Helen Marshall
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Matthew Q Hatton
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Jim M Wild
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Bilal A Tahir
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, The University of Sheffield, Sheffield, UK
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10
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Saunders LC, Collier GJ, Chan HF, Hughes PJC, Smith LJ, Watson JGR, Meiring JE, Gabriel Z, Newman T, Plowright M, Wade P, Eaden JA, Thomas S, Strickland S, Gustafsson L, Bray J, Marshall H, Capener DA, Armstrong L, Rodgers J, Brook M, Biancardi AM, Rao MR, Norquay G, Rodgers O, Munro R, Ball JE, Stewart NJ, Lawrie A, Jenkins RG, Grist JT, Gleeson F, Schulte RF, Johnson KM, Wilson FJ, Cahn A, Swift AJ, Rajaram S, Mills GH, Watson L, Collini PJ, Lawson R, Thompson AAR, Wild JM. Longitudinal Lung Function Assessment of Patients Hospitalized With COVID-19 Using 1H and 129Xe Lung MRI. Chest 2023; 164:700-716. [PMID: 36965765 PMCID: PMC10036146 DOI: 10.1016/j.chest.2023.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Microvascular abnormalities and impaired gas transfer have been observed in patients with COVID-19. The progression of pulmonary changes in these patients remains unclear. RESEARCH QUESTION Do patients hospitalized with COVID-19 without evidence of architectural distortion on structural imaging exhibit longitudinal improvements in lung function measured by using 1H and 129Xe MRI between 6 and 52 weeks following hospitalization? STUDY DESIGN AND METHODS Patients who were hospitalized with COVID-19 pneumonia underwent a pulmonary 1H and 129Xe MRI protocol at 6, 12, 25, and 51 weeks following hospital admission in a prospective cohort study between November 2020 and February 2022. The imaging protocol was as follows: 1H ultra-short echo time, contrast-enhanced lung perfusion, 129Xe ventilation, 129Xe diffusion-weighted, and 129Xe spectroscopic imaging of gas exchange. RESULTS Nine patients were recruited (age 57 ± 14 [median ± interquartile range] years; six of nine patients were male). Patients underwent MRI at 6 (n = 9), 12 (n = 9), 25 (n = 6), and 51 (n = 8) weeks following hospital admission. Patients with signs of interstitial lung damage were excluded. At 6 weeks, patients exhibited impaired 129Xe gas transfer (RBC to membrane fraction), but lung microstructure was not increased (apparent diffusion coefficient and mean acinar airway dimensions). Minor ventilation abnormalities present in four patients were largely resolved in the 6- to 25-week period. At 12 weeks, all patients with lung perfusion data (n = 6) showed an increase in both pulmonary blood volume and flow compared with 6 weeks, although this was not statistically significant. At 12 weeks, significant improvements in 129Xe gas transfer were observed compared with 6-week examinations; however, 129Xe gas transfer remained abnormally low at weeks 12, 25, and 51. INTERPRETATION 129Xe gas transfer was impaired up to 1 year following hospitalization in patients who were hospitalized with COVID-19 pneumonia, without evidence of architectural distortion on structural imaging, whereas lung ventilation was normal at 52 weeks.
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Affiliation(s)
- Laura C Saunders
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Guilhem J Collier
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Ho-Fung Chan
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Paul J C Hughes
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Laurie J Smith
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - J G R Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - James E Meiring
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Zoë Gabriel
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Thomas Newman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Megan Plowright
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Phillip Wade
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - James A Eaden
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Siby Thomas
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | | | - Lotta Gustafsson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Jody Bray
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Helen Marshall
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - David A Capener
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Leanne Armstrong
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Jennifer Rodgers
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Martin Brook
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Alberto M Biancardi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Madhwesha R Rao
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Graham Norquay
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Oliver Rodgers
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Ryan Munro
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - James E Ball
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Neil J Stewart
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, England
| | - James T Grist
- Department of Radiology, Oxford University Hospitals, Oxford, England; Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, England; Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, England
| | - Fergus Gleeson
- Department of Oncology, University of Oxford, Oxford, England; Department of Radiology, Oxford University Hospitals, Oxford, England
| | | | - Kevin M Johnson
- Department of Medical Physics, University of Madison, Madison, WI, USA
| | | | | | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Smitha Rajaram
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Gary H Mills
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Lisa Watson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Paul J Collini
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, England.
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11
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Vaeggemose M, Schulte RF, Hansen ESS, Miller JJ, Rasmussen CW, Pilgrim-Morris JH, Stewart NJ, Collier GJ, Wild JM, Laustsen C. A Framework for Predicting X-Nuclei Transmitter Gain Using 1H Signal. Tomography 2023; 9:1603-1616. [PMID: 37736981 PMCID: PMC10514872 DOI: 10.3390/tomography9050128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/13/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023] Open
Abstract
Commercial human MR scanners are optimised for proton imaging, containing sophisticated prescan algorithms with setting parameters such as RF transmit gain and power. These are not optimal for X-nuclear application and are challenging to apply to hyperpolarised experiments, where the non-renewable magnetisation signal changes during the experiment. We hypothesised that, despite the complex and inherently nonlinear electrodynamic physics underlying coil loading and spatial variation, simple linear regression would be sufficient to accurately predict X-nuclear transmit gain based on concomitantly acquired data from the proton body coil. We collected data across 156 scan visits at two sites as part of ongoing studies investigating sodium, hyperpolarised carbon, and hyperpolarised xenon. We demonstrate that simple linear regression is able to accurately predict sodium, carbon, or xenon transmit gain as a function of position and proton gain, with variation that is less than the intrasubject variability. In conclusion, sites running multinuclear studies may be able to remove the time-consuming need to separately acquire X-nuclear reference power calibration, inferring it from the proton instead.
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Affiliation(s)
- Michael Vaeggemose
- GE HealthCare, 2605 Brondby, Denmark;
- MR Research Centre, Aarhus University, 8200 Aarhus, Denmark; (E.S.S.H.); (J.J.M.)
| | | | - Esben S. S. Hansen
- MR Research Centre, Aarhus University, 8200 Aarhus, Denmark; (E.S.S.H.); (J.J.M.)
| | - Jack J. Miller
- MR Research Centre, Aarhus University, 8200 Aarhus, Denmark; (E.S.S.H.); (J.J.M.)
| | - Camilla W. Rasmussen
- MR Research Centre, Aarhus University, 8200 Aarhus, Denmark; (E.S.S.H.); (J.J.M.)
| | - Jemima H. Pilgrim-Morris
- POLARIS Group, University of Sheffield, Sheffield S10 2TN, UK; (J.H.P.-M.); (N.J.S.); (G.J.C.); (J.M.W.)
| | - Neil J. Stewart
- POLARIS Group, University of Sheffield, Sheffield S10 2TN, UK; (J.H.P.-M.); (N.J.S.); (G.J.C.); (J.M.W.)
| | - Guilhem J. Collier
- POLARIS Group, University of Sheffield, Sheffield S10 2TN, UK; (J.H.P.-M.); (N.J.S.); (G.J.C.); (J.M.W.)
| | - Jim M. Wild
- POLARIS Group, University of Sheffield, Sheffield S10 2TN, UK; (J.H.P.-M.); (N.J.S.); (G.J.C.); (J.M.W.)
| | - Christoffer Laustsen
- MR Research Centre, Aarhus University, 8200 Aarhus, Denmark; (E.S.S.H.); (J.J.M.)
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12
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Alabed S, Garg P, Alandejani F, Dwivedi K, Maiter A, Karunasaagarar K, Rajaram S, Hill C, Thomas S, Gossling R, Sharkey MJ, Salehi M, Wild JM, Watson L, Hameed A, Charalampopoulos A, Lu H, Rothman AMK, Thompson AAR, Elliot CA, Hamilton N, Johns CS, Armstrong I, Condliffe R, van der Geest RJ, Swift AJ, Kiely DG. Establishing minimally important differences for cardiac MRI end-points in pulmonary arterial hypertension. Eur Respir J 2023; 62:2202225. [PMID: 37414419 PMCID: PMC10397469 DOI: 10.1183/13993003.02225-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/23/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) is the gold standard technique to assess biventricular volumes and function, and is increasingly being considered as an end-point in clinical studies. Currently, with the exception of right ventricular (RV) stroke volume and RV end-diastolic volume, there is only limited data on minimally important differences (MIDs) reported for CMR metrics. Our study aimed to identify MIDs for CMR metrics based on US Food and Drug Administration recommendations for a clinical outcome measure that should reflect how a patient "feels, functions or survives". METHODS Consecutive treatment-naïve patients with pulmonary arterial hypertension (PAH) between 2010 and 2022 who had two CMR scans (at baseline prior to treatment and 12 months following treatment) were identified from the ASPIRE registry. All patients were followed up for 1 additional year after the second scan. For both scans, cardiac measurements were obtained from a validated fully automated segmentation tool. The MID in CMR metrics was determined using two distribution-based (0.5sd and minimal detectable change) and two anchor-based (change difference and generalised linear model regression) methods benchmarked to how a patient "feels" (emPHasis-10 quality of life questionnaire), "functions" (incremental shuttle walk test) or "survives" for 1-year mortality to changes in CMR measurements. RESULTS 254 patients with PAH were included (mean±sd age 53±16 years, 79% female and 66% categorised as intermediate risk based on the 2022 European Society of Cardiology/European Respiratory Society risk score). We identified a 5% absolute increase in RV ejection fraction and a 17 mL decrease in RV end-diastolic or end-systolic volumes as the MIDs for improvement. Conversely, a 5% decrease in RV ejection fraction and a 10 mL increase in RV volumes were associated with worsening. CONCLUSIONS This study establishes clinically relevant CMR MIDs for how a patient "feels, functions or survives" in response to PAH treatment. These findings provide further support for the use of CMR as a clinically relevant clinical outcome measure and will aid trial size calculations for studies using CMR.
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Affiliation(s)
- Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Ahmed Maiter
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Kavita Karunasaagarar
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Smitha Rajaram
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Catherine Hill
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Steven Thomas
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Rebecca Gossling
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Michael J Sharkey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Mahan Salehi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Lisa Watson
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Abdul Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Haiping Lu
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Alex M K Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Charlie A Elliot
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Neil Hamilton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Christopher S Johns
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Iain Armstrong
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Robin Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
- National Institute for Health and Care Research, Sheffield Biomedical Research Centre, Sheffield, UK
- Joint senior authors
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for in silico Medicine, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
- National Institute for Health and Care Research, Sheffield Biomedical Research Centre, Sheffield, UK
- Joint senior authors
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13
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Astley JR, Biancardi AM, Marshall H, Smith LJ, Hughes PJC, Collier GJ, Saunders LC, Norquay G, Tofan MM, Hatton MQ, Hughes R, Wild JM, Tahir BA. PhysVENeT: a physiologically-informed deep learning-based framework for the synthesis of 3D hyperpolarized gas MRI ventilation. Sci Rep 2023; 13:11273. [PMID: 37438406 DOI: 10.1038/s41598-023-38105-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023] Open
Abstract
Functional lung imaging modalities such as hyperpolarized gas MRI ventilation enable visualization and quantification of regional lung ventilation; however, these techniques require specialized equipment and exogenous contrast, limiting clinical adoption. Physiologically-informed techniques to map proton (1H)-MRI ventilation have been proposed. These approaches have demonstrated moderate correlation with hyperpolarized gas MRI. Recently, deep learning (DL) has been used for image synthesis applications, including functional lung image synthesis. Here, we propose a 3D multi-channel convolutional neural network that employs physiologically-informed ventilation mapping and multi-inflation structural 1H-MRI to synthesize 3D ventilation surrogates (PhysVENeT). The dataset comprised paired inspiratory and expiratory 1H-MRI scans and corresponding hyperpolarized gas MRI scans from 170 participants with various pulmonary pathologies. We performed fivefold cross-validation on 150 of these participants and used 20 participants with a previously unseen pathology (post COVID-19) for external validation. Synthetic ventilation surrogates were evaluated using voxel-wise correlation and structural similarity metrics; the proposed PhysVENeT framework significantly outperformed conventional 1H-MRI ventilation mapping and other DL approaches which did not utilize structural imaging and ventilation mapping. PhysVENeT can accurately reflect ventilation defects and exhibits minimal overfitting on external validation data compared to DL approaches that do not integrate physiologically-informed mapping.
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Affiliation(s)
- Joshua R Astley
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alberto M Biancardi
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Helen Marshall
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Laurie J Smith
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Laura C Saunders
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Graham Norquay
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Malina-Maria Tofan
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Matthew Q Hatton
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Rod Hughes
- Early Development Respiratory Medicine, AstraZeneca, Cambridge, UK
| | - Jim M Wild
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Insigneo Institute for in Silico Medicine, The University of Sheffield, Sheffield, UK
| | - Bilal A Tahir
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK.
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, The University of Sheffield, Sheffield, UK.
- Insigneo Institute for in Silico Medicine, The University of Sheffield, Sheffield, UK.
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14
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Eaden JA, Weatherley ND, Chan HF, Collier G, Norquay G, Swift AJ, Rajaram S, Smith LJ, Bartholmai BJ, Bianchi SM, Wild JM. Hyperpolarised xenon-129 diffusion-weighted magnetic resonance imaging for assessing lung microstructure in idiopathic pulmonary fibrosis. ERJ Open Res 2023; 9:00048-2023. [PMID: 37650085 PMCID: PMC10463035 DOI: 10.1183/23120541.00048-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/12/2023] [Indexed: 09/01/2023] Open
Abstract
Background Hyperpolarised 129-xenon (129Xe) magnetic resonance imaging (MRI) shows promise in monitoring the progression of idiopathic pulmonary fibrosis (IPF) due to the lack of ionising radiation and the ability to quantify functional impairment. Diffusion-weighted (DW)-MRI with hyperpolarised gases can provide information about lung microstructure. The aims were to compare 129Xe DW-MRI measurements with pulmonary function tests (PFTs), and to assess whether they can detect early signs of disease progression in patients with newly diagnosed IPF. Methods This is a prospective, single-centre, observational imaging study of patients presenting with IPF to Northern General Hospital (Sheffield, UK). Hyperpolarised 129Xe DW-MRI was performed at 1.5 T on a whole-body General Electric HDx scanner and PFTs were performed on the same day as the MRI scan. Results There was an increase in global 129Xe apparent diffusion coefficient (ADC) between the baseline and 12-month visits (mean 0.043 cm2·s-1, 95% CI 0.040-0.047 cm2·s-1 versus mean 0.045 cm2·s-1, 95% CI 0.040-0.049 cm2·s-1; p=0.044; n=20), with no significant change in PFTs over the same time period. There was also an increase in 129Xe ADC in the lower zone (p=0.027), and an increase in 129Xe mean acinar dimension in the lower zone (p=0.033) between the baseline and 12-month visits. 129Xe DW-MRI measurements correlated strongly with diffusing capacity of the lung for carbon monoxide (% predicted), transfer coefficient of the lung for carbon monoxide (KCO) and KCO (% predicted). Conclusions 129Xe DW-MRI measurements appear to be sensitive to early changes of microstructural disease that are consistent with progression in IPF at 12 months. As new drug treatments are developed, the ability to quantify subtle changes using 129Xe DW-MRI could be particularly valuable.
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Affiliation(s)
- James A. Eaden
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nicholas D. Weatherley
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ho-Fung Chan
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Guilhem Collier
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Graham Norquay
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J. Swift
- Department of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Smitha Rajaram
- Department of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Laurie J. Smith
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Stephen M. Bianchi
- Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim M. Wild
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK
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15
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Astley JR, Biancardi AM, Marshall H, Hughes PJC, Collier GJ, Smith LJ, Eaden JA, Hughes R, Wild JM, Tahir BA. A Dual-Channel Deep Learning Approach for Lung Cavity Estimation From Hyperpolarized Gas and Proton MRI. J Magn Reson Imaging 2023; 57:1878-1890. [PMID: 36373828 PMCID: PMC10947587 DOI: 10.1002/jmri.28519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hyperpolarized gas MRI can quantify regional lung ventilation via biomarkers, including the ventilation defect percentage (VDP). VDP is computed from segmentations derived from spatially co-registered functional hyperpolarized gas and structural proton (1 H)-MRI. Although acquired at similar lung inflation levels, they are frequently misaligned, requiring a lung cavity estimation (LCE). Recently, single-channel, mono-modal deep learning (DL)-based methods have shown promise for pulmonary image segmentation problems. Multichannel, multimodal approaches may outperform single-channel alternatives. PURPOSE We hypothesized that a DL-based dual-channel approach, leveraging both 1 H-MRI and Xenon-129-MRI (129 Xe-MRI), can generate LCEs more accurately than single-channel alternatives. STUDY TYPE Retrospective. POPULATION A total of 480 corresponding 1 H-MRI and 129 Xe-MRI scans from 26 healthy participants (median age [range]: 11 [8-71]; 50% females) and 289 patients with pulmonary pathologies (median age [range]: 47 [6-83]; 51% females) were split into training (422 scans [88%]; 257 participants [82%]) and testing (58 scans [12%]; 58 participants [18%]) sets. FIELD STRENGTH/SEQUENCE 1.5-T, three-dimensional (3D) spoiled gradient-recalled 1 H-MRI and 3D steady-state free-precession 129 Xe-MRI. ASSESSMENT We developed a multimodal DL approach, integrating 129 Xe-MRI and 1 H-MRI, in a dual-channel convolutional neural network. We compared this approach to single-channel alternatives using manually edited LCEs as a benchmark. We further assessed a fully automatic DL-based framework to calculate VDPs and compared it to manually generated VDPs. STATISTICAL TESTS Friedman tests with post hoc Bonferroni correction for multiple comparisons compared single-channel and dual-channel DL approaches using Dice similarity coefficient (DSC), average boundary Hausdorff distance (average HD), and relative error (XOR) metrics. Bland-Altman analysis and paired t-tests compared manual and DL-generated VDPs. A P value < 0.05 was considered statistically significant. RESULTS The dual-channel approach significantly outperformed single-channel approaches, achieving a median (range) DSC, average HD, and XOR of 0.967 (0.867-0.978), 1.68 mm (37.0-0.778), and 0.066 (0.246-0.045), respectively. DL-generated VDPs were statistically indistinguishable from manually generated VDPs (P = 0.710). DATA CONCLUSION Our dual-channel approach generated LCEs, which could be integrated with ventilated lung segmentations to produce biomarkers such as the VDP without manual intervention. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Joshua R. Astley
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
- Department of Oncology and MetabolismThe University of SheffieldSheffieldUK
| | - Alberto M. Biancardi
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Helen Marshall
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Paul J. C. Hughes
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Guilhem J. Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Laurie J. Smith
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - James A. Eaden
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
| | - Rod Hughes
- Early Development RespiratoryAstraZenecaCambridgeUK
| | - Jim M. Wild
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
- Insigneo Institute for in silico medicine, The University of SheffieldSheffieldUK
| | - Bilal A. Tahir
- POLARIS, Department of Infection, Immunity & Cardiovascular DiseaseThe University of SheffieldSheffieldUK
- Department of Oncology and MetabolismThe University of SheffieldSheffieldUK
- Insigneo Institute for in silico medicine, The University of SheffieldSheffieldUK
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16
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Marshall H, Voskrebenzev A, Smith LJ, Biancardi AM, Kern AL, Collier GJ, Wielopolski PA, Ciet P, Tiddens HAWM, Vogel‐Claussen J, Wild JM. 129 Xe and Free-Breathing 1 H Ventilation MRI in Patients With Cystic Fibrosis: A Dual-Center Study. J Magn Reson Imaging 2023; 57:1908-1921. [PMID: 36218321 PMCID: PMC10946578 DOI: 10.1002/jmri.28470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Free-breathing 1 H ventilation MRI shows promise but only single-center validation has yet been performed against methods which directly image lung ventilation in patients with cystic fibrosis (CF). PURPOSE To investigate the relationship between 129 Xe and 1 H ventilation images using data acquired at two centers. STUDY TYPE Sequence comparison. POPULATION Center 1; 24 patients with CF (12 female) aged 9-47 years. Center 2; 7 patients with CF (6 female) aged 13-18 years, and 6 healthy controls (6 female) aged 21-31 years. Data were acquired in different patients at each center. FIELD STRENGTH/SEQUENCE 1.5 T, 3D steady-state free precession and 2D spoiled gradient echo. ASSESSMENT Subjects were scanned with 129 Xe ventilation and 1 H free-breathing MRI and performed pulmonary function tests. Ventilation defect percent (VDP) was calculated using linear binning and images were visually assessed by H.M., L.J.S., and G.J.C. (10, 5, and 8 years' experience). STATISTICAL TESTS Correlations and linear regression analyses were performed between 129 Xe VDP, 1 H VDP, FEV1 , and LCI. Bland-Altman analysis of 129 Xe VDP and 1 H VDP was carried out. Differences in metrics were assessed using one-way ANOVA or Kruskal-Wallis tests. RESULTS 129 Xe VDP and 1 H VDP correlated strongly with; each other (r = 0.84), FEV1 z-score (129 Xe VDP r = -0.83, 1 H VDP r = -0.80), and LCI (129 Xe VDP r = 0.91, 1 H VDP r = 0.82). Bland-Altman analysis of 129 Xe VDP and 1 H VDP from both centers had a bias of 0.07% and limits of agreement of -16.1% and 16.2%. Linear regression relationships of VDP with FEV1 were not significantly different between 129 Xe and 1 H VDP (P = 0.08), while 129 Xe VDP had a stronger relationship with LCI than 1 H VDP. DATA CONCLUSION 1 H ventilation MRI shows large-scale agreement with 129 Xe ventilation MRI in CF patients with established lung disease but may be less sensitive to subtle ventilation changes in patients with early-stage lung disease. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Helen Marshall
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)German Center for Lung Research (DZL)HannoverGermany
| | - Laurie J. Smith
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | - Alberto M. Biancardi
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | - Agilo L. Kern
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)German Center for Lung Research (DZL)HannoverGermany
| | - Guilhem J. Collier
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
| | | | - Pierluigi Ciet
- Department of Radiology and Nuclear medicineErasmus MCRotterdamThe Netherlands
- Department of Pediatric Pulmonology and AllergologySophia Children's Hospital, Erasmus MCRotterdamThe Netherlands
| | - Harm A. W. M. Tiddens
- Department of Radiology and Nuclear medicineErasmus MCRotterdamThe Netherlands
- Department of Pediatric Pulmonology and AllergologySophia Children's Hospital, Erasmus MCRotterdamThe Netherlands
| | - Jens Vogel‐Claussen
- Institute for Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH)German Center for Lung Research (DZL)HannoverGermany
| | - Jim M. Wild
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
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17
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Schofield LM, Singh SJ, Yousaf Z, Wild JM, Hind D. Personalising airway clearance in chronic suppurative lung diseases: a scoping review. ERJ Open Res 2023; 9:00010-2023. [PMID: 37342087 PMCID: PMC10277870 DOI: 10.1183/23120541.00010-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/14/2023] [Indexed: 06/22/2023] Open
Abstract
Background Personalised airway clearance techniques are commonly recommended to augment mucus clearance in chronic suppurative lung diseases. It is unclear what current literature tells us about how airway clearance regimens should be personalised. This scoping review explores current research on airway clearance technique in chronic suppurative lung diseases, to establish the extent and type of guidance in this area, identify knowledge gaps and determine the factors which physiotherapists should consider when personalising airway clearance regimens. Methods Systematic searching of online databases (MEDLINE, EMBASE, CINAHL, PEDro, Cochrane, Web of Science) was used to identify full-text publications in the last 25 years that described methods of personalising airway clearance techniques in chronic suppurative lung diseases. Items from the TIDieR framework provided a priori categories which were modified based on the initial data to develop a "Best-fit" framework for data charting. The findings were subsequently transformed into a personalisation model. Results A broad range of publications were identified, most commonly general review papers (44%). The items identified were grouped into seven personalisation factors: physical, psychosocial, airway clearance technique (ACT) type, procedures, dosage, response and provider. As only two divergent models of ACT personalisation were found, the personalisation factors identified were then used to develop a model for physiotherapists. Conclusions The personalisation of airway clearance regimens is widely discussed in the current literature, which provides a range of factors that should be considered. This review summarises the current literature, organising findings into a proposed airway clearance personalisation model, to provide clarity in this field.
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Affiliation(s)
- Lynne M. Schofield
- Faculty of Medicine Dentistry and Health, IICD, University of Sheffield, Sheffield, UK
- Paediatric Physiotherapy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sally J. Singh
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Zarah Yousaf
- Patient and Public Involvement Member, Leeds Teaching Hospitals NHS Trust, UK
| | - Jim M Wild
- Faculty of Medicine Dentistry and Health, IICD, University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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18
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Alkhanfar D, Dwivedi K, Alandejani F, Shahin Y, Alabed S, Johns C, Garg P, Thompson AAR, Rothman AMK, Hameed A, Charalampopoulos A, Wild JM, Condliffe R, Kiely DG, Swift AJ. Non-invasive detection of severe PH in lung disease using magnetic resonance imaging. Front Cardiovasc Med 2023; 10:1016994. [PMID: 37139140 PMCID: PMC10149807 DOI: 10.3389/fcvm.2023.1016994] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Severe pulmonary hypertension (mean pulmonary artery pressure ≥35 mmHg) in chronic lung disease (PH-CLD) is associated with high mortality and morbidity. Data suggesting potential response to vasodilator therapy in patients with PH-CLD is emerging. The current diagnostic strategy utilises transthoracic Echocardiography (TTE), which can be technically challenging in some patients with advanced CLD. The aim of this study was to evaluate the diagnostic role of MRI models to diagnose severe PH in CLD. Methods 167 patients with CLD referred for suspected PH who underwent baseline cardiac MRI, pulmonary function tests and right heart catheterisation were identified. In a derivation cohort (n = 67) a bi-logistic regression model was developed to identify severe PH and compared to a previously published multiparameter model (Whitfield model), which is based on interventricular septal angle, ventricular mass index and diastolic pulmonary artery area. The model was evaluated in a test cohort. Results The CLD-PH MRI model [= (-13.104) + (13.059 * VMI)-(0.237 * PA RAC) + (0.083 * Systolic Septal Angle)], had high accuracy in the test cohort (area under the ROC curve (0.91) (p < 0.0001), sensitivity 92.3%, specificity 70.2%, PPV 77.4%, and NPV 89.2%. The Whitfield model also had high accuracy in the test cohort (area under the ROC curve (0.92) (p < 0.0001), sensitivity 80.8%, specificity 87.2%, PPV 87.5%, and NPV 80.4%. Conclusion The CLD-PH MRI model and Whitfield model have high accuracy to detect severe PH in CLD, and have strong prognostic value.
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Affiliation(s)
- Dheyaa Alkhanfar
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO, Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Chris Johns
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Pankaj Garg
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - A. A. Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alexander M. K. Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Abdul Hameed
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Athanasios Charalampopoulos
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Jim M. Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO, Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - David G. Kiely
- INSIGNEO, Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO, Institute for in Silico Medicine, University of Sheffield, Sheffield, United Kingdom
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19
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Stewart I, Jacob J, George PM, Molyneaux PL, Porter JC, Allen RJ, Aslani S, Baillie JK, Barratt SL, Beirne P, Bianchi SM, Blaikley JF, Chalmers JD, Chambers RC, Chadhuri N, Coleman C, Collier G, Denneny EK, Docherty A, Elneima O, Evans RA, Fabbri L, Gibbons MA, Gleeson FV, Gooptu B, Greening NJ, Guio BG, Hall IP, Hanley NA, Harris V, Harrison EM, Heightman M, Hillman TE, Horsley A, Houchen-Wolloff L, Jarrold I, Johnson SR, Jones MG, Khan F, Lawson R, Leavy O, Lone N, Marks M, McAuley H, Mehta P, Parekh D, Hanley KP, Platé M, Pearl J, Poinasamy K, Quint JK, Raman B, Richardson M, Rivera-Ortega P, Saunders L, Saunders R, Semple MG, Sereno M, Shikotra A, Simpson AJ, Singapuri A, Smith DJF, Spears M, Spencer LG, Stanel S, Thickett DR, Thompson AAR, Thorpe M, Walsh SLF, Walker S, Weatherley ND, Weeks ME, Wild JM, Wootton DG, Brightling CE, Ho LP, Wain LV, Jenkins GR. Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study. Am J Respir Crit Care Med 2023; 207:693-703. [PMID: 36457159 PMCID: PMC10037479 DOI: 10.1164/rccm.202203-0564oc] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
Rationale: Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage. Objectives: The UK Interstitial Lung Disease Consortium (UKILD) post-COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata. Methods: The PHOSP-COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP-COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up. Measurements and Main Results: The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83-155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05-1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00-1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07-1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6-9.5), rising to 11.7% (95% CrI, 10.3-13.1) in the sensitivity analysis. Conclusions: Residual lung abnormalities were estimated in up to 11% of people discharged after COVID-19-related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications.
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Affiliation(s)
- Iain Stewart
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Peter M. George
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Philip L. Molyneaux
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Richard J. Allen
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | | | | | - Paul Beirne
- Leeds Teaching Hospitals NHS Foundation Trust, Leeds, United Kingdom
| | - Stephen M. Bianchi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | | | | | | | | | | | | | | | - Omer Elneima
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Rachael A. Evans
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Laura Fabbri
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | - Fergus V. Gleeson
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Bibek Gooptu
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Neil J. Greening
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Beatriz Guillen Guio
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ian P. Hall
- University of Nottingham, Nottingham, United Kingdom
| | | | - Victoria Harris
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | | | | | - Alex Horsley
- University of Manchester, Manchester, United Kingdom
| | | | | | | | - Mark G. Jones
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Fasihul Khan
- University of Nottingham, Nottingham, United Kingdom
| | - Rod Lawson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Olivia Leavy
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Michael Marks
- University College London Hospital, London, United Kingdom
| | - Hamish McAuley
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Puja Mehta
- University College London Hospital, London, United Kingdom
| | - Dhruv Parekh
- University of Birmingham, Brimingham, United Kingdom
| | - Karen Piper Hanley
- University of Manchester, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Manuela Platé
- University College London Hospital, London, United Kingdom
| | - John Pearl
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Jennifer K. Quint
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Betty Raman
- University of Oxford, Oxford, United Kingdom
| | | | | | | | - Ruth Saunders
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | - Marco Sereno
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Aarti Shikotra
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | | | - Amisha Singapuri
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - David J. F. Smith
- Royal Brompton and Harefield Clinical Group, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mark Spears
- Perth Royal Infirmary, NHS Tayside, Perth, United Kingdom; and
| | - Lisa G. Spencer
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Stefan Stanel
- University of Manchester, Manchester, United Kingdom
| | | | | | | | - Simon L. F. Walsh
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | | | | | - Mark E. Weeks
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Jim M. Wild
- University of Sheffield, Sheffield, United Kingdom
| | | | | | - Ling-Pei Ho
- University of Oxford, Oxford, United Kingdom
| | - Louise V. Wain
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Gisli R. Jenkins
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
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Marshall H, Wild JM, Smith LJ, Hardaker L, Fihn-Wikander T, Müllerová H, Hughes R. Functional imaging in asthma and COPD: design of the NOVELTY ADPro substudy. ERJ Open Res 2023; 9:00344-2022. [PMID: 37020837 PMCID: PMC10068571 DOI: 10.1183/23120541.00344-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/17/2022] [Indexed: 01/27/2023] Open
Abstract
The NOVEL observational longiTudinal studY (NOVELTY; ClinicalTrials.gov identifier NCT02760329) is a global, prospective, observational study of ∼12 000 patients with a diagnosis of asthma and/or COPD. Here, we describe the design of the Advanced Diagnostic Profiling (ADPro) substudy of NOVELTY being conducted in a subset of ∼180 patients recruited from two primary care sites in York, UK. ADPro is employing a combination of novel functional imaging and physiological and metabolic modalities to explore structural and functional changes in the lungs, and their association with different phenotypes and endotypes. Patients participating in the ADPro substudy will attend two visits at the University of Sheffield, UK, 12±2 months apart, at which they will undergo imaging and physiological lung function testing. The primary end-points are the distributions of whole lung functional and morphological measurements assessed with xenon-129 magnetic resonance imaging, including ventilation, gas transfer and airway microstructural indices. Physiological assessments of pulmonary function include spirometry, bronchodilator reversibility, static lung volumes via body plethysmography, transfer factor of the lung for carbon monoxide, multiple-breath nitrogen washout and airway oscillometry. Fractional exhaled nitric oxide will be measured as a marker of type-2 airways inflammation. Regional and global assessment of lung function using these techniques will enable more precise phenotyping of patients with physician-assigned asthma and/or COPD. These techniques will be assessed for their sensitivity to markers of early disease progression.
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Affiliation(s)
- Helen Marshall
- POLARIS, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M. Wild
- POLARIS, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Laurie J. Smith
- POLARIS, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Titti Fihn-Wikander
- Evidence Delivery, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Hana Müllerová
- Respiratory and Immunology, Medical and Payer Evidence Strategy, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Rod Hughes
- External Scientific Engagement, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
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21
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Collier GJ, Schulte RF, Rao M, Norquay G, Ball J, Wild JM. Imaging gas-exchange lung function and brain tissue uptake of hyperpolarized 129 Xe using sampling density-weighted MRSI. Magn Reson Med 2023; 89:2217-2226. [PMID: 36744585 DOI: 10.1002/mrm.29602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Imaging of the different resonances of hyperpolarized 129 Xe in the brain and lungs was performed using a 3D sampling density-weighted MRSI technique in healthy volunteers. METHODS Four volunteers underwent dissolved-phase hyperpolarized 129 Xe imaging in the lung with the MRSI technique, which was designed to improve the point-spread function while preserving SNR (1799 phase-encoding steps, 14-s breath hold, 2.1-cm isotropic resolution). A frequency-tailored RF excitation pulse was implemented to reliably excite both the 129 Xe gas and dissolved phase (tissue/blood signal) with 0.1° and 10° flip angles, respectively. Images of xenon gas in the lung airspaces and xenon dissolved in lung tissue/blood were used to generate quantitative signal ratio maps. The method was also optimized and used for imaging dissolved resonances of 129 Xe in the brain in 2 additional volunteers. RESULTS High-quality regional spectra of hyperpolarized 129 Xe were achieved in both the lung and the brain. Ratio maps of the different xenon resonances were obtained in the lung with sufficient SNR (> 10) at both 1.5 T and 3 T, making a triple Lorentzian fit possible and enabling the measurement of relaxation times and xenon frequency shifts on a voxel-wise basis. The imaging technique was successfully adapted for brain imaging, resulting in the first demonstration of 3D xenon brain images with a 2-cm isotropic resolution. CONCLUSION Density-weighted MRSI is an SNR and encoding-efficient way to image 129 Xe resonances in the lung and the brain, providing a valuable tool to quantify regional spectroscopic information.
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Affiliation(s)
- Guilhem J Collier
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.,INSIGNEO institute, University of Sheffield, Sheffield, UK
| | | | - Madhwesha Rao
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Graham Norquay
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James Ball
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M Wild
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK.,INSIGNEO institute, University of Sheffield, Sheffield, UK
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22
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Tibiletti M, Eaden JA, Naish JH, Hughes PJC, Waterton JC, Heaton MJ, Chaudhuri N, Skeoch S, Bruce IN, Bianchi S, Wild JM, Parker GJM. Imaging biomarkers of lung ventilation in interstitial lung disease from 129Xe and oxygen enhanced 1H MRI. Magn Reson Imaging 2023; 95:39-49. [PMID: 36252693 DOI: 10.1016/j.mri.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare imaging biomarkers from hyperpolarised 129Xe ventilation MRI and dynamic oxygen-enhanced MRI (OE-MRI) with standard pulmonary function tests (PFT) in interstitial lung disease (ILD) patients. To evaluate if biomarkers can separate ILD subtypes and detect early signs of disease resolution or progression. STUDY TYPE Prospective longitudinal. POPULATION Forty-one ILD (fourteen idiopathic pulmonary fibrosis (IPF), eleven hypersensitivity pneumonitis (HP), eleven drug-induced ILD (DI-ILD), five connective tissue disease related-ILD (CTD-ILD)) patients and ten healthy volunteers imaged at visit 1. Thirty-four ILD patients completed visit 2 (eleven IPF, eight HP, ten DIILD, five CTD-ILD) after 6 or 26 weeks. FIELD STRENGTH/SEQUENCE MRI was performed at 1.5 T, including inversion recovery T1 mapping, dynamic MRI acquisition with varying oxygen levels, and hyperpolarised 129Xe ventilation MRI. Subjects underwent standard spirometry and gas transfer testing. ASSESSMENT Five 1H MRI and two 129Xe MRI ventilation metrics were compared with spirometry and gas transfer measurements. STATISTICAL TEST To evaluate differences at visit 1 among subgroups: ANOVA or Kruskal-Wallis rank tests with correction for multiple comparisons. To assess the relationships between imaging biomarkers, PFT, age and gender, at visit 1 and for the change between visit 1 and 2: Pearson correlations and multilinear regression models. RESULTS The global PFT tests could not distinguish ILD subtypes. Percentage ventilated volumes were lower in ILD patients than in HVs when measured with 129Xe MRI (HV 97.4 ± 2.6, CTD-ILD: 91.0 ± 4.8 p = 0.017, DI-ILD 90.1 ± 7.4 p = 0.003, HP 92.6 ± 4.0 p = 0.013, IPF 88.1 ± 6.5 p < 0.001), but not with OE-MRI. 129Xe reported more heterogeneous ventilation in DI-ILD and IPF than in HV, and OE-MRI reported more heterogeneous ventilation in DI-ILD and IPF than in HP or CTD-ILD. The longitudinal changes reported by the imaging biomarkers did not correlate with the PFT changes between visits. DATA CONCLUSION Neither 129Xe ventilation nor OE-MRI biomarkers investigated in this study were able to differentiate between ILD subtypes, suggesting that ventilation-only biomarkers are not indicated for this task. Limited but progressive loss of ventilated volume as measured by 129Xe-MRI may be present as the biomarker of focal disease progresses. OE-MRI biomarkers are feasible in ILD patients and do not correlate strongly with PFT. Both OE-MRI and 129Xe MRI revealed more spatially heterogeneous ventilation in DI-ILD and IPF.
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Affiliation(s)
- Marta Tibiletti
- Bioxydyn Limited, Rutherford House, Manchester Science Park, Manchester M15 6SZ, United Kingdom
| | - James A Eaden
- POLARIS, University of Sheffield MRI Unit, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Josephine H Naish
- Bioxydyn Limited, Rutherford House, Manchester Science Park, Manchester M15 6SZ, United Kingdom; MCMR, Manchester University NHS Foundation Trust, Wythenshawe, Manchester, UK
| | - Paul J C Hughes
- POLARIS, University of Sheffield MRI Unit, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - John C Waterton
- Bioxydyn Limited, Rutherford House, Manchester Science Park, Manchester M15 6SZ, United Kingdom; Centre for Imaging Sciences, University of Manchester, Manchester, UK
| | - Matthew J Heaton
- Bioxydyn Limited, Rutherford House, Manchester Science Park, Manchester M15 6SZ, United Kingdom
| | - Nazia Chaudhuri
- North West Lung Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Skeoch
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Ian N Bruce
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK; Centre for Musculoskeletal Research, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen Bianchi
- Academic Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim M Wild
- POLARIS, University of Sheffield MRI Unit, Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK; Insigneo Insititute for in silico medicine, Sheffield, UK
| | - Geoff J M Parker
- Bioxydyn Limited, Rutherford House, Manchester Science Park, Manchester M15 6SZ, United Kingdom; Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
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23
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Chan HF, Smith LJ, Biancardi AM, Bray J, Marshall H, Hughes PJC, Collier GJ, Rao M, Norquay G, Swift AJ, Hart K, Cousins M, Watkins WJ, Wild JM, Kotecha S. Image Phenotyping of Preterm-Born Children Using Hyperpolarized 129Xe Lung Magnetic Resonance Imaging and Multiple-Breath Washout. Am J Respir Crit Care Med 2023; 207:89-100. [PMID: 35972833 PMCID: PMC9952860 DOI: 10.1164/rccm.202203-0606oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/16/2022] [Indexed: 02/03/2023] Open
Abstract
Rationale: Preterm birth is associated with low lung function in childhood, but little is known about the lung microstructure in childhood. Objectives: We assessed the differential associations between the historical diagnosis of bronchopulmonary dysplasia (BPD) and current lung function phenotypes on lung ventilation and microstructure in preterm-born children using hyperpolarized 129Xe ventilation and diffusion-weighted magnetic resonance imaging (MRI) and multiple-breath washout (MBW). Methods: Data were available from 63 children (aged 9-13 yr), including 44 born preterm (⩽34 weeks' gestation) and 19 term-born control subjects (⩾37 weeks' gestation). Preterm-born children were classified, using spirometry, as prematurity-associated obstructive lung disease (POLD; FEV1 < lower limit of normal [LLN] and FEV1/FVC < LLN), prematurity-associated preserved ratio of impaired spirometry (FEV1 < LLN and FEV1/FVC ⩾ LLN), preterm-(FEV1 ⩾ LLN) and term-born control subjects, and those with and without BPD. Ventilation heterogeneity metrics were derived from 129Xe ventilation MRI and SF6 MBW. Alveolar microstructural dimensions were derived from 129Xe diffusion-weighted MRI. Measurements and Main Results: 129Xe ventilation defect percentage and ventilation heterogeneity index were significantly increased in preterm-born children with POLD. In contrast, mean 129Xe apparent diffusion coefficient, 129Xe apparent diffusion coefficient interquartile range, and 129Xe mean alveolar dimension interquartile range were significantly increased in preterm-born children with BPD, suggesting changes of alveolar dimensions. MBW metrics were all significantly increased in the POLD group compared with preterm- and term-born control subjects. Linear regression confirmed the differential effects of obstructive disease on ventilation defects and BPD on lung microstructure. Conclusion: We show that ventilation abnormalities are associated with POLD, and BPD in infancy is associated with abnormal lung microstructure.
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Affiliation(s)
- Ho-Fung Chan
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Laurie J. Smith
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Alberto M. Biancardi
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Jody Bray
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Helen Marshall
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Paul J. C. Hughes
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Guilhem J. Collier
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Madhwesha Rao
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Graham Norquay
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Andrew J. Swift
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Kylie Hart
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Michael Cousins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - W. John Watkins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Jim M. Wild
- Pulmonary, Lung and Respiratory Imaging Sheffield (POLARIS), Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neonatal Unit, Cardiff and Vale University Health Board, Cardiff, United Kingdom
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24
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Grist JT, Collier GJ, Walters H, Kim M, Chen M, Abu Eid G, Laws A, Matthews V, Jacob K, Cross S, Eves A, Durrant M, McIntyre A, Thompson R, Schulte RF, Raman B, Robbins PA, Wild JM, Fraser E, Gleeson F. Lung Abnormalities Detected with Hyperpolarized 129Xe MRI in Patients with Long COVID. Radiology 2022; 305:709-717. [PMID: 35608443 PMCID: PMC9134268 DOI: 10.1148/radiol.220069] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/25/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
Background Post-COVID-19 condition encompasses symptoms following COVID-19 infection that linger at least 4 weeks after the end of active infection. Symptoms are wide ranging, but breathlessness is common. Purpose To determine if the previously described lung abnormalities seen on hyperpolarized (HP) pulmonary xenon 129 (129Xe) MRI scans in participants with post-COVID-19 condition who were hospitalized are also present in participants with post-COVID-19 condition who were not hospitalized. Materials and Methods In this prospective study, nonhospitalized participants with post-COVID-19 condition (NHLC) and posthospitalized participants with post-COVID-19 condition (PHC) were enrolled from June 2020 to August 2021. Participants underwent chest CT, HP 129Xe MRI, pulmonary function testing, and the 1-minute sit-to-stand test and completed breathlessness questionnaires. Control subjects underwent HP 129Xe MRI only. CT scans were analyzed for post-COVID-19 interstitial lung disease severity using a previously published scoring system and full-scale airway network (FAN) modeling. Analysis used group and pairwise comparisons between participants and control subjects and correlations between participant clinical and imaging data. Results A total of 11 NHLC participants (four men, seven women; mean age, 44 years ± 11 [SD]; 95% CI: 37, 50) and 12 PHC participants (10 men, two women; mean age, 58 years ±10; 95% CI: 52, 64) were included, with a significant difference in age between groups (P = .05). Mean time from infection was 287 days ± 79 (95% CI: 240, 334) and 143 days ± 72 (95% CI: 105, 190) in NHLC and PHC participants, respectively. NHLC and PHC participants had normal or near normal CT scans (mean, 0.3/25 ± 0.6 [95% CI: 0, 0.63] and 7/25 ± 5 [95% CI: 4, 10], respectively). Gas transfer (Dlco) was different between NHLC and PHC participants (mean Dlco, 76% ± 8 [95% CI: 73, 83] vs 86% ± 8 [95% CI: 80, 91], respectively; P = .04), but there was no evidence of other differences in lung function. Mean red blood cell-to-tissue plasma ratio was different between volunteers (mean, 0.45 ± 0.07; 95% CI: 0.43, 0.47]) and PHC participants (mean, 0.31 ± 0.10; 95% CI: 0.24, 0.37; P = .02) and between volunteers and NHLC participants (mean, 0.37 ± 0.10; 95% CI: 0.31, 0.44; P = .03) but not between NHLC and PHC participants (P = .26). FAN results did not correlate with Dlco) or HP 129Xe MRI results. Conclusion Nonhospitalized participants with post-COVID-19 condition (NHLC) and posthospitalized participants with post-COVID-19 condition (PHC) showed hyperpolarized pulmonary xenon 129 MRI and red blood cell-to-tissue plasma abnormalities, with NHLC participants demonstrating lower gas transfer than PHC participants despite having normal CT findings. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Parraga and Matheson in this issue.
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Affiliation(s)
- James T. Grist
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Guilhem J. Collier
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Huw Walters
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Minsuok Kim
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Mitchell Chen
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Gabriele Abu Eid
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Aviana Laws
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Violet Matthews
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Kenneth Jacob
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Susan Cross
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Alexandra Eves
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Marianne Durrant
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Anthony McIntyre
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Roger Thompson
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Rolf F. Schulte
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Betty Raman
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Peter A. Robbins
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Jim M. Wild
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Emily Fraser
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
| | - Fergus Gleeson
- From the Department of Radiology (J.T.G., H.W., M.C., G.A.E., A.L.,
V.M., K.J., S.C., A.E., M.D., A.M., F.G.) and Oxford Interstitial Lung Disease
Service (E.F.), Oxford University Hospitals NHS Trust, Oxford, UK; Department of
Physiology, Anatomy, and Genetics (J.T.G., P.A.R.), Radcliffe Department of
Medicine, Oxford Centre for Clinical Magnetic Resonance Research (J.T.G., B.R.),
and Department of Oncology (F.G.), University of Oxford, Old Road Headington,
Oxford 0X3 7DQ, UK; Institute of Cancer and Genomic Sciences, University
of Birmingham, Birmingham, UK (J.T.G.); POLARIS, Department of Infection
Immunity and Cardiovascular Disease (G.J.C., J.M.W.), and Department of
Infection, Immunity, and Cardiovascular Disease (R.T.), University of Sheffield,
Sheffield, UK; Wolfson School of Mechanical, Electrical and Manufacturing
Engineering, Loughborough University, Loughborough, UK (M.K.); and GE
Healthcare, Munich, Germany (R.F.S.)
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25
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Wild JM, Collier G. 129Xe Pulmonary MRI for Individuals with Post-acute COVID-19 Syndrome. Radiology 2022; 305:477-478. [PMID: 35762895 PMCID: PMC9272687 DOI: 10.1148/radiol.221361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Jim M. Wild
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Royal Hallamshire Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, UK
| | - Guilhem Collier
- From the Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Royal Hallamshire Hospital, Glossop Rd, Floor C, Sheffield S10 2JF, UK
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26
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Zhang X, Angelini ED, Haghpanah FS, Laine AF, Sun Y, Hiura GT, Dashnaw SM, Prince MR, Hoffman EA, Ambale-Venkatesh B, Lima JA, Wild JM, Hughes EW, Barr RG, Shen W. Quantification of lung ventilation defects on hyperpolarized MRI: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD study. Magn Reson Imaging 2022; 92:140-149. [PMID: 35777684 PMCID: PMC9957614 DOI: 10.1016/j.mri.2022.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/11/2022] [Accepted: 06/23/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE To develop an end-to-end deep learning (DL) framework to segment ventilation defects on pulmonary hyperpolarized MRI. MATERIALS AND METHODS The Multi-Ethnic Study of Atherosclerosis Chronic Obstructive Pulmonary Disease (COPD) study is a nested longitudinal case-control study in older smokers. Between February 2016 and July 2017, 56 participants (age, mean ± SD, 74 ± 8 years; 34 men) underwent same breath-hold proton (1H) and helium (3He) MRI, which were annotated for non-ventilated, hypo-ventilated, and normal-ventilated lungs. In this retrospective DL study, 820 1H and 3He slices from 42/56 (75%) participants were randomly selected for training, with the remaining 14/56 (25%) for test. Full lung masks were segmented using a traditional U-Net on 1H MRI and were imported into a cascaded U-Net, which were used to segment ventilation defects on 3He MRI. Models were trained with conventional data augmentation (DA) and generative adversarial networks (GAN)-DA. RESULTS Conventional-DA improved 1H and 3He MRI segmentation over the non-DA model (P = 0.007 to 0.03) but GAN-DA did not yield further improvement. The cascaded U-Net improved non-ventilated lung segmentation (P < 0.005). Dice similarity coefficients (DSC) between manually and DL-segmented full lung, non-ventilated, hypo-ventilated, and normal-ventilated regions were 0.965 ± 0.010, 0.840 ± 0.057, 0.715 ± 0.175, and 0.883 ± 0.060, respectively. We observed no statistically significant difference in DCSs between participants with and without COPD (P = 0.41, 0.06, and 0.18 for non-ventilated, hypo-ventilated, and normal-ventilated regions, respectively). CONCLUSION The proposed cascaded U-Net framework generated fully-automated segmentation of ventilation defects on 3He MRI among older smokers with and without COPD that is consistent with our reference method.
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Affiliation(s)
- Xuzhe Zhang
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Elsa D Angelini
- Department of Biomedical Engineering, Columbia University, New York, NY, USA; NIHR Imperial BRC, ITMAT Data Science Group, Department of Metabolism, Digestion and Reproduction, Imperial College, London, UK
| | - Fateme S Haghpanah
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Andrew F Laine
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Yanping Sun
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Grant T Hiura
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Stephen M Dashnaw
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Martin R Prince
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA; Department of Radiology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA; Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA; Department of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Joao A Lima
- School of Medicine, John Hopkins University, Baltimore, MD, USA
| | - Jim M Wild
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Emlyn W Hughes
- Department of Physics, Columbia University, New York, NY, USA
| | - R Graham Barr
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Wei Shen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center, New York, NY, USA; Institute of Human Nutrition, Columbia University Irving Medical Center, New York, NY, USA; Columbia Magnetic Resonance Research Center (CMRRC), Columbia University, New York, NY, USA.
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27
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Taskiran NP, Hiura GT, Zhang X, Barr RG, Dashnaw SM, Hoffman EA, Malinsky D, Oelsner EC, Prince MR, Smith BM, Sun Y, Sun Y, Wild JM, Shen W, Hughes EW. Mapping Alveolar Oxygen Partial Pressure in COPD Using Hyperpolarized Helium-3: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study. Tomography 2022; 8:2268-2284. [PMID: 36136886 PMCID: PMC9498778 DOI: 10.3390/tomography8050190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) and emphysema are characterized by functional and structural damage which increases the spaces for gaseous diffusion and impairs oxygen exchange. Here we explore the potential for hyperpolarized (HP) 3He MRI to characterize lung structure and function in a large-scale population-based study. Participants (n = 54) from the Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study, a nested case-control study of COPD among participants with 10+ packyears underwent HP 3He MRI measuring pAO2, apparent diffusion coefficient (ADC), and ventilation. HP MRI measures were compared to full-lung CT and pulmonary function testing. High ADC values (>0.4 cm2/s) correlated with emphysema and heterogeneity in pAO2 measurements. Strong correlations were found between the heterogeneity of global pAO2 as summarized by its standard deviation (SD) (p < 0.0002) and non-physiologic pAO2 values (p < 0.0001) with percent emphysema on CT. A regional study revealed a strong association between pAO2 SD and visual emphysema severity (p < 0.003) and an association with the paraseptal emphysema subtype (p < 0.04) after adjustment for demographics and smoking status. HP noble gas pAO2 heterogeneity and the fraction of non-physiological pAO2 results increase in mild to moderate COPD. Measurements of pAO2 are sensitive to regional emphysematous damage detected by CT and may be used to probe pulmonary emphysema subtypes. HP noble gas lung MRI provides non-invasive information about COPD severity and lung function without ionizing radiation.
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Affiliation(s)
- Naz P. Taskiran
- Department of Chemical Engineering, Columbia University, New York, NY 10027, USA
- Correspondence: (N.P.T.); (E.W.H.); Tel.: +1-347-3693052 (N.P.T.); +1-626-4838731 (E.W.H.)
| | - Grant T. Hiura
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
| | - Xuzhe Zhang
- Department of Biomedical Engineering, Columbia University, New York, NY 10027, USA
| | - R. Graham Barr
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
| | - Stephen M. Dashnaw
- Neurological Institute, Radiology, Columbia University, New York, NY 10032, USA
| | - Eric A. Hoffman
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Daniel Malinsky
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Elizabeth C. Oelsner
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
| | - Martin R. Prince
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
- Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Benjamin M. Smith
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
- Department of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Yanping Sun
- Division of General Medicine, Columbia University Irving Medial Center, New York, NY 10032, USA
| | - Yifei Sun
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Jim M. Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
| | - Wei Shen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Institute of Human Nutrition, College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY 10032, USA
- Columbia Magnetic Resonance Research Center (CMRRC), Columbia University, New York, NY 10027, USA
| | - Emlyn W. Hughes
- Department of Physics, Columbia University, New York, NY 10027, USA
- Correspondence: (N.P.T.); (E.W.H.); Tel.: +1-347-3693052 (N.P.T.); +1-626-4838731 (E.W.H.)
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28
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Goh ZM, Balasubramanian N, Alabed S, Dwivedi K, Shahin Y, Rothman AMK, Garg P, Lawrie A, Capener D, Thompson AAR, Alandejani F, Wild JM, Johns CS, Lewis RA, Gosling R, Sharkey M, Condliffe R, Kiely DG, Swift AJ. Right ventricular remodelling in pulmonary arterial hypertension predicts treatment response. Heart 2022; 108:1392-1400. [PMID: 35512982 PMCID: PMC9380507 DOI: 10.1136/heartjnl-2021-320733] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/29/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To determine the prognostic value of patterns of right ventricular adaptation in patients with pulmonary arterial hypertension (PAH), assessed using cardiac magnetic resonance (CMR) imaging at baseline and follow-up. METHODS Patients attending the Sheffield Pulmonary Vascular Disease Unit with suspected pulmonary hypertension were recruited into the ASPIRE (Assessing the Spectrum of Pulmonary hypertension Identified at a REferral Centre) Registry. With exclusion of congenital heart disease, consecutive patients with PAH were followed up until the date of census or death. Right ventricular end-systolic volume index adjusted for age and sex and ventricular mass index were used to categorise patients into four different volume/mass groups: low-volume-low-mass, low-volume-high-mass, high-volume-low-mass and high-volume-high-mass. The prognostic value of the groups was assessed with one-way analysis of variance and Kaplan-Meier plots. Transition of the groups was studied. RESULTS A total of 505 patients with PAH were identified, 239 (47.3%) of whom have died at follow-up (median 4.85 years, IQR 4.05). The mean age of the patients was 59±16 and 161 (32.7%) were male. Low-volume-low-mass was associated with CMR and right heart catheterisation metrics predictive of improved prognosis. There were 124 patients who underwent follow-up CMR (median 1.11 years, IQR 0.78). At both baseline and follow-up, the high-volume-low-mass group had worse prognosis than the low-volume-low-mass group (p<0.001). With PAH therapy, 73.5% of low-volume-low-mass patients remained in this group, whereas only 17.4% of high-volume-low-mass patients transitioned into low-volume-low-mass. CONCLUSIONS Right ventricular adaptation assessed using CMR has prognostic value in patients with PAH. Patients with maladaptive remodelling (high-volume-low-mass) are at high risk of treatment failure.
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Affiliation(s)
- Ze Ming Goh
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Nithin Balasubramanian
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Radiology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- INSIGNEO, Institute of Insilico Medicine, Sheffield, UK
| | - Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Radiology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Alexander M K Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David Capener
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- INSIGNEO, Institute of Insilico Medicine, Sheffield, UK
| | | | - Robert A Lewis
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Michael Sharkey
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- INSIGNEO, Institute of Insilico Medicine, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- INSIGNEO, Institute of Insilico Medicine, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Radiology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
- INSIGNEO, Institute of Insilico Medicine, Sheffield, UK
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29
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Whitfield CA, Horsley A, Jensen OE, Horn FC, Collier GJ, Smith LJ, Wild JM. Model-based Bayesian inference of the ventilation distribution in patients with cystic fibrosis from multiple breath washout, with comparison to ventilation MRI. Respir Physiol Neurobiol 2022; 302:103919. [PMID: 35562095 DOI: 10.1016/j.resp.2022.103919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Indices of ventilation heterogeneity (VH) from multiple breath washout (MBW) have been shown to correlate well with VH indices derived from hyperpolarised gas ventilation MRI. Here we report the prediction of ventilation distributions from MBW data using a mathematical model, and the comparison of these predictions with imaging data. METHODS We developed computer simulations of the ventilation distribution in the lungs to model MBW measurement with 3 parameters: σV, determining the extent of VH; V0, the lung volume; and VD, the dead-space volume. These were inferred for each individual from supine MBW data recorded from 25 patients with cystic fibrosis (CF) using approximate Bayesian computation. The fitted models were used to predict the distribution of gas imaged by 3He ventilation MRI measurements collected from the same visit. RESULTS The MRI indices measured (I1/3, the fraction of pixels below one-third of the mean intensity and ICV, the coefficient of variation of pixel intensity) correlated strongly with those predicted by the MBW model fits (r=0.93,0.88 respectively). There was also good agreement between predicted and measured MRI indices (mean bias ± limits of agreement: I1/3:-0.003±0.118 and ICV:-0.004±0.298). Fitted model parameters were robust to truncation of MBW data. CONCLUSION We have shown that the ventilation distribution in the lung can be inferred from an MBW signal, and verified this using ventilation MRI. The Bayesian method employed extracts this information with fewer breath cycles than required for LCI, reducing acquisition time required, and gives uncertainty bounds, which are important for clinical decision making.
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Affiliation(s)
- Carl A Whitfield
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; Department of Mathematics, University of Manchester, Manchester, UK.
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - Oliver E Jensen
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Felix C Horn
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, UK
| | - Laurie J Smith
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, UK
| | - Jim M Wild
- POLARIS, Imaging Sciences, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, UK
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30
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Alabed S, Maiter A, Salehi M, Mahmood A, Daniel S, Jenkins S, Goodlad M, Sharkey M, Mamalakis M, Rakocevic V, Dwivedi K, Assadi H, Wild JM, Lu H, O’Regan DP, van der Geest RJ, Garg P, Swift AJ. Quality of reporting in AI cardiac MRI segmentation studies - A systematic review and recommendations for future studies. Front Cardiovasc Med 2022; 9:956811. [PMID: 35911553 PMCID: PMC9334661 DOI: 10.3389/fcvm.2022.956811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background There has been a rapid increase in the number of Artificial Intelligence (AI) studies of cardiac MRI (CMR) segmentation aiming to automate image analysis. However, advancement and clinical translation in this field depend on researchers presenting their work in a transparent and reproducible manner. This systematic review aimed to evaluate the quality of reporting in AI studies involving CMR segmentation. Methods MEDLINE and EMBASE were searched for AI CMR segmentation studies in April 2022. Any fully automated AI method for segmentation of cardiac chambers, myocardium or scar on CMR was considered for inclusion. For each study, compliance with the Checklist for Artificial Intelligence in Medical Imaging (CLAIM) was assessed. The CLAIM criteria were grouped into study, dataset, model and performance description domains. Results 209 studies published between 2012 and 2022 were included in the analysis. Studies were mainly published in technical journals (58%), with the majority (57%) published since 2019. Studies were from 37 different countries, with most from China (26%), the United States (18%) and the United Kingdom (11%). Short axis CMR images were most frequently used (70%), with the left ventricle the most commonly segmented cardiac structure (49%). Median compliance of studies with CLAIM was 67% (IQR 59-73%). Median compliance was highest for the model description domain (100%, IQR 80-100%) and lower for the study (71%, IQR 63-86%), dataset (63%, IQR 50-67%) and performance (60%, IQR 50-70%) description domains. Conclusion This systematic review highlights important gaps in the literature of CMR studies using AI. We identified key items missing-most strikingly poor description of patients included in the training and validation of AI models and inadequate model failure analysis-that limit the transparency, reproducibility and hence validity of published AI studies. This review may support closer adherence to established frameworks for reporting standards and presents recommendations for improving the quality of reporting in this field. Systematic Review Registration [www.crd.york.ac.uk/prospero/], identifier [CRD42022279214].
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Affiliation(s)
- Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
- INSIGNEO, Institute for in silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Ahmed Maiter
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Mahan Salehi
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Aqeeb Mahmood
- Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Sonali Daniel
- Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Sam Jenkins
- Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Marcus Goodlad
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Michael Sharkey
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
| | - Michail Mamalakis
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- INSIGNEO, Institute for in silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Vera Rakocevic
- Medical School, The University of Sheffield, Sheffield, United Kingdom
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom
| | - Hosamadin Assadi
- University of East Anglia, Norwich Medical School, Norwich, United Kingdom
| | - Jim M. Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- INSIGNEO, Institute for in silico Medicine, The University of Sheffield, Sheffield, United Kingdom
| | - Haiping Lu
- INSIGNEO, Institute for in silico Medicine, The University of Sheffield, Sheffield, United Kingdom
- Department of Computer Science, The University of Sheffield, Sheffield, United Kingdom
| | - Declan P. O’Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | | | - Pankaj Garg
- University of East Anglia, Norwich Medical School, Norwich, United Kingdom
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, United Kingdom
- INSIGNEO, Institute for in silico Medicine, The University of Sheffield, Sheffield, United Kingdom
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Garg P, Gosling R, Swoboda P, Jones R, Rothman A, Wild JM, Kiely DG, Condliffe R, Alabed S, Swift AJ. Cardiac magnetic resonance identifies raised left ventricular filling pressure: prognostic implications. Eur Heart J 2022; 43:2511-2522. [PMID: 35512290 PMCID: PMC9259376 DOI: 10.1093/eurheartj/ehac207] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 03/13/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022] Open
Abstract
AIMS Non-invasive imaging is routinely used to estimate left ventricular (LV) filling pressure (LVFP) in heart failure (HF). Cardiovascular magnetic resonance (CMR) is emerging as an important imaging tool for sub-phenotyping HF. However, currently, LVFP cannot be estimated from CMR. This study sought to investigate (i) if CMR can estimate LVFP in patients with suspected HF and (ii) if CMR-modelled LVFP has prognostic power. METHODS AND RESULTS Suspected HF patients underwent right heart catheterization (RHC), CMR and transthoracic echocardiography (TTE) (validation cohort only) within 24 h of each other. Right heart catheterization measured pulmonary capillary wedge pressure (PCWP) was used as a reference for LVFP. At follow-up, death was considered as the primary endpoint. We enrolled 835 patients (mean age: 65 ± 13 years, 40% male). In the derivation cohort (n = 708, 85%), two CMR metrics were associated with RHC PCWP:LV mass and left atrial volume. When applied to the validation cohort (n = 127, 15%), the correlation coefficient between RHC PCWP and CMR-modelled PCWP was 0.55 (95% confidence interval: 0.41-0.66, P < 0.0001). Cardiovascular magnetic resonance-modelled PCWP was superior to TTE in classifying patients as normal or raised filling pressures (76 vs. 25%). Cardiovascular magnetic resonance-modelled PCWP was associated with an increased risk of death (hazard ratio: 1.77, P < 0.001). At Kaplan-Meier analysis, CMR-modelled PCWP was comparable to RHC PCWP (≥15 mmHg) to predict survival at 7-year follow-up (35 vs. 37%, χ2 = 0.41, P = 0.52). CONCLUSION A physiological CMR model can estimate LVFP in patients with suspected HF. In addition, CMR-modelled LVFP has a prognostic role.
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Affiliation(s)
- Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Peter Swoboda
- The Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Rachel Jones
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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32
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Shepelytskyi Y, Grynko V, Rao MR, Li T, Agostino M, Wild JM, Albert MS. Hyperpolarized 129 Xe imaging of the brain: Achievements and future challenges. Magn Reson Med 2022; 88:83-105. [PMID: 35253919 PMCID: PMC9314594 DOI: 10.1002/mrm.29200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/22/2021] [Accepted: 01/25/2022] [Indexed: 11/25/2022]
Abstract
Hyperpolarized (HP) xenon-129 (129 Xe) brain MRI is a promising imaging modality currently under extensive development. HP 129 Xe is nontoxic, capable of dissolving in pulmonary blood, and is extremely sensitive to the local environment. After dissolution in the pulmonary blood, HP 129 Xe travels with the blood flow to the brain and can be used for functional imaging such as perfusion imaging, hemodynamic response detection, and blood-brain barrier permeability assessment. HP 129 Xe MRI imaging of the brain has been performed in animals, healthy human subjects, and in patients with Alzheimer's disease and stroke. In this review, the overall progress in the field of HP 129 Xe brain imaging is discussed, along with various imaging approaches and pulse sequences used to optimize HP 129 Xe brain MRI. In addition, current challenges and limitations of HP 129 Xe brain imaging are discussed, as well as possible methods for their mitigation. Finally, potential pathways for further development are also discussed. HP 129 Xe MRI of the brain has the potential to become a valuable novel perfusion imaging technique and has the potential to be used in the clinical setting in the future.
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Affiliation(s)
- Yurii Shepelytskyi
- Chemistry Department, Lakehead University, Thunder Bay, Ontario, Canada.,Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
| | - Vira Grynko
- Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada.,Chemistry and Materials Science Program, Lakehead University, Thunder Bay, Ontario, Canada
| | - Madhwesha R Rao
- POLARIS, Unit of Academic Radiology, Department of IICD, University of Sheffield, Sheffield, UK
| | - Tao Li
- Chemistry Department, Lakehead University, Thunder Bay, Ontario, Canada
| | - Martina Agostino
- Chemistry Department, Lakehead University, Thunder Bay, Ontario, Canada
| | - Jim M Wild
- POLARIS, Unit of Academic Radiology, Department of IICD, University of Sheffield, Sheffield, UK.,Insigneo Institute for in Silico Medicine, Sheffield, UK
| | - Mitchell S Albert
- Chemistry Department, Lakehead University, Thunder Bay, Ontario, Canada.,Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada.,Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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33
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Alabed S, Uthoff J, Zhou S, Garg P, Dwivedi K, Alandejani F, Gosling R, Schobs L, Brook M, Shahin Y, Capener D, Johns CS, Wild JM, Rothman AMK, van der Geest RJ, Condliffe R, Kiely DG, Lu H, Swift AJ. Machine learning cardiac-MRI features predict mortality in newly diagnosed pulmonary arterial hypertension. Eur Heart J Digit Health 2022; 3:265-275. [PMID: 36713008 PMCID: PMC9708011 DOI: 10.1093/ehjdh/ztac022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/19/2022] [Indexed: 02/01/2023]
Abstract
Aims Pulmonary arterial hypertension (PAH) is a rare but serious disease associated with high mortality if left untreated. This study aims to assess the prognostic cardiac magnetic resonance (CMR) features in PAH using machine learning. Methods and results Seven hundred and twenty-three consecutive treatment-naive PAH patients were identified from the ASPIRE registry; 516 were included in the training, and 207 in the validation cohort. A multilinear principal component analysis (MPCA)-based machine learning approach was used to extract mortality and survival features throughout the cardiac cycle. The features were overlaid on the original imaging using thresholding and clustering of high- and low-risk of mortality prediction values. The 1-year mortality rate in the validation cohort was 10%. Univariable Cox regression analysis of the combined short-axis and four-chamber MPCA-based predictions was statistically significant (hazard ratios: 2.1, 95% CI: 1.3, 3.4, c-index = 0.70, P = 0.002). The MPCA features improved the 1-year mortality prediction of REVEAL from c-index = 0.71 to 0.76 (P ≤ 0.001). Abnormalities in the end-systolic interventricular septum and end-diastolic left ventricle indicated the highest risk of mortality. Conclusion The MPCA-based machine learning is an explainable time-resolved approach that allows visualization of prognostic cardiac features throughout the cardiac cycle at the population level, making this approach transparent and clinically interpretable. In addition, the added prognostic value over the REVEAL risk score and CMR volumetric measurements allows for a more accurate prediction of 1-year mortality risk in PAH.
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Affiliation(s)
| | - Johanna Uthoff
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Shuo Zhou
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Pankaj Garg
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Rebecca Gosling
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Lawrence Schobs
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Martin Brook
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Dave Capener
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Christopher S Johns
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,Department of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,INSIGNEO, Institute for in silico medicine, University of Sheffield, UK
| | - Alexander M K Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Robin Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK,INSIGNEO, Institute for in silico medicine, University of Sheffield, UK,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
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34
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Alandejani F, Alabed S, Garg P, Goh ZM, Karunasaagarar K, Sharkey M, Salehi M, Aldabbagh Z, Dwivedi K, Mamalakis M, Metherall P, Uthoff J, Johns C, Rothman A, Condliffe R, Hameed A, Charalampoplous A, Lu H, Plein S, Greenwood JP, Lawrie A, Wild JM, de Koning PJH, Kiely DG, Van Der Geest R, Swift AJ. Training and clinical testing of artificial intelligence derived right atrial cardiovascular magnetic resonance measurements. J Cardiovasc Magn Reson 2022; 24:25. [PMID: 35387651 PMCID: PMC8988415 DOI: 10.1186/s12968-022-00855-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/19/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Right atrial (RA) area predicts mortality in patients with pulmonary hypertension, and is recommended by the European Society of Cardiology/European Respiratory Society pulmonary hypertension guidelines. The advent of deep learning may allow more reliable measurement of RA areas to improve clinical assessments. The aim of this study was to automate cardiovascular magnetic resonance (CMR) RA area measurements and evaluate the clinical utility by assessing repeatability, correlation with invasive haemodynamics and prognostic value. METHODS A deep learning RA area CMR contouring model was trained in a multicentre cohort of 365 patients with pulmonary hypertension, left ventricular pathology and healthy subjects. Inter-study repeatability (intraclass correlation coefficient (ICC)) and agreement of contours (DICE similarity coefficient (DSC)) were assessed in a prospective cohort (n = 36). Clinical testing and mortality prediction was performed in n = 400 patients that were not used in the training nor prospective cohort, and the correlation of automatic and manual RA measurements with invasive haemodynamics assessed in n = 212/400. Radiologist quality control (QC) was performed in the ASPIRE registry, n = 3795 patients. The primary QC observer evaluated all the segmentations and recorded them as satisfactory, suboptimal or failure. A second QC observer analysed a random subcohort to assess QC agreement (n = 1018). RESULTS All deep learning RA measurements showed higher interstudy repeatability (ICC 0.91 to 0.95) compared to manual RA measurements (1st observer ICC 0.82 to 0.88, 2nd observer ICC 0.88 to 0.91). DSC showed high agreement comparing automatic artificial intelligence and manual CMR readers. Maximal RA area mean and standard deviation (SD) DSC metric for observer 1 vs observer 2, automatic measurements vs observer 1 and automatic measurements vs observer 2 is 92.4 ± 3.5 cm2, 91.2 ± 4.5 cm2 and 93.2 ± 3.2 cm2, respectively. Minimal RA area mean and SD DSC metric for observer 1 vs observer 2, automatic measurements vs observer 1 and automatic measurements vs observer 2 was 89.8 ± 3.9 cm2, 87.0 ± 5.8 cm2 and 91.8 ± 4.8 cm2. Automatic RA area measurements all showed moderate correlation with invasive parameters (r = 0.45 to 0.66), manual (r = 0.36 to 0.57). Maximal RA area could accurately predict elevated mean RA pressure low and high-risk thresholds (area under the receiver operating characteristic curve artificial intelligence = 0.82/0.87 vs manual = 0.78/0.83), and predicted mortality similar to manual measurements, both p < 0.01. In the QC evaluation, artificial intelligence segmentations were suboptimal at 108/3795 and a low failure rate of 16/3795. In a subcohort (n = 1018), agreement by two QC observers was excellent, kappa 0.84. CONCLUSION Automatic artificial intelligence CMR derived RA size and function are accurate, have excellent repeatability, moderate associations with invasive haemodynamics and predict mortality.
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Affiliation(s)
- Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ze Ming Goh
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Kavita Karunasaagarar
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Michael Sharkey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mahan Salehi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ziad Aldabbagh
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Michail Mamalakis
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Pete Metherall
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Johanna Uthoff
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Chris Johns
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alexander Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Abdul Hameed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Athanasios Charalampoplous
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Haiping Lu
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) &, Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) &, Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Clarendon Way, Leeds, UK
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Patrick J H de Koning
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rob Van Der Geest
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK.
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35
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Alkhanfar D, Shahin Y, Alandejani F, Dwivedi K, Alabed S, Johns C, Lawrie A, Thompson AAR, Rothman AMK, Tschirren J, Uthoff JM, Hoffman E, Condliffe R, Wild JM, Kiely DG, Swift AJ. Severe pulmonary hypertension associated with lung disease is characterised by a loss of small pulmonary vessels on quantitative computed tomography. ERJ Open Res 2022; 8:00503-2021. [PMID: 35586449 PMCID: PMC9108962 DOI: 10.1183/23120541.00503-2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Pulmonary hypertension (PH) in patients with chronic lung disease (CLD) predicts reduced functional status, clinical worsening and increased mortality, with patients with severe PH-CLD (≥35 mmHg) having a significantly worse prognosis than mild to moderate PH-CLD (21-34 mmHg). The aim of this cross-sectional study was to assess the association between computed tomography (CT)-derived quantitative pulmonary vessel volume, PH severity and disease aetiology in CLD. Methods Treatment-naïve patients with CLD who underwent CT pulmonary angiography, lung function testing and right heart catheterisation were identified from the ASPIRE registry between October 2012 and July 2018. Quantitative assessments of total pulmonary vessel and small pulmonary vessel volume were performed. Results 90 patients had PH-CLD including 44 associated with COPD/emphysema and 46 with interstitial lung disease (ILD). Patients with severe PH-CLD (n=40) had lower small pulmonary vessel volume compared to patients with mild to moderate PH-CLD (n=50). Patients with PH-ILD had significantly reduced small pulmonary blood vessel volume, compared to PH-COPD/emphysema. Higher mortality was identified in patients with lower small pulmonary vessel volume. Conclusion Patients with severe PH-CLD, regardless of aetiology, have lower small pulmonary vessel volume compared to patients with mild-moderate PH-CLD, and this is associated with a higher mortality. Whether pulmonary vessel changes quantified by CT are a marker of remodelling of the distal pulmonary vasculature requires further study.
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Affiliation(s)
- Dheyaa Alkhanfar
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Yousef Shahin
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Dept of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Faisal Alandejani
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Krit Dwivedi
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Dept of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Chris Johns
- Dept of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Allan Lawrie
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A A Roger Thompson
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alexander M K Rothman
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Johanna M Uthoff
- Dept of Computer Science, University of Sheffield, Sheffield, UK
| | - Eric Hoffman
- Dept of Radiology, University of Iowa, Iowa City, IA, USA
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim M Wild
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - David G Kiely
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,These authors contributed equally
| | - Andrew J Swift
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK.,These authors contributed equally
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36
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Behrendt L, Smith LJ, Voskrebenzev A, Klimeš F, Kaireit TF, Pöhler GH, Kern AL, Gonzalez CC, Dittrich AM, Marshall H, Schütz K, Hughes PJC, Ciet P, Tiddens HAWM, Wild JM, Vogel-Claussen J. A dual center and dual vendor comparison study of automated perfusion-weighted phase-resolved functional lung magnetic resonance imaging with dynamic contrast-enhanced magnetic resonance imaging in patients with cystic fibrosis. Pulm Circ 2022; 12:e12054. [PMID: 35514781 PMCID: PMC9063970 DOI: 10.1002/pul2.12054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/17/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
For sensitive diagnosis and monitoring of pulmonary disease, ionizing radiation-free imaging methods are of great importance. A noncontrast and free-breathing proton magnetic resonance imaging (MRI) technique for assessment of pulmonary perfusion is phase-resolved functional lung (PREFUL) MRI. Since there is no validation of PREFUL MRI across different centers and scanners, the purpose of this study was to compare perfusion-weighted PREFUL MRI with the well-established dynamic contrast-enhanced (DCE) MRI across two centers on scanners from two different vendors. Sixteen patients with cystic fibrosis (CF) (Center 1: 10 patients; Center 2: 6 patients) underwent PREFUL and DCE MRI at 1.5T in the same imaging session. Normalized perfusion-weighted values and perfusion defect percentage (QDP) values were calculated for the whole lung and three central slices (dorsal, central, ventral of the carina). Obtained parameters were compared using Pearson correlation, Spearman correlation, Bland-Altman analysis, Wilcoxon signed-rank test, and Wilcoxon rank-sum test. Moderate-to-strong correlations between normalized perfusion-weighted PREFUL and DCE values were found (posterior slice: r = 0.69, p < 0.01). Spatial overlap of PREFUL and DCE QDP maps showed an agreement of 79.4% for the whole lung. Further, spatial overlap values of Center 1 were not significantly different to those of Center 2 for the three central slices (p > 0.07). The feasibility of PREFUL MRI across two different centers and two different vendors was shown in patients with CF and obtained results were in agreement with DCE MRI.
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Affiliation(s)
- Lea Behrendt
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Laurie J Smith
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Andreas Voskrebenzev
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Filip Klimeš
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Till F Kaireit
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Gesa H Pöhler
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Agilo L Kern
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Cristian Crisosto Gonzalez
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
| | - Anna-Maria Dittrich
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany.,Department for Pediatric Pulmonology, Allergology and Neonatology Hannover Medical School Hannover Germany
| | - Helen Marshall
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Katharina Schütz
- Department for Pediatric Pulmonology, Allergology and Neonatology Hannover Medical School Hannover Germany
| | - Paul J C Hughes
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Pierluigi Ciet
- Department of Pediatric Pulmonology and Allergology Sophia Children's Hospital, Erasmus MC Rotterdam The Netherlands
| | - Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology Sophia Children's Hospital, Erasmus MC Rotterdam The Netherlands.,Department of Radiology and Nuclear medicine Erasmus MC Rotterdam The Netherlands
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, POLARIS, Imaging Sciences University of Sheffield Sheffield UK
| | - Jens Vogel-Claussen
- Department for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH) German Center for Lung Research (DZL) Hannover Germany
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37
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Stewart NJ, Smith LJ, Chan HF, Eaden JA, Rajaram S, Swift AJ, Weatherley ND, Biancardi A, Collier GJ, Hughes D, Klafkowski G, Johns CS, West N, Ugonna K, Bianchi SM, Lawson R, Sabroe I, Marshall H, Wild JM. Lung MRI with hyperpolarised gases: current & future clinical perspectives. Br J Radiol 2022; 95:20210207. [PMID: 34106792 PMCID: PMC9153706 DOI: 10.1259/bjr.20210207] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The use of pulmonary MRI in a clinical setting has historically been limited. Whilst CT remains the gold-standard for structural lung imaging in many clinical indications, technical developments in ultrashort and zero echo time MRI techniques are beginning to help realise non-ionising structural imaging in certain lung disorders. In this invited review, we discuss a complementary technique - hyperpolarised (HP) gas MRI with inhaled 3He and 129Xe - a method for functional and microstructural imaging of the lung that has great potential as a clinical tool for early detection and improved understanding of pathophysiology in many lung diseases. HP gas MRI now has the potential to make an impact on clinical management by enabling safe, sensitive monitoring of disease progression and response to therapy. With reference to the significant evidence base gathered over the last two decades, we review HP gas MRI studies in patients with a range of pulmonary disorders, including COPD/emphysema, asthma, cystic fibrosis, and interstitial lung disease. We provide several examples of our experience in Sheffield of using these techniques in a diagnostic clinical setting in challenging adult and paediatric lung diseases.
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Affiliation(s)
- Neil J Stewart
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Laurie J Smith
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ho-Fung Chan
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James A Eaden
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Smitha Rajaram
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Nicholas D Weatherley
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alberto Biancardi
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David Hughes
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Christopher S Johns
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Noreen West
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Kelechi Ugonna
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Stephen M Bianchi
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Rod Lawson
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Ian Sabroe
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Helen Marshall
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
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38
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Abstract
The recent resurgence of deep learning (DL) has dramatically influenced the medical imaging field. Medical image analysis applications have been at the forefront of DL research efforts applied to multiple diseases and organs, including those of the lungs. The aims of this review are twofold: (i) to briefly overview DL theory as it relates to lung image analysis; (ii) to systematically review the DL research literature relating to the lung image analysis applications of segmentation, reconstruction, registration and synthesis. The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. 479 studies were initially identified from the literature search with 82 studies meeting the eligibility criteria. Segmentation was the most common lung image analysis DL application (65.9% of papers reviewed). DL has shown impressive results when applied to segmentation of the whole lung and other pulmonary structures. DL has also shown great potential for applications in image registration, reconstruction and synthesis. However, the majority of published studies have been limited to structural lung imaging with only 12.9% of reviewed studies employing functional lung imaging modalities, thus highlighting significant opportunities for further research in this field. Although the field of DL in lung image analysis is rapidly expanding, concerns over inconsistent validation and evaluation strategies, intersite generalisability, transparency of methodological detail and interpretability need to be addressed before widespread adoption in clinical lung imaging workflow.
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Affiliation(s)
| | - Jim M Wild
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, United Kingdom
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39
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Saunders LC, Hughes PJC, Alabed S, Capener DJ, Marshall H, Vogel-Claussen J, van Beek EJR, Kiely DG, Swift AJ, Wild JM. Integrated Cardiopulmonary MRI Assessment of Pulmonary Hypertension. J Magn Reson Imaging 2022; 55:633-652. [PMID: 34350655 DOI: 10.1002/jmri.27849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 11/12/2022] Open
Abstract
Pulmonary hypertension (PH) is a heterogeneous condition that can affect the lung parenchyma, pulmonary vasculature, and cardiac chambers. Accurate diagnosis often requires multiple complex assessments of the cardiac and pulmonary systems. MRI is able to comprehensively assess cardiac structure and function, as well as lung parenchymal, pulmonary vascular, and functional lung changes. Therefore, MRI has the potential to provide an integrated functional and structural assessment of the cardiopulmonary system in a single exam. Cardiac MRI is used in the assessment of PH in most large PH centers, whereas lung MRI is an emerging technique in patients with PH. This article reviews the current literature on cardiopulmonary MRI in PH, including cine MRI, black-blood imaging, late gadolinium enhancement, T1 mapping, myocardial strain analysis, contrast-enhanced perfusion imaging and contrast-enhanced MR angiography, and hyperpolarized gas functional lung imaging. This article also highlights recent developments in this field and areas of interest for future research including cardiac MRI-based diagnostic models, machine learning in cardiac MRI, oxygen-enhanced 1 H imaging, contrast-free 1 H perfusion and ventilation imaging, contrast-free angiography and UTE imaging. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Laura C Saunders
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | | | - Helen Marshall
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - David G Kiely
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Imaging, Sheffield Teaching Hospitals, Sheffield, UK
| | - Jim M Wild
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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40
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Singh D, Wild JM, Saralaya D, Lawson R, Marshall H, Goldin J, Brown MS, Kostikas K, Belmore K, Fogel R, Patalano F, Drollmann A, Machineni S, Jones I, Yates D, Tillmann HC. Effect of indacaterol/glycopyrronium on ventilation and perfusion in COPD: a randomized trial. Respir Res 2022; 23:26. [PMID: 35144620 PMCID: PMC8832861 DOI: 10.1186/s12931-022-01949-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Abstract
RATIONALE The long-acting β2-agonist/long-acting muscarinic antagonist combination indacaterol/glycopyrronium (IND/GLY) elicits bronchodilation, improves symptoms, and reduces exacerbations in COPD. Magnetic resonance imaging (MRI) of the lung with hyperpolarized gas and gadolinium contrast enhancement enables assessment of whole lung functional responses to IND/GLY. OBJECTIVES The primary objective was assessment of effect of IND/GLY on global ventilated lung volume (%VV) versus placebo in COPD. Lung function, regional ventilation and perfusion in response to IND/GLY were also measured. METHODS This double-blind, randomized, placebo-controlled, crossover study assessed %VV and pulmonary perfusion in patients with moderate-to-severe COPD after 8 days of once-daily IND/GLY treatment (110/50 µg) followed by 8 days of placebo, or vice versa, using inhaled hyperpolarized 3He gas and gadolinium contrast-enhanced MRI, respectively. Lung function measures including spirometry were performed for each treatment after 8 days. MEASUREMENTS AND MAIN RESULTS Of 31 patients randomized, 29 completed both treatment periods. IND/GLY increased global %VV versus placebo (61.73% vs. 56.73%, respectively, least squares means treatment difference: 5.00% [90% CI 1.40 to 8.60]; P = 0.025). IND/GLY improved whole lung index of ventilation volume to perfusion volume (V/Q) ratio versus placebo; 94% (90% CI 83 to 105) versus 86% (90% CI 75 to 97; P = 0.047), respectively. IND/GLY showed a trend to improve diffusing capacity for carbon monoxide (DLCO) (+ 0.66 mL/min/mmHg; P = 0.082). By Day 8, forced expiratory volume in 1 s (FEV1) was increased by 0.32 L versus placebo (90% CI 0.26 to 0.38; P < 0.0001), substantiating earlier findings and providing evidence of assay sensitivity for this trial. CONCLUSIONS IND/GLY improved lung ventilation assessed by 3He MRI after 1 week of treatment. This observation may provide mechanistic support for the symptomatic clinical benefit shown with IND/GLY in COPD. Clinical trial registered with www.clinicaltrials.gov (NCT02634983).
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Affiliation(s)
- Dave Singh
- Medicines Evaluation Unit, University of Manchester, Manchester University National Health Service Foundation Trust, Manchester, UK
| | - Jim M Wild
- Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, POLARIS, University of Sheffield, Sheffield, UK
| | - Dinesh Saralaya
- Respiratory Clinical Trials Unit, Bradford Teaching Hospitals National Health Service Foundation Trust, Bradford, UK
| | - Rod Lawson
- National Institute for Health Research, Sheffield Clinical Research Facility, Sheffield, UK
| | - Helen Marshall
- Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, POLARIS, University of Sheffield, Sheffield, UK
| | | | - Matthew S Brown
- MedQIA, Los Angeles, CA, USA.,Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | | | - Kristin Belmore
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Robert Fogel
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | | | - Denise Yates
- Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | - Hanns-Christian Tillmann
- Novartis Institutes for Biomedical Research, Fabrikstrasse 2, Novartis Campus, 4056, Basel, Switzerland.
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41
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Dwivedi K, Condliffe R, Sharkey M, Lewis R, Alabed S, Rajaram S, Hill C, Saunders L, Metherall P, Alandejani F, Alkhanfar D, Wild JM, Lu H, Kiely DG, Swift AJ. Computed tomography lung parenchymal descriptions in routine radiological reporting have diagnostic and prognostic utility in patients with idiopathic pulmonary arterial hypertension and pulmonary hypertension associated with lung disease. ERJ Open Res 2022; 8:00549-2021. [PMID: 35083317 PMCID: PMC8784758 DOI: 10.1183/23120541.00549-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients with pulmonary hypertension (PH) and lung disease may pose a diagnostic dilemma between idiopathic pulmonary arterial hypertension (IPAH) and PH associated with lung disease (PH-CLD). The prognostic impact of common computed tomography (CT) parenchymal features is unknown. METHODS 660 IPAH and PH-CLD patients assessed between 2001 and 2019 were included. Reports for all CT scans 1 year prior to diagnosis were analysed for common lung parenchymal patterns. Cox regression and Kaplan-Meier analysis were performed. RESULTS At univariate analysis of the whole cohort, centrilobular ground-glass (CGG) changes (hazard ratio, HR 0.29) and ground-glass opacification (HR 0.53) predicted improved survival, while honeycombing (HR 2.79), emphysema (HR 2.09) and fibrosis (HR 2.38) predicted worse survival (all p<0.001). Fibrosis was an independent predictor after adjusting for baseline demographics, PH severity and diffusing capacity of the lung for carbon monoxide (HR 1.37, p<0.05). Patients with a clinical diagnosis of IPAH who had an absence of reported parenchymal lung disease (IPAH-noLD) demonstrated superior survival to patients diagnosed with either IPAH who had coexistent CT lung disease or PH-CLD (2-year survival of 85%, 60% and 46%, respectively, p<0.05). CGG changes were present in 23.3% of IPAH-noLD and 5.8% of PH-CLD patients. There was no significant difference in survival between IPAH-noLD patients with or without CGG changes. PH-CLD patients with fibrosis had worse survival than those with emphysema. INTERPRETATION Routine clinical reports of CT lung parenchymal disease identify groups of patients with IPAH and PH-CLD with significantly different prognoses. Isolated CGG changes are not uncommon in IPAH but are not associated with worse survival.
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Affiliation(s)
- Krit Dwivedi
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK.,Dept of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,Co-first authors
| | - Robin Condliffe
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospitals, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,Co-first authors
| | - Michael Sharkey
- Dept of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,3DLab, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Robert Lewis
- Pulmonary Vascular Disease Unit, Royal Hallamshire Hospitals, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Samer Alabed
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK.,Dept of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Smitha Rajaram
- Dept of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Catherine Hill
- Dept of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Laura Saunders
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Peter Metherall
- Dept of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,3DLab, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Faisal Alandejani
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Dheyaa Alkhanfar
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Jim M Wild
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK
| | - Haiping Lu
- Dept of Computer Science, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK.,Pulmonary Vascular Disease Unit, Royal Hallamshire Hospitals, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,Co-senior authors
| | - Andrew J Swift
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Medical School, Sheffield, UK.,Dept of Radiology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,3DLab, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK.,Co-senior authors
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42
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Alandejani F, Hameed A, Tubman E, Alabed S, Shahin Y, Lewis RA, Dwivedi K, Mahmood A, Middleton J, Watson L, Alkhanfar D, Johns CS, Rajaram S, Garg P, Condliffe R, Elliot CA, Thompson AAR, Rothman AMK, Charalampopoulos A, Lawrie A, Wild JM, Swift AJ, Kiely DG. Imaging and Risk Stratification in Pulmonary Arterial Hypertension: Time to Include Right Ventricular Assessment. Front Cardiovasc Med 2022; 9:797561. [PMID: 35402574 PMCID: PMC8989834 DOI: 10.3389/fcvm.2022.797561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Current European Society of Cardiology and European Respiratory Society guidelines recommend regular risk stratification with an aim of treating patients with pulmonary arterial hypertension (PAH) to improve or maintain low-risk status (<5% 1-year mortality). Methods Consecutive patients with PAH who underwent cardiac magnetic resonance imaging (cMRI) were identified from the Assessing the Spectrum of Pulmonary hypertension Identified at a Referral centre (ASPIRE) registry. Kaplan-Meier survival curves, locally weighted scatterplot smoothing regression and multi-variable logistic regression analysis were performed. Results In 311 consecutive, treatment-naïve patients with PAH undergoing cMRI including 121 undergoing follow-up cMRI, measures of right ventricular (RV) function including right ventricular ejection fraction (RVEF) and RV end systolic volume and right atrial (RA) area had prognostic value. However, only RV metrics were able to identify a low-risk status. Age (p < 0.01) and RVEF (p < 0.01) but not RA area were independent predictors of 1-year mortality. Conclusion This study highlights the need for guidelines to include measures of RV function rather than RA area alone to aid the risk stratification of patients with PAH.
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Affiliation(s)
- Faisal Alandejani
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Abdul Hameed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Euan Tubman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Institute for in silico Medicine (INSIGNEO), University of Sheffield, Sheffield, United Kingdom
| | - Yousef Shahin
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Institute for in silico Medicine (INSIGNEO), University of Sheffield, Sheffield, United Kingdom
| | - Robert A Lewis
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Aqeeb Mahmood
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Jennifer Middleton
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Lisa Watson
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Dheyaa Alkhanfar
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Christopher S Johns
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Smitha Rajaram
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Charlie A Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alexander M K Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.,Institute for in silico Medicine (INSIGNEO), University of Sheffield, Sheffield, United Kingdom
| | - Athanasios Charalampopoulos
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Allan Lawrie
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Institute for in silico Medicine (INSIGNEO), University of Sheffield, Sheffield, United Kingdom
| | - Andrew J Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Institute for in silico Medicine (INSIGNEO), University of Sheffield, Sheffield, United Kingdom
| | - David G Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom.,Institute for in silico Medicine (INSIGNEO), University of Sheffield, Sheffield, United Kingdom
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Mamalakis M, Garg P, Nelson T, Lee J, Wild JM, Clayton RH. MA-SOCRATIS: An automatic pipeline for robust segmentation of the left ventricle and scar. Comput Med Imaging Graph 2021; 93:101982. [PMID: 34481237 DOI: 10.1016/j.compmedimag.2021.101982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 11/18/2022]
Abstract
Multi-atlas segmentation of cardiac regions and total infarct scar (MA-SOCRATIS) is an unsupervised automatic pipeline to segment left ventricular myocardium and scar from late gadolinium enhanced MR images (LGE-MRI) of the heart. We implement two different pipelines for myocardial and scar segmentation from short axis LGE-MRI. Myocardial segmentation has two steps; initial segmentation and re-estimation. The initial segmentation step makes a first estimate of myocardium boundaries by using multi-atlas segmentation techniques. The re-estimation step refines the myocardial segmentation by a combination of k-means clustering and a geometric median shape variation technique. An active contour technique determines the unhealthy and healthy myocardial wall. The scar segmentation pipeline is a combination of a Rician-Gaussian mixture model and full width at half maximum (FWHM) thresholding, to determine the intensity pixels in scar regions. Following this step a watershed method with an automatic seed-points framework segments the final scar region. MA-SOCRATIS was evaluated using two different datasets. In both datasets ground truths were based on manual segmentation of short axis images from LGE-MRI scans. The first dataset included 40 patients from the MS-CMRSeg 2019 challenge dataset (STACOM at MICCAI 2019). The second is a collection of 20 patients with scar regions that are challenging to segment. MA-SOCRATIS achieved robust and accurate performance in automatic segmentation of myocardium and scar regions without the need of training or tuning in both cohorts, compared with state-of-the-art techniques (intra-observer and inter observer myocardium segmentation: 81.9% and 70% average Dice value, and scar (intra-observer and inter observer segmentation: 70.5% and 70.5% average Dice value).
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Affiliation(s)
- Michail Mamalakis
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Department of Computer Science, University of Sheffield, Regent Court, Sheffield S1 4DP, UK.
| | - Pankaj Garg
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Tom Nelson
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Justin Lee
- Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, Sheffield S5 7AU, UK
| | - Jim M Wild
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Polaris, Imaging Sciences, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Richard H Clayton
- Insigneo Institute for In-Silico Medicine, University of Sheffield, Sheffield, UK; Department of Computer Science, University of Sheffield, Regent Court, Sheffield S1 4DP, UK
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Mussell GT, Marshall H, Smith LJ, Biancardi AM, Hughes PJC, Capener DJ, Bray J, Swift AJ, Rajaram S, Condliffe AM, Collier GJ, Johns CS, Weatherley ND, Wild JM, Sabroe I. Xenon ventilation MRI in difficult asthma: initial experience in a clinical setting. ERJ Open Res 2021; 7:00785-2020. [PMID: 34589542 PMCID: PMC8473920 DOI: 10.1183/23120541.00785-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 07/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hyperpolarised gas magnetic resonance imaging (MRI) can be used to assess ventilation patterns. Previous studies have shown the image-derived metric of ventilation defect per cent (VDP) to correlate with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and FEV1 in asthma. Objectives The aim of this study was to explore the utility of hyperpolarised xenon-129 (129Xe) ventilation MRI in clinical care and examine its relationship with spirometry and other clinical metrics in people seen in a severe asthma service. Methods 26 people referred from a severe asthma clinic for MRI scanning were assessed by contemporaneous 129Xe MRI and spirometry. A subgroup of 18 patients also underwent reversibility testing with spirometry and MRI. Quantitative MRI measures of ventilation were calculated, VDP and the ventilation heterogeneity index (VHI), and compared to spirometry, Asthma Control Questionnaire 7 (ACQ7) and blood eosinophil count. Images were reviewed by a multidisciplinary team. Results VDP and VHI correlated with FEV1, FEV1/FVC and forced expiratory flow between 25% and 75% of FVC but not with ACQ7 or blood eosinophil count. Discordance of MRI imaging and symptoms and/or pulmonary function tests also occurred, prompting diagnostic re-evaluation in some cases. Conclusion Hyperpolarised gas MRI provides a complementary method of assessment in people with difficult to manage asthma in a clinical setting. When used as a tool supporting clinical care in a severe asthma service, occurrences of discordance between symptoms, spirometry and MRI scanning indicate how MRI scanning may add to a management pathway. This article demonstrates the feasibility of using 129Xe MRI in clinical practice. Discordance between symptoms, spirometry and MRI can support the use of further treatment or suggest coexisting breathing control issues or laryngeal disorders.https://bit.ly/3ky4oXP
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Affiliation(s)
- Grace T Mussell
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Helen Marshall
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Laurie J Smith
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alberto M Biancardi
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Paul J C Hughes
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David J Capener
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jody Bray
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Smitha Rajaram
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alison M Condliffe
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Chris S Johns
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Nick D Weatherley
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Jim M Wild
- POLARIS, Academic Radiology, Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ian Sabroe
- Respiratory Medicine, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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Taskiran NP, Hiura GT, Zhang X, Dashnaw SM, Hoffman EA, Malinsky D, Oelsner EC, Prince MR, Smith BM, Sun Y, Sun Y, Wild JM, Shen W, Barr RG, Hughes EW. Estimation of the Alveolar Partial Pressure of Oxygen using Hyperpolarized Helium-3: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study. Imaging 2021. [DOI: 10.1183/13993003.congress-2021.oa1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Niedbalski PJ, Hall CS, Castro M, Eddy RL, Rayment JH, Svenningsen S, Parraga G, Zanette B, Santyr GE, Thomen RP, Stewart NJ, Collier GJ, Chan HF, Wild JM, Fain SB, Miller GW, Mata JF, Mugler JP, Driehuys B, Willmering MM, Cleveland ZI, Woods JC. Protocols for multi-site trials using hyperpolarized 129 Xe MRI for imaging of ventilation, alveolar-airspace size, and gas exchange: A position paper from the 129 Xe MRI clinical trials consortium. Magn Reson Med 2021; 86:2966-2986. [PMID: 34478584 DOI: 10.1002/mrm.28985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 12/12/2022]
Abstract
Hyperpolarized (HP) 129 Xe MRI uniquely images pulmonary ventilation, gas exchange, and terminal airway morphology rapidly and safely, providing novel information not possible using conventional imaging modalities or pulmonary function tests. As such, there is mounting interest in expanding the use of biomarkers derived from HP 129 Xe MRI as outcome measures in multi-site clinical trials across a range of pulmonary disorders. Until recently, HP 129 Xe MRI techniques have been developed largely independently at a limited number of academic centers, without harmonizing acquisition strategies. To promote uniformity and adoption of HP 129 Xe MRI more widely in translational research, multi-site trials, and ultimately clinical practice, this position paper from the 129 Xe MRI Clinical Trials Consortium (https://cpir.cchmc.org/XeMRICTC) recommends standard protocols to harmonize methods for image acquisition in HP 129 Xe MRI. Recommendations are described for the most common HP gas MRI techniques-calibration, ventilation, alveolar-airspace size, and gas exchange-across MRI scanner manufacturers most used for this application. Moreover, recommendations are described for 129 Xe dose volumes and breath-hold standardization to further foster consistency of imaging studies. The intention is that sites with HP 129 Xe MRI capabilities can readily implement these methods to obtain consistent high-quality images that provide regional insight into lung structure and function. While this document represents consensus at a snapshot in time, a roadmap for technical developments is provided that will further increase image quality and efficiency. These standardized dosing and imaging protocols will facilitate the wider adoption of HP 129 Xe MRI for multi-site pulmonary research.
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Affiliation(s)
- Peter J Niedbalski
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Chase S Hall
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Rachel L Eddy
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan H Rayment
- Division of Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Svenningsen
- Firestone Institute for Respiratory Health, St Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.,Department of Medicine, Division of Respirology, McMaster University, Hamilton, Ontario, Canada
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Brandon Zanette
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Giles E Santyr
- Translational Medicine Program, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Robert P Thomen
- Departments of Radiology and Bioengineering, University of Missouri, Columbia, Missouri, USA
| | - Neil J Stewart
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ho-Fung Chan
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jim M Wild
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Sean B Fain
- Departments of Medical Physics, Radiology, and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA
| | - G Wilson Miller
- Center for In-vivo Hyperpolarized Gas MR Imaging, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Jaime F Mata
- Center for In-vivo Hyperpolarized Gas MR Imaging, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - John P Mugler
- Center for In-vivo Hyperpolarized Gas MR Imaging, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia, USA
| | - Bastiaan Driehuys
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Matthew M Willmering
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Zackary I Cleveland
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Departments of Pediatrics (Pulmonary Medicine) and Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Departments of Pediatrics (Pulmonary Medicine) and Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Wild JM, Porter JC, Molyneaux PL, George PM, Stewart I, Allen RJ, Aul R, Baillie JK, Barratt SL, Beirne P, Bianchi SM, Blaikley JF, Brooke J, Chaudhuri N, Collier G, Denneny EK, Docherty A, Fabbri L, Gibbons MA, Gleeson FV, Gooptu B, Hall IP, Hanley NA, Heightman M, Hillman TE, Johnson SR, Jones MG, Khan F, Lawson R, Mehta P, Mitchell JA, Platé M, Poinasamy K, Quint JK, Rivera-Ortega P, Semple M, Simpson AJ, Smith D, Spears M, Spencer LIG, Stanel SC, Thickett DR, Thompson AAR, Walsh SL, Weatherley ND, Weeks ME, Wootton DG, Brightling CE, Chambers RC, Ho LP, Jacob J, Piper Hanley K, Wain LV, Jenkins RG. Understanding the burden of interstitial lung disease post-COVID-19: the UK Interstitial Lung Disease-Long COVID Study (UKILD-Long COVID). BMJ Open Respir Res 2021; 8:e001049. [PMID: 34556492 PMCID: PMC8461362 DOI: 10.1136/bmjresp-2021-001049] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/19/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has led to over 100 million cases worldwide. The UK has had over 4 million cases, 400 000 hospital admissions and 100 000 deaths. Many patients with COVID-19 suffer long-term symptoms, predominantly breathlessness and fatigue whether hospitalised or not. Early data suggest potentially severe long-term consequence of COVID-19 is development of long COVID-19-related interstitial lung disease (LC-ILD). METHODS AND ANALYSIS The UK Interstitial Lung Disease Consortium (UKILD) will undertake longitudinal observational studies of patients with suspected ILD following COVID-19. The primary objective is to determine ILD prevalence at 12 months following infection and whether clinically severe infection correlates with severity of ILD. Secondary objectives will determine the clinical, genetic, epigenetic and biochemical factors that determine the trajectory of recovery or progression of ILD. Data will be obtained through linkage to the Post-Hospitalisation COVID platform study and community studies. Additional substudies will conduct deep phenotyping. The Xenon MRI investigation of Alveolar dysfunction Substudy will conduct longitudinal xenon alveolar gas transfer and proton perfusion MRI. The POST COVID-19 interstitial lung DiseasE substudy will conduct clinically indicated bronchoalveolar lavage with matched whole blood sampling. Assessments include exploratory single cell RNA and lung microbiomics analysis, gene expression and epigenetic assessment. ETHICS AND DISSEMINATION All contributing studies have been granted appropriate ethical approvals. Results from this study will be disseminated through peer-reviewed journals. CONCLUSION This study will ensure the extent and consequences of LC-ILD are established and enable strategies to mitigate progression of LC-ILD.
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Affiliation(s)
- Jim M Wild
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Joanna C Porter
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Respiratory Medicine, University College London, London, UK
| | - Philip L Molyneaux
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Peter M George
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Iain Stewart
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Raminder Aul
- Respiratory Medicine, St George's Hospital NHS Foundation Trust, London, UK
| | | | - Shaney L Barratt
- Bristol Interstitial Lung Diseases Service, North Bristol NHS Trust, Bristol, UK
| | - Paul Beirne
- Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephen M Bianchi
- Academic Department of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John F Blaikley
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Jonathan Brooke
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Nazia Chaudhuri
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Respiratory Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - Guilhem Collier
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Emma K Denneny
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Respiratory Medicine, University College London, London, UK
| | - Annemarie Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Laura Fabbri
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michael A Gibbons
- Respiratory Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Bibek Gooptu
- Department of Molecular and Cell Biology, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ian P Hall
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Neil A Hanley
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Wythenshaw Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melissa Heightman
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Toby E Hillman
- Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon R Johnson
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark G Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Fasihul Khan
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Rod Lawson
- Academic Department of Respiratory Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
- School of Life & Medical Sciences, UCL, London, UK
| | - Jane A Mitchell
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Manuela Platé
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
- UCL Respiratory, UCL, London, UK
| | | | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Pilar Rivera-Ortega
- Respiratory Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | | | - A John Simpson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Djf Smith
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Spears
- Respiratory Medicine, Perth Royal Infirmary, NHS Tayside, Perth, UK
- School of Medicine, University of Dundee, Dundee, UK
| | - LIsa G Spencer
- Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stefan C Stanel
- Respiratory Department, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology & Gastroenterology, The University of Manchester, Manchester, UK
| | - David R Thickett
- Birmingham Acute Care Research Group, University of Birmingham, Birmingham, UK
- Acute and Respiratory Medicine, University Hospitals Birmingham Foundation Trust, Birmingham, uk
| | - A A Roger Thompson
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | - Simon Lf Walsh
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nicholas D Weatherley
- Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
| | | | - Dan G Wootton
- Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- Institute of Infection Veterinary and Ecological Science, University of Liverpool, Liverpool, UK
| | - Chris E Brightling
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine Oncology, Oxford, UK
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Joseph Jacob
- Department of Respiratory Medicine, University College London, London, UK
- Centre for Medical Imaging and Computing, University College London, London, UK
| | - Karen Piper Hanley
- Division of Diabetes, Endocrinology & Gastroenterology, The University of Manchester, Manchester, UK
| | - Louise V Wain
- Department of Health Sciences, University of Leicester, Leicester, UK
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - R Gisli Jenkins
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Interstitial Lung Disease, Royal Brompton and Harefield Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
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Anton A, Mead RJ, Shaw PJ, Edden RAE, Bigley J, Jenkins TM, Wild JM, Hoggard N, Wilkinson ID. Assessment of the Precision in Measuring Glutathione at 3 T With a MEGA-PRESS Sequence in Primary Motor Cortex and Occipital Cortex. J Magn Reson Imaging 2021; 55:435-442. [PMID: 34322948 DOI: 10.1002/jmri.27842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Glutathione (GSH) is an important brain antioxidant and a number of studies have reported its measurement by edited and nonedited localized 1 H spectroscopy techniques within a range of applications in healthy volunteers and disease states. Good test-retest reproducibility is key when assessing the efficacy of treatments aimed at modulating GSH levels within the central nervous system or when noninvasively assessing changes in GSH content over time. PURPOSE To evaluate the intraday (in vitro and in vivo) and 1-month apart (in vivo) test-retest reproducibility of GSH measurements from GSH-edited MEGA-PRESS acquisitions at 3 T in a phantom and in the brain of a cohort of middle-aged and older healthy volunteers. STUDY TYPE Prospective. SUBJECTS/PHANTOMS A phantom containing physiological concentrations of GSH and metabolites with overlapping spectral signatures and 10 healthy volunteers (4 F, 6 M, 55 ± 14 years old). FIELD STRENGTH/SEQUENCE GSH-edited spectra were acquired at 3 T using the MEGA-PRESS sequence. ASSESSMENT The phantom was scanned twice and the healthy subjects were scanned three times (on two separate days, 1 month apart). GSH was quantified from each acquisition, with the in vivo voxels placed at the primary motor cortex (PMC) and the occipital cortex (OCC). STATISTICAL TESTS Mean coefficients of variation (CV) were used to assess short-term (in vitro and in vivo) and longer-term (in vivo) test-retest reproducibility. RESULTS In vitro, the CV was 2.3%. In vivo, the mean intraday CV was 3.3% in the PMC and 2.4% in the OCC, while the CVs at 1 month apart were 4.6% in the PMC and 7.8% in the OCC. DATA CONCLUSION GSH-edited MEGA-PRESS spectroscopy allows measurement of GSH with excellent precision. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Adriana Anton
- Department of Infection, Immunity & Cardiovascular Disease, Medical School, Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK
- Sheffield NIHR Biomedical Research Centre: Translational Neuroscience for Chronic Neurological Disorders, Sheffield, UK
| | - Richard J Mead
- Department of Neuroscience, School of Medicine, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Sheffield NIHR Biomedical Research Centre: Translational Neuroscience for Chronic Neurological Disorders, Sheffield, UK
- Department of Neuroscience, School of Medicine, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Julia Bigley
- Department of Infection, Immunity & Cardiovascular Disease, Medical School, Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Thomas M Jenkins
- Department of Neuroscience, School of Medicine, Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim M Wild
- Department of Infection, Immunity & Cardiovascular Disease, Medical School, Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Nigel Hoggard
- Department of Infection, Immunity & Cardiovascular Disease, Medical School, Faculty of Medicine Dentistry and Health, University of Sheffield, Sheffield, UK
- Sheffield NIHR Biomedical Research Centre: Translational Neuroscience for Chronic Neurological Disorders, Sheffield, UK
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Puddu C, Rao M, Xu X, Deppe MH, Collier G, Maunder A, Chan HF, De Zanche N, Robb F, Wild JM. An asymmetrical whole-body birdcage RF coil without RF shield for hyperpolarized 129 Xe lung MR imaging at 1.5 T. Magn Reson Med 2021; 86:3373-3381. [PMID: 34268802 DOI: 10.1002/mrm.28915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE This study describes the development and testing of an asymmetrical xenon-129 (129 Xe) birdcage radiofrequency (RF) coil for 129 Xe lung ventilation imaging at 1.5 Tesla, which allows proton (1 H) system body coil transmit-receive functionality. METHODS The 129 Xe RF coil is a whole-body asymmetrical elliptical birdcage constructed without an outer RF shield to enable 1 H imaging. B 1 + field homogeneity and flip angle mapping of the 129 Xe birdcage RF coil and 1 H system body RF coil with the 129 Xe RF coil in situ were evaluated in the MR scanner. The functionality of the 129 Xe birdcage RF coil was demonstrated through hyperpolarized 129 Xe lung ventilation imaging with the birdcage in both transceiver configuration and transmit-only configuration when combined with an 8-channel 129 Xe receive-only RF coil array. The functionality of 1 H system body coil with the 129 Xe RF coil in situ was demonstrated by acquiring coregistered 1 H lung anatomical MR images. RESULTS The asymmetrical birdcage produced a homogeneous B 1 + field (±10%) in agreement with electromagnetic simulations. Simulations indicated an optimal detuning configuration with 4 diodes. The obtained g-factor of 1.4 for acceleration factor of R = 2 indicates optimal array configuration. Coregistered 1 H anatomical images from the system body coil along with 129 Xe lung images demonstrated concurrent and compatible arrangement of the RF coils. CONCLUSION A large asymmetrical birdcage for homogenous B 1 + transmission with high sensitivity reception for 129 Xe lung MRI at 1.5 Tesla has been demonstrated. The unshielded asymmetrical birdcage design enables 1 H structural lung MR imaging in the same exam.
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Affiliation(s)
- Claudio Puddu
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Madhwesha Rao
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Xiaojun Xu
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Martin H Deppe
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Guilhem Collier
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Adam Maunder
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Ho-Fung Chan
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Nicola De Zanche
- Department of Medical Physics, Cross Cancer Institute and University of Alberta, Alberta, Canada
| | - Fraser Robb
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,GE Healthcare, Aurora, Ohio, USA
| | - Jim M Wild
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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Alabed S, Karunasaagarar K, Alandejani F, Garg P, Uthoff J, Metherall P, Sharkey M, Lu H, Wild JM, Kiely DG, Van Der Geest RJ, Swift AJ. High interstudy repeatability of automatic deep learnt biventricular CMR measurements. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Wellcome Trust (UK), NIHR (UK)
Introduction
Cardiac magnetic resonance (CMR) measurements have significant diagnostic and prognostic value. Accurate and repeatable measurements are essential to assess disease severity, evaluate therapy response and monitor disease progression. Deep learning approaches have shown promise for automatic left ventricular (LV) segmentation on CMR, however fully automatic right ventricular (RV) segmentation remains challenging. We aimed to develop a biventricular automatic contouring model and evaluate the interstudy repeatability of the model in a prospectively recruited cohort.
Methods
A deep learning CMR contouring model was developed in a retrospective multi-vendor (Siemens and General Electric), multi-pathology cohort of patients, predominantly with heart failure, pulmonary hypertension and lung diseases (n = 400, ASPIRE registry). Biventricular segmentations were made on all CMR studies across cardiac phases. To test the accuracy of the automatic segmentation, 30 ASPIRE CMRs were segmented independently by two CMR experts. Each segmentation was compared to the automatic contouring with agreement assessed using the Dice similarity coefficient (DSC).
A prospective validation cohort of 46 subjects (10 healthy volunteers and 36 patients with pulmonary hypertension) were recruited to assess interstudy agreement of automatic and manual CMR assessments. Two CMR studies were performed during separate sessions on the same day. Interstudy repeatability was assessed using intraclass correlation coefficient (ICC) and Bland-Altman plots.
Results
DSC showed high agreement (figure 1) comparing automatic and expert CMR readers, with minimal bias towards either CMR expert. The scan-scan repeatability CMR measurements were higher for all automatic RV measurements (ICC 0.89 to 0.98) compared to manual RV measurements (0.78 to 0.98). LV automatic and manual measurements were similarly repeatable (figure 2). Bland-Altman plots showed strong agreement with small mean differences between the scan-scan measurements (figure 2).
Conclusion
Fully automatic biventricular short-axis segmentations are comparable with expert manual segmentations, and have shown excellent interstudy repeatability.
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Affiliation(s)
- S Alabed
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - K Karunasaagarar
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - F Alandejani
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - P Garg
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - J Uthoff
- University of Sheffield, Department of Computer Science, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - P Metherall
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - M Sharkey
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - H Lu
- University of Sheffield, Department of Computer Science, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - JM Wild
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | - DG Kiely
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
| | | | - AJ Swift
- University of Sheffield, Department of Infection, Immunity & Cardiovascular Disease, Sheffield, United Kingdom of Great Britain & Northern Ireland
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