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Triphan SMF, Bauman G, Konietzke P, Konietzke M, Wielpütz MO. Magnetic Resonance Imaging of Lung Perfusion. J Magn Reson Imaging 2024; 59:784-796. [PMID: 37466278 DOI: 10.1002/jmri.28912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/20/2023] Open
Abstract
"Lung perfusion" in the context of imaging conventionally refers to the delivery of blood to the pulmonary capillary bed through the pulmonary arteries originating from the right ventricle required for oxygenation. The most important physiological mechanism in the context of imaging is the so-called hypoxic pulmonary vasoconstriction (HPV, also known as "Euler-Liljestrand-Reflex"), which couples lung perfusion to lung ventilation. In obstructive airway diseases such as asthma, chronic-obstructive pulmonary disease (COPD), cystic fibrosis (CF), and asthma, HPV downregulates pulmonary perfusion in order to redistribute blood flow to functional lung areas in order to conserve optimal oxygenation. Imaging of lung perfusion can be seen as a reflection of lung ventilation in obstructive airway diseases. Other conditions that primarily affect lung perfusion are pulmonary vascular diseases, pulmonary hypertension, or (chronic) pulmonary embolism, which also lead to inhomogeneity in pulmonary capillary blood distribution. Several magnetic resonance imaging (MRI) techniques either dependent on exogenous contrast materials, exploiting periodical lung signal variations with cardiac action, or relying on intrinsic lung voxel attributes have been demonstrated to visualize lung perfusion. Additional post-processing may add temporal information and provide quantitative information related to blood flow. The most widely used and robust technique, dynamic-contrast enhanced MRI, is available in clinical routine assessment of COPD, CF, and pulmonary vascular disease. Non-contrast techniques are important research tools currently requiring clinical validation and cross-correlation in the absence of a viable standard of reference. First data on many of these techniques in the context of observational studies assessing therapy effects have just become available. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Simon M F Triphan
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University Hospital of Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Philip Konietzke
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
| | - Marilisa Konietzke
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University Hospital Heidelberg, Heidelberg, Germany
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Benlala I, Klaar R, Gaass T, Macey J, Bui S, Senneville BDD, Berger P, Laurent F, Dournes G, Dinkel J. Non-Contrast-Enhanced Functional Lung MRI to Evaluate Treatment Response of Allergic Bronchopulmonary Aspergillosis in Patients With Cystic Fibrosis: A Pilot Study. J Magn Reson Imaging 2024; 59:909-919. [PMID: 37265441 DOI: 10.1002/jmri.28844] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is associated with severe lung damage and requires specific therapeutic management. Repeated imaging is recommended to both diagnose and follow-up response to treatment of ABPA in CF. However, high risk of cumulative radiation exposure requires evaluation of free-radiation techniques in the follow-up of CF patients with ABPA. PURPOSE To evaluate whether Fourier decomposition (FD) functional lung MRI can detect response to treatment of ABPA in CF patients. STUDY TYPE Retrospective longitudinal. POPULATION Twelve patients (7M, median-age:14 years) with CF and ABPA with pre- and post-treatment MRI. FIELD STRENGTH/SEQUENCE 2D-balanced-steady-state free-precession (bSSFP) sequence with FD at 1.5T. ASSESSMENT Ventilation-weighted (V) and perfusion-weighted (Q) maps were obtained after FD processing of 2D-coronal bSSFP time-resolved images acquired before and 3-9 months after treatment. Defects extent was assessed on the functional maps using a qualitative semi-quantitative score (0 = absence/negligible, 1 = <50%, 2 = >50%). Mean and coefficient of variation (CV) of the ventilation signal-intensity (VSI) and the perfusion signal-intensity (QSI) were calculated. Measurements were performed independently by three readers and averaged. Inter-reader reproducibility of the measurements was assessed. Pulmonary function tests (PFTs) were performed within 1 week of both MRI studies as markers of the airflow-limitation severity. STATISTICAL TESTS Comparisons of medians were performed using the paired Wilcoxon-test. Reproducibility was assessed using intraclass correlation coefficient (ICC). Correlations between MRI and PFT parameters were assessed using the Spearman-test (rho correlation-coefficient). A P-value <0.05 was considered as significant. RESULTS Defects extent on both V and Q maps showed a significant reduction after ABPA treatment (4.25 vs. 1.92 for V-defect-score and 5 vs. 2.75 for Q-defect-score). VSI_mean was significantly increased after treatment (280 vs. 167). Qualitative analyses reproducibility showed an ICC > 0.90, while the ICCs of the quantitative measurements was almost perfect (>0.99). Changes in VSI_cv and QSI_cv before and after treatment correlated inversely with changes of FEV1%p (rho = -0.68 for both). DATA CONCLUSION Non-contrast-enhanced FD lung MRI has potential to reproducibly assess response to treatment of ABPA in CF patients and correlates with PFT obstructive parameters. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Ilyes Benlala
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
- INSERM, U1045, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
| | - Rabea Klaar
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Thomas Gaass
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Julie Macey
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - Stéphanie Bui
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | | | - Patrick Berger
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - François Laurent
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - Gael Dournes
- Univ. Bordeaux, Centre de Recherche Cardio-thoracique de Bordeaux, Pessac, France
- CHU Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, Unité de Pneumologie Pédiatrique, CIC 1401, Pessac, France
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Kay FU, Madhuranthakam AJ. MR Perfusion Imaging of the Lung. Magn Reson Imaging Clin N Am 2024; 32:111-123. [PMID: 38007274 DOI: 10.1016/j.mric.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Lung perfusion assessment is critical for diagnosing and monitoring a variety of respiratory conditions. MRI perfusion provides a radiation-free technique, making it an ideal choice for longitudinal imaging in younger populations. This review focuses on the techniques and applications of MRI perfusion, including contrast-enhanced (CE) MRI and non-CE methods such as arterial spin labeling (ASL), fourier decomposition (FD), and hyperpolarized 129-Xenon (129-Xe) MRI. ASL leverages endogenous water protons as tracers for a non-invasive measure of lung perfusion, while FD offers simultaneous measurements of lung perfusion and ventilation, enabling the generation of ventilation/perfusion mapsHyperpolarized 129-Xe MRI emerges as a novel tool for assessing regional gas exchange in the lungs. Despite the promise of MRI perfusion techniques, challenges persist, including competition with other imaging techniques and the need for additional validation and standardization. In conditions such as cystic fibrosis and lung cancer, MRI has displayed encouraging results, whereas in diseases like chronic obstructive pulmonary disease, further validation remains necessary. In conclusion, while MRI perfusion techniques hold immense potential for a comprehensive, non-invasive assessment of lung function and perfusion, their broader clinical adoption hinges on technological advancements, collaborative research, and rigorous validation.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Ananth J Madhuranthakam
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, North Campus 2201 Inwood Road, Dallas, TX 75390-8568, USA
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Bergmann LL, Ackman JB, Starekova J, Moeller A, Reeder S, Nagle SK, Schiebler ML. MR Angiography of Pulmonary Vasculature. Magn Reson Imaging Clin N Am 2023; 31:475-491. [PMID: 37414473 DOI: 10.1016/j.mric.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Pulmonary MR angiography (MRA) is a useful alternative to computed tomographic angiography (CTA) for the study of the pulmonary vasculature. For pulmonary hypertension and partial anomalous pulmonary venous return, a cardiac MR imaging and the pulmonary MRA are useful for flow quantification and planning treatment. For the diagnosis of pulmonary embolism (PE), MRA-PE has been shown to have non-inferior outcomes at 6 months when compared with CTA-PE. Over the last 15 years, pulmonary MRA has become a routine and reliable examination for the workup of pulmonary hypertension and the primary diagnosis of PE at the University of Wisconsin.
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Affiliation(s)
- Liisa L Bergmann
- Department of Radiology, University of Kentucky College of Medicine, 800 Rose Street, HX332E, Lexington, KY 40536-0293, USA; Department of Medicine, University of Kentucky College of Medicine, 800 Rose Street, HX332E, Lexington, KY 40536-0293, USA.
| | - Jeanne B Ackman
- Massachusetts General Hospital, Department of Radiology, Division of Thoracic Imaging and Intervention Austin Building 202, 55 Fruit Street, Boston, MA 02114, USA
| | - Jitka Starekova
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Alexander Moeller
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Scott Reeder
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Scott K Nagle
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA.
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5
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Feasibility of flow-related enhancement brain perfusion MRI. PLoS One 2022; 17:e0276912. [DOI: 10.1371/journal.pone.0276912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
Brain perfusion imaging is of enormous importance for various neurological diseases. Fast gradient-echo sequences offering flow-related enhancement (FREE) could present a basis to generate perfusion-weighted maps. In this study, we obtained perfusion-weighted maps without contrast media by a previously described postprocessing algorithm from the field of functional lung MRI. At first, the perfusion signal was analyzed in fast low-angle shot (FLASH) and balanced steady-state free precession (bSSFP) sequences. Secondly, perfusion maps were compared to pseudo-continuous arterial spin labeling (pCASL) MRI in a healthy cohort. Thirdly, the feasibility of the new technique was demonstrated in a small selected group of patients with metastases and acute stroke.
Methods
One participant was examined with bSSFP and FLASH sequences at 1.5T and 3T, different flip angles and slice thicknesses. Twenty-five volunteers had bSSFP imaging and pCASL MRI. Three patients with cerebral metastases and one with acute ischemic stroke had bSSFP imaging and were compared to T1 post-contrast images and CT perfusion. Frequency analyses, SNR and perfusion contrast were compared at different flip angles and slice thicknesses. Regional correlations and Sorensen-Dice overlap were calculated in the healthy cohort. Dice overlap of the pathologies in the patient cohort were calculated.
Results
The bSSFP sequence presented detectable perfusion signal within brain vessel and parenchyma together with superior SNR compared to FLASH. Perfusion contrast and its corticomedullary differentiation increased with flip angle. Mean regional correlation was 0.36 and highly significant between FREE maps and pCASL and grey and white matter Dice match were 72% and 60% in the healthy cohort. Pathologies presented good overlap between FREE perfusion-weighted and T1 post-contrast images.
Conclusion
The feasibility of FREE brain perfusion imaging has been shown in a healthy cohort and selected patient cases with brain metastases and acute stroke. The study demonstrates a new approach for non-contrast brain perfusion imaging.
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Lévy S, Heiss R, Grimm R, Grodzki D, Hadler D, Voskrebenzev A, Vogel-Claussen J, Fuchs F, Strauss R, Achenbach S, Hinsen M, Klett D, Schmid J, Kremer AE, Uder M, Nagel AM, Bickelhaupt S. Free-Breathing Low-Field MRI of the Lungs Detects Functional Alterations Associated With Persistent Symptoms After COVID-19 Infection. Invest Radiol 2022; 57:742-751. [PMID: 35640012 DOI: 10.1097/rli.0000000000000892] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES With the COVID-19 pandemic, repetitive lung examinations have become necessary to follow-up symptoms and associated alterations. Low-field MRI, benefiting from reduced susceptibility effects, is a promising alternative for lung imaging to limit radiations absorbed by patients during CT examinations, which also have limited capability to assess functional alterations. The aim of this investigative study was to explore the functional abnormalities that free-breathing 0.55 T MRI in combination with the phase-resolved functional lung (PREFUL) analysis could identify in patients with persistent symptoms after COVID-19 infection. MATERIALS AND METHODS Seventy-four COVID-19 patients and 8 healthy volunteers were prospectively scanned in free-breathing with a balanced steady-state free-precession sequence optimized at 0.55 T, 5 months postinfection on average. Normalized perfusion (Q), fractional ventilation (FV), and flow-volume loop correlation (FVLc) maps were extracted with the PREFUL technique. Q, FV, and FVLc defects as well as defect overlaps between these metrics were quantified. Morphological turbo-spin-echo images were also acquired, and the extent of abnormalities was scored by a board-certified radiologist. To investigate the functional correlates of persistent symptoms, a recursive feature elimination algorithm was applied to find the most informative variables to detect the presence of persistent symptoms with a logistic regression model and a cross-validation strategy. All MRI metrics, sex, age, body mass index, and the presence of preexisting lung conditions were included. RESULTS The most informative variables to detect persistent symptoms were the percentage of concurrent Q and FVLc defects and of areas free of those defects. A detection accuracy of 71.4% was obtained with these 2 variables when fitting the model on the entire dataset. Although none of the single variables differed between patients with and without persistent symptoms ( P > 0.05), the combined score of these 2 variables did ( P < 0.02). This score also showed a consistent increase from healthy volunteers (7.7) to patients without persistent symptoms (8.2) and with persistent symptoms (8.6). The morphological abnormality score showed poor correlation with the functional parameters. CONCLUSIONS Functional pulmonary examinations using free-breathing 0.55 T MRI with PREFUL analysis revealed potential quantitative markers of impaired lung function in patients with persistent symptoms after COVID-19 infection, potentially complementing morphologic imaging. Future work is needed to explore the translational relevance and clinical implication of these findings.
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Affiliation(s)
- Simon Lévy
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Rafael Heiss
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Robert Grimm
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen
| | - David Grodzki
- MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen
| | - Dominique Hadler
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | | | | | - Florian Fuchs
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Richard Strauss
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Susanne Achenbach
- Department of Transfusion Medicine and Haemostaseology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Maximilian Hinsen
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Daniel Klett
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | - Jonas Schmid
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | | | - Michael Uder
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
| | | | - Sebastian Bickelhaupt
- From the Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg
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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] [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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Wang C, Li H, Xiao S, Li Z, Zhao X, Xie J, Ye C, Xia L, Lou X, Zhou X. Abnormal dynamic ventilation function of COVID-19 survivors detected by pulmonary free-breathing proton MRI. Eur Radiol 2022; 32:5297-5307. [PMID: 35184219 PMCID: PMC8858033 DOI: 10.1007/s00330-022-08605-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/13/2021] [Accepted: 01/22/2022] [Indexed: 01/03/2023]
Abstract
Objectives To visualize and quantitatively assess regional lung function of survivors of COVID-19 who were hospitalized using pulmonary free-breathing 1H MRI. Methods A total of 12 healthy volunteers and 27 COVID-19 survivors (62.4 ± 8.1 days between infection and image acquisition) were recruited in this prospective study and performed chest 1H MRI acquisitions with free tidal breathing. Then, conventional Fourier decomposition ventilation (FD-V) and global fractional ventilation (FVGlobal) were analyzed. Besides, a modified PREFUL (mPREFUL) method was developed to adapt to COVID-19 survivors and generate dynamic ventilation maps and parameters. All the ventilation maps and parameters were analyzed using Student’s t-test. Pearson’s correlation and a Bland-Altman plot between FVGlobal and mPREFUL were analyzed. Results There was no significant difference between COVID-19 and healthy groups regarding a static FD-V map (0.47 ± 0.12 vs 0.42 ± 0.08; p = .233). However, mPREFUL demonstrated lots of regional high ventilation areas (high ventilation percentage (HVP): 23.7% ± 10.6%) existed in survivors. This regional heterogeneity (i.e., HVP) in survivors was significantly higher than in healthy volunteers (p = .003). The survivors breathed deeper (flow-volume loop: 5375 ± 3978 vs 1688 ± 789; p = .005), and breathed more air in respiratory cycle (total amount: 62.6 ± 19.3 vs 37.3 ± 9.9; p < .001). Besides, mPREFUL showed both good Pearson’s correlation (r = 0.74; p < .001) and Bland-Altman consistency (mean bias = −0.01) with FVGlobal. Conclusions Dynamic ventilation imaging using pulmonary free-breathing 1H MRI found regional abnormity of dynamic ventilation function in COVID-19 survivors. Key Points • Pulmonary free-breathing1H MRI was used to visualize and quantitatively assess regional lung ventilation function of COVID-19 survivors. • Dynamic ventilation maps generated from1H MRI were more sensitive to distinguish the COVID-19 and healthy groups (total air amount: 62.6 ± 19.3 vs 37.3 ± 9.9; p < .001), compared with static ventilation maps (FD-V value: 0.47 ± 0.12 vs 0.42 ± 0.08; p = .233). • COVID-19 survivors had larger regional heterogeneity (high ventilation percentage: 23.7% ± 10.6% vs 13.1% ± 7.9%; p = .003), and breathed deeper (flow-volume loop: 5375 ± 3978 vs 1688 ± 789; p = .005) than healthy volunteers. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-022-08605-w.
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9
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Willers C, Maager L, Bauman G, Cholewa D, Stranzinger E, Raio L, Casaulta C, Latzin P. School-age structural and functional MRI and lung function in children following lung resection for congenital lung malformation in infancy. Pediatr Radiol 2022; 52:1255-1265. [PMID: 35305121 PMCID: PMC9192451 DOI: 10.1007/s00247-022-05317-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 10/21/2021] [Accepted: 02/03/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The management of asymptomatic congenital lung malformations is debated. Particularly, there is a lack of information regarding long-term growth and development of the remaining lung in children following lung resection for congenital lung malformations. In addition to conventional pulmonary function tests, we used novel functional magnetic resonance imaging (MRI) methods to measure perfusion and ventilation. OBJECTIVE To assess functionality of the remaining lung expanded into the thoracic cavity after resection of congenital lung malformations. MATERIALS AND METHODS A prospective, cross-sectional pilot study in five children who had surgery for congenital lung malformations during infancy. Participants had structural and functional MRI as well as spirometry, body plethysmography and multiple breath washout at school age. RESULTS Structural MRI showed an expansion of the remaining lung in all cases. Fractional ventilation and relative perfusion of the expanded lung were locally decreased in functional MRI. In all other parts of the lungs, fractional ventilation and relative perfusion were normal in all children. There was an association between overall impairment of perfusion and elevated lung clearance index. The results of spirometry and body plethysmography varied between patients, including normal lung function, restriction and obstruction. CONCLUSION Fractional ventilation and relative perfusion maps from functional MRI specifically locate impairment of the remaining lung after lung resection. These changes are not captured by conventional measures such as structural MRI and standard pulmonary function tests. Therefore, following lung resection for congenital lung malformation, children should be investigated more systematically with functional lung MRI.
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Affiliation(s)
- Corin Willers
- grid.5734.50000 0001 0726 5157Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
| | - Lukas Maager
- grid.5734.50000 0001 0726 5157Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
| | - Grzegorz Bauman
- grid.410567.1Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Dietmar Cholewa
- grid.5734.50000 0001 0726 5157Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Enno Stranzinger
- grid.5734.50000 0001 0726 5157Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luigi Raio
- grid.5734.50000 0001 0726 5157Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carmen Casaulta
- grid.5734.50000 0001 0726 5157Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010 Bern, Switzerland
| | - Philipp Latzin
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland.
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10
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Weng AM, Heidenreich JF, Metz C, Veldhoen S, Bley TA, Wech T. Deep learning-based segmentation of the lung in MR-images acquired by a stack-of-spirals trajectory at ultra-short echo-times. BMC Med Imaging 2021; 21:79. [PMID: 33964892 PMCID: PMC8106126 DOI: 10.1186/s12880-021-00608-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Functional lung MRI techniques are usually associated with time-consuming post-processing, where manual lung segmentation represents the most cumbersome part. The aim of this study was to investigate whether deep learning-based segmentation of lung images which were scanned by a fast UTE sequence exploiting the stack-of-spirals trajectory can provide sufficiently good accuracy for the calculation of functional parameters. METHODS In this study, lung images were acquired in 20 patients suffering from cystic fibrosis (CF) and 33 healthy volunteers, by a fast UTE sequence with a stack-of-spirals trajectory and a minimum echo-time of 0.05 ms. A convolutional neural network was then trained for semantic lung segmentation using 17,713 2D coronal slices, each paired with a label obtained from manual segmentation. Subsequently, the network was applied to 4920 independent 2D test images and results were compared to a manual segmentation using the Sørensen-Dice similarity coefficient (DSC) and the Hausdorff distance (HD). Obtained lung volumes and fractional ventilation values calculated from both segmentations were compared using Pearson's correlation coefficient and Bland Altman analysis. To investigate generalizability to patients outside the CF collective, in particular to those exhibiting larger consolidations inside the lung, the network was additionally applied to UTE images from four patients with pneumonia and one with lung cancer. RESULTS The overall DSC for lung tissue was 0.967 ± 0.076 (mean ± standard deviation) and HD was 4.1 ± 4.4 mm. Lung volumes derived from manual and deep learning based segmentations as well as values for fractional ventilation exhibited a high overall correlation (Pearson's correlation coefficent = 0.99 and 1.00). For the additional cohort with unseen pathologies / consolidations, mean DSC was 0.930 ± 0.083, HD = 12.9 ± 16.2 mm and the mean difference in lung volume was 0.032 ± 0.048 L. CONCLUSIONS Deep learning-based image segmentation in stack-of-spirals based lung MRI allows for accurate estimation of lung volumes and fractional ventilation values and promises to replace the time-consuming step of manual image segmentation in the future.
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Affiliation(s)
- Andreas M Weng
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Julius F Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Corona Metz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Simon Veldhoen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Thorsten A Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Tobias Wech
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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11
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Glandorf J, Klimeš F, Behrendt L, Voskrebenzev A, Kaireit TF, Gutberlet M, Wacker F, Vogel-Claussen J. Perfusion quantification using voxel-wise proton density and median signal decay in PREFUL MRI. Magn Reson Med 2021; 86:1482-1493. [PMID: 33837557 DOI: 10.1002/mrm.28787] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE Contrast-free lung MRI based on Fourier decomposition is an attractive method to monitor various lung diseases. However, the accuracy of the current perfusion quantification is limited. In this study, a new approach for perfusion quantification based on voxel-wise proton density and median signal decay toward the steady state for Fourier decomposition-based techniques is proposed called QQuantified (QQuant ). METHODS Twenty patients with chronic obstructive pulmonary disease and 18 patients with chronic thromboembolic pulmonary hypertension received phase-resolved functional lung-MRI (PREFUL) and dynamic contrast-enhanced (DCE)-MRI. Nine healthy participants received phase-resolved functional lung-MRI only. Median values of QQuant were compared to a Fourier decomposition perfusion quantification presented by Kjørstad et al (QKjørstad ) and validated toward pulmonary blood flow derived by DCE-MRI (PBFDCE ). Blood fraction maps determined by the new approach were calculated. Regional and global correlation coefficients were calculated, and Bland-Altman plots were created. Histogram analyses of all cohorts were created. RESULTS The introduced parameter QQuant showed only 2 mL/min/100 mL mean deviation to PBFDCE in the patient cohort and showed less bias than QKjørstad . Significant increases of regional correlation with PBFDCE were achieved (r = 0.3 vs. r = 0.2, P < .01*). The trend of global correlation toward PBFDCE is not uniform, showing higher values for QKjørstad in the chronic obstructive pulmonary disease cohort than for QQuant and vice versa in the chronic thromboembolic pulmonary hypertension cohort. In contrast to QKjørstad , QQuant perfusion maps indicate a physiologic dorsoventral gradient in supine position similar to PBFDCE with similar value distribution in the histograms. CONCLUSION We proposed a new approach for perfusion quantification of phase-resolved functional lung measurements. The developed parameter QQuant reveals a higher accuracy compared to QKjørstad .
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Affiliation(s)
- Julian Glandorf
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Filip Klimeš
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Lea Behrendt
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Till F Kaireit
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Lower Saxony, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Centre for Lung Research (DZL), Hannover, Lower Saxony, Germany
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12
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Benlala I, Laurent F, Dournes G. Structural and functional changes in COPD: What we have learned from imaging. Respirology 2021; 26:731-741. [PMID: 33829593 DOI: 10.1111/resp.14047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. It is a heterogeneous disease involving different components of the lung to varying extents. Developments in medical imaging and image analysis techniques provide new insights in the assessment of the structural and functional changes of the disease. This article reviews the leading imaging techniques: CT and MRI of the lung in research settings and clinical routine. Both visual and quantitative methods are reviewed, emphasizing their relevance to patient phenotyping and outcome prediction.
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Affiliation(s)
- Ilyes Benlala
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
| | - François Laurent
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
| | - Gael Dournes
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
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13
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Ohno Y, Hanamatsu S, Obama Y, Ueda T, Ikeda H, Hattori H, Murayama K, Toyama H. Overview of MRI for pulmonary functional imaging. Br J Radiol 2021; 95:20201053. [PMID: 33529053 DOI: 10.1259/bjr.20201053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Morphological evaluation of the lung is important in the clinical evaluation of pulmonary diseases. However, the disease process, especially in its early phases, may primarily result in changes in pulmonary function without changing the pulmonary structure. In such cases, the traditional imaging approaches to pulmonary morphology may not provide sufficient insight into the underlying pathophysiology. Pulmonary imaging community has therefore tried to assess pulmonary diseases and functions utilizing not only nuclear medicine, but also CT and MR imaging with various technical approaches. In this review, we overview state-of-the art MR methods and the future direction of: (1) ventilation imaging, (2) perfusion imaging and (3) biomechanical evaluation for pulmonary functional imaging.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan.,Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan
| | - Satomu Hanamatsu
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Yuki Obama
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Takahiro Ueda
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hirotaka Ikeda
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hidekazu Hattori
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, School of Medicine, Toyoake, Japan
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14
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Goralski JL, Stewart NJ, Woods JC. Novel imaging techniques for cystic fibrosis lung disease. Pediatr Pulmonol 2021; 56 Suppl 1:S40-S54. [PMID: 32592531 PMCID: PMC7808406 DOI: 10.1002/ppul.24931] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022]
Abstract
With an increasing number of patients with cystic fibrosis (CF) receiving highly effective CFTR (cystic fibrosis transmembrane regulator protein) modulator therapy, particularly at a young age, there is an increasing need to identify imaging tools that can detect and regionally visualize mild CF lung disease and subtle changes in disease state. In this review, we discuss the latest developments in imaging modalities for both structural and functional imaging of the lung available to CF clinicians and researchers, from the widely available, clinically utilized imaging methods for assessing CF lung disease-chest radiography and computed tomography-to newer techniques poised to become the next phase of clinical tools-structural/functional proton and hyperpolarized gas magnetic resonance imaging (MRI). Finally, we provide a brief discussion of several newer lung imaging techniques that are currently available only in selected research settings, including chest tomosynthesis, and fluorinated gas MRI. We provide an update on the clinical and/or research status of each technique, with a focus on sensitivity, early disease detection, and possibilities for monitoring treatment efficacy.
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Affiliation(s)
- Jennifer L Goralski
- UNC Cystic Fibrosis Center, Marsico Lung Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Pulmonary and Critical Care Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Division of Pediatric Pulmonology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Neil J Stewart
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Infection, Immunity & Cardiovascular Disease, POLARIS Group, Imaging Sciences, University of Sheffield, Sheffield, UK
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Cincinnati Children's Hospital, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.,Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio
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15
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Dournes G, Walkup LL, Benlala I, Willmering MM, Macey J, Bui S, Laurent F, Woods JC. The Clinical Use of Lung MRI in Cystic Fibrosis: What, Now, How? Chest 2020; 159:2205-2217. [PMID: 33345950 PMCID: PMC8579315 DOI: 10.1016/j.chest.2020.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/24/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022] Open
Abstract
To assess airway and lung parenchymal damage noninvasively in cystic fibrosis (CF), chest MRI has been historically out of the scope of routine clinical imaging because of technical difficulties such as low proton density and respiratory and cardiac motion. However, technological breakthroughs have emerged that dramatically improve lung MRI quality (including signal-to-noise ratio, resolution, speed, and contrast). At the same time, novel treatments have changed the landscape of CF clinical care. In this contemporary context, there is now consensus that lung MRI can be used clinically to assess CF in a radiation-free manner and to enable quantification of lung disease severity. MRI can now achieve three-dimensional, high-resolution morphologic imaging, and beyond this morphologic information, MRI may offer the ability to sensitively differentiate active inflammation vs scarring tissue. MRI could also characterize various forms of inflammation for early guidance of treatment. Moreover, functional information from MRI can be used to assess regional, small-airway disease with sensitivity to detect small changes even in patients with mild CF. Finally, automated quantification methods have emerged to support conventional visual analyses for more objective and reproducible assessment of disease severity. This article aims to review the most recent developments of lung MRI, with a focus on practical application and clinical value in CF, and the perspectives on how these modern techniques may converge and impact patient care soon.
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Affiliation(s)
- Gaël Dournes
- University of Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Bordeaux, France; CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, CIC 1401, Pessac, France; Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Laura L Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Ilyes Benlala
- University of Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Bordeaux, France; CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, CIC 1401, Pessac, France
| | - Matthew M Willmering
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Julie Macey
- CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, CIC 1401, Pessac, France
| | - Stephanie Bui
- CHU Bordeaux, Hôpital Pellegrin-Enfants, Pediatric Cystic Fibrosis Reference Center (CRCM), Centre d'Investigation Clinique (CIC 1401), Bordeaux, France
| | - François Laurent
- University of Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Bordeaux, France; INSERM, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC 1401, Bordeaux, France; CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service d'Exploration Fonctionnelle Respiratoire, CIC 1401, Pessac, France
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
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16
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Munidasa S, Couch MJ, Rayment JH, Voskrebenzev A, Seethamraju R, Vogel-Claussen J, Ratjen F, Santyr G. Free-breathing MRI for monitoring ventilation changes following antibiotic treatment of pulmonary exacerbations in paediatric cystic fibrosis. Eur Respir J 2020; 57:13993003.03104-2020. [PMID: 33303537 DOI: 10.1183/13993003.03104-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/22/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Samal Munidasa
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Marcus J Couch
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Jonathan H Rayment
- Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Andreas Voskrebenzev
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Ravi Seethamraju
- MR Collaborations North East, Siemens Medical Solutions, Boston, MA, USA
| | - Jens Vogel-Claussen
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Felix Ratjen
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Respiratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Giles Santyr
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada .,Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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17
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Pöhler GH, Klimeš F, Behrendt L, Voskrebenzev A, Gonzalez CC, Wacker F, Hohlfeld JM, Vogel‐Claussen J. Repeatability of Phase‐Resolved Functional Lung (
PREFUL
)‐
MRI
Ventilation and Perfusion Parameters in Healthy Subjects and
COPD
Patients. J Magn Reson Imaging 2020; 53:915-927. [DOI: 10.1002/jmri.27385] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Gesa H. Pöhler
- Institute for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Filip Klimeš
- Institute for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Lea Behrendt
- Institute for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Cristian Crisosto Gonzalez
- Institute for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL) Hannover Germany
| | - Jens M. Hohlfeld
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL) Hannover Germany
- Department of Respiratory Medicine Hannover Medical School Hannover Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine Hannover Germany
| | - Jens Vogel‐Claussen
- Institute for Diagnostic and Interventional Radiology Hannover Medical School Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL) Hannover Germany
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18
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[Assessment of lung impairment in patients with cystic fibrosis : Novel magnetic resonance imaging methods]. Radiologe 2020; 60:823-830. [PMID: 32776240 DOI: 10.1007/s00117-020-00730-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CLINICAL/METHODOLOGICAL ISSUE The differentiated assessment of respiratory mechanics, gas exchange and pulmonary circulation, as well as structural impairment of the lung are essential for the treatment of patients with cystic fibrosis (CF). Clinical lung function measurements are often not sufficiently specific and are often difficult to perform. STANDARD RADIOLOGICAL METHODS The standard procedures for pulmonary imaging are chest X‑ray and computed tomography (CT) for assessing lung morphology. In more recent studies, an increasing number of centers are using magnetic resonance imaging (MRI) to assess lung structure and function. However, functional imaging is currently limited to specialized centers. METHODOLOGICAL INNOVATIONS In patients with CF, studies showed that MRI with hyperpolarized gases and Fourier decomposition/matrix pencil MRI (FD/MP-MRI) are feasible for assessing pulmonary ventilation. For pulmonary perfusion, dynamic contrast-enhanced MRI (DCE-MRI) or contrast-free methods, e.g., FD-MRI, can be used. PERFORMANCE Functional MRI provides more accurate insight into the pathophysiology of pulmonary function at the regional level. Advantages of MRI over X‑ray are its lack of ionizing radiation, the large number of lung function parameters that can be extracted using different contrast mechanisms, and ability to be used repeatedly over time. ACHIEVEMENTS Early assessment of lung function impairment is needed as the structural changes usually occur later in the course of the disease. However, sufficient experience in clinical application exist only for certain functional lung MRI procedures. PRACTICAL RECOMMENDATIONS Clinical application of the aforementioned techniques, except for DCE-MRI, should be restricted to scientific studies.
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19
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Willers C, Bauman G, Andermatt S, Santini F, Sandkühler R, Ramsey KA, Cattin PC, Bieri O, Pusterla O, Latzin P. The impact of segmentation on whole-lung functional MRI quantification: Repeatability and reproducibility from multiple human observers and an artificial neural network. Magn Reson Med 2020; 85:1079-1092. [PMID: 32892445 DOI: 10.1002/mrm.28476] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the repeatability and reproducibility of lung segmentation and their impact on the quantitative outcomes from functional pulmonary MRI. Additionally, to validate an artificial neural network (ANN) to accelerate whole-lung quantification. METHOD Ten healthy children and 25 children with cystic fibrosis underwent matrix pencil decomposition MRI (MP-MRI). Impaired relative fractional ventilation (RFV ) and relative perfusion (RQ ) from MP-MRI were compared using whole-lung segmentation performed by a physician at two time-points (At1 and At2 ), by an MRI technician (B), and by an ANN (C). Repeatability and reproducibility were assess with Dice similarity coefficient (DSC), paired t-test and Intraclass-correlation coefficient (ICC). RESULTS The repeatability within an observer (At1 vs At2 ) resulted in a DSC of 0.94 ± 0.01 (mean ± SD) and an unsystematic difference of -0.01% for RFV (P = .92) and +0.1% for RQ (P = .21). The reproducibility between human observers (At1 vs B) resulted in a DSC of 0.88 ± 0.02, and a systematic absolute difference of -0.81% (P < .001) for RFV and -0.38% (P = .037) for RQ . The reproducibility between human and the ANN (At1 vs C) resulted in a DSC of 0.89 ± 0.03 and a systematic absolute difference of -0.36% for RFV (P = .017) and -0.35% for RQ (P = .002). The ICC was >0.98 for all variables and comparisons. CONCLUSIONS Despite high overall agreement, there were systematic differences in lung segmentation between observers. This needs to be considered for longitudinal studies and could be overcome by using an ANN, which performs as good as human observers and fully automatizes MP-MRI post-processing.
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Affiliation(s)
- Corin Willers
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Simon Andermatt
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Francesco Santini
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Robin Sandkühler
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Kathryn A Ramsey
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe C Cattin
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Orso Pusterla
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Philipp Latzin
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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20
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Neal MA, Pippard BJ, Simpson AJ, Thelwall PE. Dynamic susceptibility contrast 19 F-MRI of inhaled perfluoropropane: a novel approach to combined pulmonary ventilation and perfusion imaging. Magn Reson Med 2019; 83:452-461. [PMID: 31468589 PMCID: PMC6899496 DOI: 10.1002/mrm.27933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess alveolar perfusion by applying dynamic susceptibility contrast MRI to 19 F-MRI of inhaled perfluoropropane (PFP). We hypothesized that passage of gadolinium-based contrast agent (GBCA) through the pulmonary microvasculature would reduce magnetic susceptibility differences between water and gas components of the lung, elevating the T 2 ∗ of PFP. METHODS Lung-representative phantoms were constructed of aqueous PFP-filled foams to characterize the impact of aqueous/gas phase magnetic susceptibility differences on PFP T 2 ∗ . Aqueous phase magnetic susceptibility was modulated by addition of different concentrations of GBCA. In vivo studies were performed to measure the impact of intravenously administered GBCA on the T 2 ∗ of inhaled PFP in mice (7.0 Tesla) and in healthy volunteers (3.0 Tesla). RESULTS Perfluoropropane T 2 ∗ was sensitive to modulation of magnetic susceptibility difference between gas and water components of the lung, both in phantom models and in vivo. Negation of aqueous/gas phase magnetic susceptibility difference was achieved in lung-representative phantoms and in mice, resulting in a ~2 to 3× elevation in PFP T 2 ∗ (3.7 to 8.5 ms and 0.7 to 2.6 ms, respectively). Human studies demonstrated a transient elevation of inhaled PFP T 2 ∗ (1.50 to 1.64 ms) during passage of GBCA bolus through the lung circulation, demonstrating sensitivity to lung perfusion. CONCLUSION We demonstrate indirect detection of a GBCA in the pulmonary microvasculature via changes to the T 2 ∗ of gas phase PFP within directly adjacent alveoli. This approach holds potential for assessing alveolar perfusion by dynamic susceptibility contrast 19 F-MRI of inhaled PFP, with concurrent assessment of lung ventilation properties, relevant to lung physiology and disease.
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Affiliation(s)
- Mary A Neal
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Benjamin J Pippard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A John Simpson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Peter E Thelwall
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Newcastle Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, United Kingdom
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21
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Bondesson D, Schneider MJ, Gaass T, Kühn B, Bauman G, Dietrich O, Dinkel J. Nonuniform Fourier-decomposition MRI for ventilation- and perfusion-weighted imaging of the lung. Magn Reson Med 2019; 82:1312-1321. [PMID: 31111551 PMCID: PMC6767124 DOI: 10.1002/mrm.27803] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/20/2019] [Accepted: 04/15/2019] [Indexed: 11/11/2022]
Abstract
PURPOSE To improve the robustness of pulmonary ventilation- and perfusion-weighted imaging with Fourier decomposition (FD) MRI in the presence of respiratory and cardiac frequency variations by replacing the standard fast Fourier transform with the more general nonuniform Fourier transform. THEORY AND METHODS Dynamic coronal single-slice MRI of the thorax was performed in 11 patients and 5 healthy volunteers on a 1.5T whole-body scanner using a 2D ultra-fast balanced steady-state free-precession sequence with temporal resolutions of 4-9 images/s. For the proposed nonuniform Fourier-decomposition (NUFD) approach, the original signal with variable physiological frequencies that was acquired with constant sampling rate was retrospectively transformed into a signal with (ventilation or perfusion) frequency-adapted sampling rate. For that purpose, frequency tracking was performed with the synchro-squeezed wavelet transform. Ventilation- and perfusion-weighted NUFD amplitude and signal delay maps were generated and quantitatively compared with regularly sampled FD maps based on their signal-to-noise ratio (SNR). RESULTS Volunteers and patients showed statistically significant increases of SNR in frequency-adapted NUFD results compared to regularly sampled FD results. For ventilation data, the mean SNR increased by 43.4 % ± 25.3 % and 24.4 % ± 31.9 % in volunteers and patients, respectively; for perfusion data, SNR increased by 93.0 % ± 36.1 % and 75.6 % ± 62.8 % . Two patients showed perfusion signal in pulmonary areas with NUFD that could not be imaged with FD. CONCLUSION This study demonstrates that using nonuniform Fourier transform in combination with frequency tracking can significantly increase SNR and reduce frequency overlaps by collecting the signal intensity onto single frequency bins.
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Affiliation(s)
- David Bondesson
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Moritz J Schneider
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Thomas Gaass
- Siemens Healthcare Pty Ltd, Bowen Hills, Australia
| | - Bernd Kühn
- Siemens Healthcare GmbH, Erlangen, Germany
| | - Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Olaf Dietrich
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Julien Dinkel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.,Comprehensive Pneumology Center (CPC-M), German Center for Lung Research (DZL), Munich, Germany
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22
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Vogel-Claussen J, Schönfeld CO, Kaireit TF, Voskrebenzev A, Czerner CP, Renne J, Tillmann HC, Berschneider K, Hiltl S, Bauersachs J, Welte T, Hohlfeld JM. Effect of Indacaterol/Glycopyrronium on Pulmonary Perfusion and Ventilation in Hyperinflated Patients with Chronic Obstructive Pulmonary Disease (CLAIM). A Double-Blind, Randomized, Crossover Trial. Am J Respir Crit Care Med 2019; 199:1086-1096. [DOI: 10.1164/rccm.201805-0995oc] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Christian-Olaf Schönfeld
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Till F. Kaireit
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Christoph P. Czerner
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Julius Renne
- Institute for Diagnostic and Interventional Radiology
- German Center for Lung Research (BREATH), Hannover, Germany
| | | | | | - Simone Hiltl
- Novartis Pharma GmbH, Clinical Research Respiratory, Nuremberg, Germany; and
| | | | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (BREATH), Hannover, Germany
| | - Jens M. Hohlfeld
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (BREATH), Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
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23
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Westcott A, McCormack DG, Parraga G, Ouriadov A. Advanced pulmonary MRI to quantify alveolar and acinar duct abnormalities: Current status and future clinical applications. J Magn Reson Imaging 2019; 50:28-40. [PMID: 30637857 DOI: 10.1002/jmri.26623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 12/23/2022] Open
Abstract
There are serious clinical gaps in our understanding of chronic lung disease that require novel, sensitive, and noninvasive in vivo measurements of the lung parenchyma to measure disease pathogenesis and progressive changes over time as well as response to treatment. Until recently, our knowledge and appreciation of the tissue changes that accompany lung disease has depended on ex vivo biopsy and concomitant histological and stereological measurements. These measurements have revealed the underlying pathologies that drive lung disease and have provided important observations about airway occlusion, obliteration of the terminal bronchioles and airspace enlargement, or fibrosis and their roles in disease initiation and progression. ex vivo tissue stereology and histology are the established gold standards and, more recently, micro-computed tomography (CT) measurements of ex vivo tissue samples has also been employed to reveal new mechanistic findings about the progression of obstructive lung disease in patients. While these approaches have provided important understandings using ex vivo analysis of excised samples, recently developed hyperpolarized noble gas MRI methods provide an opportunity to noninvasively measure acinar duct and terminal airway dimensions and geometry in vivo, and, without radiation burden. Therefore, in this review we summarize emerging pulmonary MRI morphometry methods that provide noninvasive in vivo measurements of the lung in patients with bronchopulmonary dysplasia and chronic obstructive pulmonary disease, among others. We discuss new findings, future research directions, as well as clinical opportunities to address current gaps in patient care and for testing of new therapies. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:28-40.
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Affiliation(s)
- Andrew Westcott
- Robarts Research Institute, University of Western Ontario, London, Canada.,Department of Medical Biophysics, University of Western Ontario, London, Canada
| | - David G McCormack
- Division of Respirology, Department of Medicine, University of Western Ontario, London, Canada
| | - Grace Parraga
- Robarts Research Institute, University of Western Ontario, London, Canada.,Department of Medical Biophysics, University of Western Ontario, London, Canada.,Division of Respirology, Department of Medicine, University of Western Ontario, London, Canada
| | - Alexei Ouriadov
- Department of Physics and Astronomy, University of Western Ontario, London, Canada
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24
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Ter-Karapetyan A, Triphan SMF, Jobst BJ, Anjorin AF, Ley-Zaporozhan J, Ley S, Sedlaczek O, Biederer J, Kauczor HU, Jakob PM, Wielpütz MO. Towards quantitative perfusion MRI of the lung in COPD: The problem of short-term repeatability. PLoS One 2018; 13:e0208587. [PMID: 30532179 PMCID: PMC6287948 DOI: 10.1371/journal.pone.0208587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/20/2018] [Indexed: 01/12/2023] Open
Abstract
Purpose 4D perfusion magnetic resonance imaging (MRI) with intravenous injection of contrast agent allows for a radiation-free assessment of regional lung function. It is therefore a valuable method to monitor response to treatment in patients with chronic obstructive pulmonary disease (COPD). This study was designed to evaluate its potential for monitoring short-term response to hyperoxia in COPD patients. Materials and methods 19 prospectively enrolled COPD patients (median age 66y) underwent paired dynamic contrast-enhanced 4D perfusion MRI within 35min, first breathing 100% oxygen (injection 1, O2) and then room air (injection 2, RA), which was repeated on two consecutive days (day 1 and 2). Post-processing software was employed to calculate mean transit time (MTT), pulmonary blood volume (PBV) and pulmonary blood flow (PBF), based on the indicator dilution theory, for the automatically segmented whole lung and 12 regions of equal volume. Results Comparing O2 with RA conditions, PBF and PBV were found to be significantly lower at O2, consistently on both days (p<10–8). Comparing day 2 to day 1, MTT was shorter by 0.59±0.63 s (p<10–8), PBF was higher by 22±80 ml/min/100ml (p<3·10–4), and PBV tended to be lower by 0.2±7.2 ml/100ml (p = 0.159) at both, RA and O2, conditions. Conclusion The second injection (RA) yielded higher PBF and PBV, which apparently contradicts the established hypothesis that hyperoxia increases lung perfusion. Quantification of 4D perfusion MRI by current software approaches may thus be limited by residual circulating contrast agent in the short-term and even the next day.
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Affiliation(s)
- Alvard Ter-Karapetyan
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Simon M. F. Triphan
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Research Center Magnetic Resonance Bavaria (MRB), Würzburg, Germany
- * E-mail:
| | - Bertram J. Jobst
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Angela F. Anjorin
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Julia Ley-Zaporozhan
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
| | - Sebastian Ley
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany
- Diagnostic & Interventional Radiology, Chirurgisches Klinikum München Süd, Munich, Germany
| | - Oliver Sedlaczek
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Jürgen Biederer
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Radiologie Darmstadt, Department of Radiology, County Hospital Gross-Gerau, Gross-Gerau, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
| | - Peter M. Jakob
- Research Center Magnetic Resonance Bavaria (MRB), Würzburg, Germany
- Department of Experimental Physics Julius-Maximilians Universität, Würzburg, Germany
| | - Mark O. Wielpütz
- Department of Diagnostic & Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
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25
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The Expanding Role of Physiologic Imaging in Radiation Oncology. Int J Radiat Oncol Biol Phys 2018; 102:694-697. [DOI: 10.1016/j.ijrobp.2018.01.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/16/2018] [Indexed: 11/19/2022]
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26
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Guo F, Capaldi DPI, McCormack DG, Fenster A, Parraga G. A framework for Fourier-decomposition free-breathing pulmonary 1 H MRI ventilation measurements. Magn Reson Med 2018; 81:2135-2146. [PMID: 30362609 DOI: 10.1002/mrm.27527] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 08/20/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To develop a rapid Fourier decomposition (FD) free-breathing pulmonary 1 H MRI (FDMRI) image processing and biomarker pipeline for research use. METHODS We acquired MRI in 20 asthmatic subjects using a balanced steady-state free precession (bSSFP) sequence optimized for ventilation imaging. 2D 1 H MRI series were segmented by enforcing the spatial similarity between adjacent images and the right-to-left lung volume-ratio. The segmented lung series were co-registered using a coarse-to-fine deformable registration framework that used dual optimization techniques. All pairwise registrations were implemented in parallel and FD was performed to generate 2D ventilation-weighted maps and ventilation-defect-percent (VDP). Lung segmentation and registration accuracy were evaluated by comparing algorithm and manual lung-masks, deformed manual lung-masks, and fiducials in the moving and fixed images using Dice-similarity-coefficient (DSC), mean-absolute-distance (MAD), and target-registration-error (TRE). The relationship of FD-VDP and 3 He-VDP was evaluated using the Pearson-correlation-coefficient (r) and Bland Altman analysis. Algorithm reproducibility was evaluated using the coefficient-of-variation (CoV) and intra-class-correlation-coefficient (ICC) for segmentation, registration, and FD-VDP components. RESULTS For lung segmentation, there was a DSC of 95 ± 1.5% and MAD of 2.3 ± 0.5 mm, and for registration there was a DSC of 97 ± 0.8%, MAD of 1.6 ± 0.4 mm and TRE of 3.6 ± 1.2 mm. Reproducibility for segmentation DSC (CoV/ICC = 0.5%/0.92), registration TRE (CoV/ICC = 0.4%/0.98), and FD-VDP (Cov/ICC = 3.9%/0.97) was high. The pipeline required 10 min/subject. FD-VDP was correlated with 3 He-VDP (r = 0.69, P < 0.001) although there was a bias toward lower FD-VDP (bias = -4.9%). CONCLUSIONS We developed and evaluated a pipeline that provides a rapid and precise method for FDMRI ventilation maps.
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Affiliation(s)
- Fumin Guo
- Robarts Research Institute, Western University, London, Ontario, Canada.,Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Dante P I Capaldi
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - David G McCormack
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - Aaron Fenster
- 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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27
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Couch MJ, Ball IK, Li T, Fox MS, Biman B, Albert MS. 19 F MRI of the Lungs Using Inert Fluorinated Gases: Challenges and New Developments. J Magn Reson Imaging 2018; 49:343-354. [PMID: 30248212 DOI: 10.1002/jmri.26292] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/23/2018] [Accepted: 07/26/2018] [Indexed: 12/27/2022] Open
Abstract
Fluorine-19 (19 F) MRI using inhaled inert fluorinated gases is an emerging technique that can provide functional images of the lungs. Inert fluorinated gases are nontoxic, abundant, relatively inexpensive, and the technique can be performed on any MRI scanner with broadband multinuclear imaging capabilities. Pulmonary 19 F MRI has been performed in animals, healthy human volunteers, and in patients with lung disease. In this review, the technical requirements of 19 F MRI are discussed, along with various imaging approaches used to optimize the image quality. Lung imaging is typically performed in humans using a gas mixture containing 79% perfluoropropane (PFP) or sulphur hexafluoride (SF6 ) and 21% oxygen. In lung diseases, such as asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF), ventilation defects are apparent in regions that the inhaled gas cannot access. 19 F lung images are typically acquired in a single breath-hold, or in a time-resolved, multiple breath fashion. The former provides measurements of the ventilation defect percent (VDP), while the latter provides measurements of gas replacement (ie, fractional ventilation). Finally, preliminary comparisons with other functional lung imaging techniques are discussed, such as Fourier decomposition MRI and hyperpolarized gas MRI. Overall, functional 19 F lung MRI is expected to complement existing proton-based structural imaging techniques, and the combination of structural and functional lung MRI will provide useful outcome measures in the future management of pulmonary diseases in the clinic. Level of Evidence: 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:343-354.
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Affiliation(s)
- Marcus J Couch
- Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Iain K Ball
- Philips Electronics Australia, North Ryde, Sydney, Australia
| | - Tao Li
- Department of Chemistry, Lakehead University, Thunder Bay, Ontario, Canada
| | - Matthew S Fox
- Imaging Program, Lawson Health Research Institute, London, Ontario, Canada.,Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Birubi Biman
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, Ontario, Canada.,Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mitchell S Albert
- Department of Chemistry, Lakehead University, Thunder Bay, Ontario, Canada.,Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.,Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
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28
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Rengier F, Melzig C, Derlin T, Marra AM, Vogel-Claussen J. Advanced imaging in pulmonary hypertension: emerging techniques and applications. Int J Cardiovasc Imaging 2018; 35:1407-1420. [DOI: 10.1007/s10554-018-1448-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
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29
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Tsuchiya N, Beek EJRV, Ohno Y, Hatabu H, Kauczor HU, Swift A, Vogel-Claussen J, Biederer J, Wild J, Wielpütz MO, Schiebler ML. Magnetic resonance angiography for the primary diagnosis of pulmonary embolism: A review from the international workshop for pulmonary functional imaging. World J Radiol 2018; 10:52-64. [PMID: 29988845 PMCID: PMC6033703 DOI: 10.4329/wjr.v10.i6.52] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 04/25/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
Pulmonary contrast enhanced magnetic resonance angiography (CE-MRA) is useful for the primary diagnosis of pulmonary embolism (PE). Many sites have chosen not to use CE-MRA as a first line of diagnostic tool for PE because of the speed and higher efficacy of computerized tomographic angiography (CTA). In this review, we discuss the strengths and weaknesses of CE-MRA and the appropriate imaging scenarios for the primary diagnosis of PE derived from our unique multi-institutional experience in this area. The optimal patient for this test has a low to intermediate suspicion for PE based on clinical decision rules. Patients in extremis are not candidates for this test. Younger women (< 35 years of age) and patients with iodinated contrast allergies are best served by using this modality We discuss the history of the use of this test, recent technical innovations, artifacts, direct and indirect findings for PE, ancillary findings, and the effectiveness (patient outcomes) of CE-MRA for the exclusion of PE. Current outcomes data shows that CE-MRA and NM V/Q scans are effective alternative tests to CTA for the primary diagnosis of PE.
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Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa 903-0215, Japan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Edwin JR van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, United Kingdom
| | - Yoshiharu Ohno
- Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Andrew Swift
- Department of Radiology, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2JF, United Kingdom
| | - Jens Vogel-Claussen
- Department of Radiology, Carl-Neuberg Strasse 1, Hannover-Gr-Buchholz 30625, Germany
| | - Jürgen Biederer
- Radiology Darmstadt, Gross-Gerau County Hospital, Gross-Gerau 64521, Germany
| | - James Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2JF, United Kingdom
| | - Mark O Wielpütz
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg 69120, Germany
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53792, United States
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30
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Nyilas S, Bauman G, Sommer G, Stranzinger E, Pusterla O, Frey U, Korten I, Singer F, Casaulta C, Bieri O, Latzin P. Novel magnetic resonance technique for functional imaging of cystic fibrosis lung disease. Eur Respir J 2017; 50:50/6/1701464. [DOI: 10.1183/13993003.01464-2017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/31/2017] [Indexed: 11/05/2022]
Abstract
Lung function tests are commonly used to monitor lung disease in cystic fibrosis (CF). While practical, they cannot locate the exact origin of functional impairment. Contemporary magnetic resonance imaging (MRI) techniques provide information on the location of disease but the need for contrast agents constrains their repeated application. We examined the correlation between functional MRI, performed without administration of contrast agent, and lung clearance index (LCI) from nitrogen multiple-breath washout (N2-MBW).40 children with CF (median (range) age 12.0 (6–18) years) and 12 healthy age-matched controls underwent functional and structural MRI and lung function tests on the same day. Functional MRI provided semiquantitative measures of perfusion (RQ) and ventilation (RFV) impairment as percentages of affected lung volume. Morphological MRI was evaluated using CF-specific scores. LCI measured global ventilation inhomogeneity.MRI detected functional impairment in CF:RFV19–38% andRQ16–35%.RFVandRQcorrelated strongly with LCI (r=0.76, p<0.0001 and r=0.85, p<0.0001, respectively), as did total morphology score (r=0.81, p<0.0001). All indices differed significantly between patients with CF and healthy controls (p<0.001).Noninvasive functional MRI is a promising method to detect and visualise perfusion and ventilation impairment in CF without the need for contrast agents.
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31
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Kaireit TF, Sorrentino SA, Renne J, Schoenfeld C, Voskrebenzev A, Gutberlet M, Schulz A, Jakob PM, Hansen G, Wacker F, Welte T, Tümmler B, Vogel-Claussen J. Functional lung MRI for regional monitoring of patients with cystic fibrosis. PLoS One 2017; 12:e0187483. [PMID: 29216201 PMCID: PMC5720731 DOI: 10.1371/journal.pone.0187483] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 10/03/2017] [Indexed: 11/29/2022] Open
Abstract
Purpose To test quantitative functional lung MRI techniques in young adults with cystic fibrosis (CF) compared to healthy volunteers and to monitor immediate treatment effects of a single inhalation of hypertonic saline in comparison to clinical routine pulmonary function tests. Materials and methods Sixteen clinically stable CF patients and 12 healthy volunteers prospectively underwent two functional lung MRI scans and pulmonary function tests before and 2h after a single treatment of inhaled hypertonic saline or without any treatment. MRI-derived oxygen enhanced T1 relaxation measurements, fractional ventilation, first-pass perfusion parameters and a morpho-functional CF-MRI score were acquired. Results Compared to healthy controls functional lung MRI detected and quantified significantly increased ventilation heterogeneity in CF patients. Regional functional lung MRI measures of ventilation and perfusion as well as the CF-MRI score and pulmonary function tests could not detect a significant treatment effect two hours after a single treatment with hypertonic saline in young adults with CF (p>0.05). Conclusion This study shows the feasibility of functional lung MRI as a non-invasive, radiation-free tool for monitoring patients with CF.
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Affiliation(s)
- Till F. Kaireit
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Sajoscha A. Sorrentino
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Julius Renne
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Christian Schoenfeld
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Andreas Voskrebenzev
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Angela Schulz
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Peter M. Jakob
- Department of Experimental Physics 5, University of Würzburg, Würzburg, Germany
| | - Gesine Hansen
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Burkhard Tümmler
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research, Hannover, Germany
- * E-mail:
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Kaireit TF, Gutberlet M, Voskrebenzev A, Freise J, Welte T, Hohlfeld JM, Wacker F, Vogel-Claussen J. Comparison of quantitative regional ventilation-weighted fourier decomposition MRI with dynamic fluorinated gas washout MRI and lung function testing in COPD patients. J Magn Reson Imaging 2017; 47:1534-1541. [DOI: 10.1002/jmri.25902] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/01/2017] [Indexed: 12/23/2022] Open
Affiliation(s)
- Till F. Kaireit
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research; Hannover Germany
| | - Marcel Gutberlet
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research; Hannover Germany
| | - Andreas Voskrebenzev
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research; Hannover Germany
| | - Julia Freise
- Clinic of Pneumology; Hannover Medical School; Hannover Germany
| | - Tobias Welte
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research; Hannover Germany
- Clinic of Pneumology; Hannover Medical School; Hannover Germany
| | - Jens M. Hohlfeld
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research; Hannover Germany
- Clinic of Pneumology; Hannover Medical School; Hannover Germany
- Fraunhofer Institute for Toxicology and Experimental Medicine; Hannover Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research; Hannover Germany
| | - Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology; Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research; Hannover Germany
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Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable causes of pulmonary hypertension and is definitively treated with pulmonary thromboendartectomy. CTEPH can be overlooked, as its symptoms are nonspecific and can be mimicked by a wide range of diseases that can cause pulmonary hypertension. Early diagnosis of CTEPH and prompt evaluation for surgical candidacy are paramount factors in determining future outcomes. Imaging plays a central role in the diagnosis of CTEPH and patient selection for pulmonary thromboendartectomy and balloon pulmonary angioplasty. Currently, various imaging tools are used in concert, with techniques such as computed tomography (CT) and conventional pulmonary angiography providing detailed structural information, tests such as ventilation-perfusion (V/Q) scanning providing functional data, and magnetic resonance imaging providing a combination of morphologic and functional information. Emerging techniques such as dual-energy CT and single photon emission computed tomography-CT V/Q scanning promise to provide both anatomic and functional information in a single test and may change the way we image these patients in the near future. In this review, we discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH. We also explore newer imaging techniques and the potential value they may offer.
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Capaldi DP, Sheikh K, Eddy RL, Guo F, Svenningsen S, Nair P, McCormack DG, Parraga G. Free-breathing Functional Pulmonary MRI: Response to Bronchodilator and Bronchoprovocation in Severe Asthma. Acad Radiol 2017; 24:1268-1276. [PMID: 28551402 DOI: 10.1016/j.acra.2017.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/05/2017] [Accepted: 04/08/2017] [Indexed: 02/03/2023]
Abstract
RATIONALE AND OBJECTIVES Ventilation heterogeneity is a hallmark feature of asthma. Our objective was to evaluate ventilation heterogeneity in patients with severe asthma, both pre- and post-salbutamol, as well as post-methacholine (MCh) challenge using the lung clearance index, free-breathing pulmonary 1H magnetic resonance imaging (FDMRI), and inhaled-gas MRI ventilation defect percent (VDP). MATERIALS AND METHODS Sixteen severe asthmatics (49 ± 10 years) provided written informed consent to an ethics board-approved protocol. Spirometry, plethysmography, and multiple breath nitrogen washout to measure the lung clearance index were performed during a single visit within 15 minutes of MRI. Inhaled-gas MRI and FDMRI were performed pre- and post-bronchodilator to generate VDP. For asthmatics with forced expiratory volume in 1 second (FEV1) >70%predicted, MRI was also performed before and after MCh challenge. Wilcoxon signed-rank tests, Spearman correlations, and a repeated-measures analysis of variance were performed. RESULTS Hyperpolarized 3He (P = .02) and FDMRI (P = .02) VDP significantly improved post-salbutamol and for four asthmatics who could perform MCh (n = 4). 3He and FDMRI VDP significantly increased at the provocative concentration of MCh, resulting in a 20% decrease in FEV1 (PC20) and decreased post-bronchodilator (P = .02), with a significant difference between methods (P = .01). FDMRI VDP was moderately correlated with 3He VDP (ρ = .61, P = .01), but underestimated VDP relative to 3He VDP (-6 ± 9%). Whereas 3He MRI VDP was significantly correlated with the lung clearance index, FDMRI was not (ρ = .49, P = .06). CONCLUSIONS FDMRI VDP generated in free-breathing asthmatic patients was correlated with static inspiratory breath-hold 3He MRI VDP but underestimated VDP relative to 3He MRI VDP. Although less sensitive to salbutamol and MCh, FDMRI VDP may be considered for asthma patient evaluations at centers without inhaled-gas MRI.
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Bahig H, Campeau MP, Lapointe A, Bedwani S, Roberge D, de Guise J, Blais D, Vu T, Lambert L, Chartrand-Lefebvre C, Lord M, Filion E. Phase 1-2 Study of Dual-Energy Computed Tomography for Assessment of Pulmonary Function in Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2017; 99:334-343. [DOI: 10.1016/j.ijrobp.2017.05.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/24/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022]
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A decade of lung expansion: A review of ventilation-weighted 1 H lung MRI. Z Med Phys 2017; 27:172-179. [DOI: 10.1016/j.zemedi.2016.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/10/2016] [Accepted: 07/26/2016] [Indexed: 11/30/2022]
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Altit G, Dancea A, Renaud C, Perreault T, Lands LC, Sant'Anna G. Pathophysiology, screening and diagnosis of pulmonary hypertension in infants with bronchopulmonary dysplasia - A review of the literature. Paediatr Respir Rev 2017; 23:16-26. [PMID: 27986502 DOI: 10.1016/j.prrv.2016.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is a common complication of extreme prematurity, which has increased over the last 20 years. BPD is associated with increased morbidities and mortality. It has been increasingly recognized that BPD affects overall lung development including the pulmonary vasculature. More recent studies have demonstrated an increased awareness of pulmonary arterial hypertension (PH) in BPD patients and recent international guidelines have advocated for better screening. This review will describe the current understanding of the pathophysiology of PH in infants with BPD, the in-depth assessment of the available literature linking PH and BPD, and propose an approach of screening and diagnosis of PH in infants with BPD.
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Veldhoen S, Weng AM, Knapp J, Kunz AS, Stäb D, Wirth C, Segerer F, Hebestreit H, Malzahn U, Köstler H, Bley TA. Self-gated Non–Contrast-enhanced Functional Lung MR Imaging for Quantitative Ventilation Assessment in Patients with Cystic Fibrosis. Radiology 2017; 283:242-251. [DOI: 10.1148/radiol.2016160355] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Simon Veldhoen
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Andreas M. Weng
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Janine Knapp
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Andreas S. Kunz
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Daniel Stäb
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Clemens Wirth
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Florian Segerer
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Helge Hebestreit
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Uwe Malzahn
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Herbert Köstler
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
| | - Thorsten A. Bley
- From the Department of Diagnostic and Interventional Radiology (S.V., A.M.W., J.K., A.S.K., D.S., C.W., H.K., T.A.B.), Department of Pediatrics (F.S., H.H.), and Clinical Trial Center Würzburg (U.M.), University Hospital Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany; and Centre of Advanced Imaging, University of Queensland, Brisbane, Australia (D.S.)
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Johns CS, Swift AJ, Hughes PJ, Ohno Y, Schiebler M, Wild JM. Pulmonary MR angiography and perfusion imaging—A review of methods and applications. Eur J Radiol 2017; 86:361-370. [DOI: 10.1016/j.ejrad.2016.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/01/2016] [Indexed: 10/20/2022]
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Voskrebenzev A, Gutberlet M, Kaireit TF, Wacker F, Vogel-Claussen J. Low-pass imaging of dynamic acquisitions (LIDA) with a group-oriented registration (GOREG) for proton MR imaging of lung ventilation. Magn Reson Med 2016; 78:1496-1505. [DOI: 10.1002/mrm.26526] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/14/2016] [Accepted: 10/04/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Andreas Voskrebenzev
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research; Hannover Germany
| | - Marcel Gutberlet
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research; Hannover Germany
| | - Till F. Kaireit
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research; Hannover Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research; Hannover Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School; Hannover Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research; Hannover Germany
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Ireland R, Tahir B, Wild J, Lee C, Hatton M. Functional Image-guided Radiotherapy Planning for Normal Lung Avoidance. Clin Oncol (R Coll Radiol) 2016; 28:695-707. [DOI: 10.1016/j.clon.2016.08.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 12/25/2022]
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Pusterla O, Bauman G, Wielpütz MO, Nyilas S, Latzin P, Heussel CP, Bieri O. Rapid 3D in vivo 1H human lung respiratory imaging at 1.5 T using ultra-fast balanced steady-state free precession. Magn Reson Med 2016; 78:1059-1069. [DOI: 10.1002/mrm.26503] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/17/2016] [Accepted: 09/18/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Orso Pusterla
- Division of Radiological Physics, Department of Radiology; University of Basel Hospital; Basel Switzerland
- Department of Biomedical Engineering; University of Basel; Basel Switzerland
| | - Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology; University of Basel Hospital; Basel Switzerland
- Department of Biomedical Engineering; University of Basel; Basel Switzerland
| | - Mark O. Wielpütz
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine; Thoraxklinik at University Hospital Heidelberg; Heidelberg Germany
- Department of Diagnostic and Interventional Radiology; University Hospital of Heidelberg; Heidelberg Germany
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL); Heidelberg Germany
| | - Sylvia Nyilas
- Division of Respiratory Medicine, Department of Pediatrics; University Children's Hospital of Bern; Bern Switzerland
- Department of Pediatric Pneumology; University Children's Hospital Basel (UKBB); Basel Switzerland
| | - Philipp Latzin
- Division of Respiratory Medicine, Department of Pediatrics; University Children's Hospital of Bern; Bern Switzerland
- Department of Pediatric Pneumology; University Children's Hospital Basel (UKBB); Basel Switzerland
| | - Claus P. Heussel
- Department of Diagnostic and Interventional Radiology with Nuclear Medicine; Thoraxklinik at University Hospital Heidelberg; Heidelberg Germany
- Department of Diagnostic and Interventional Radiology; University Hospital of Heidelberg; Heidelberg Germany
- Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL); Heidelberg Germany
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology; University of Basel Hospital; Basel Switzerland
- Department of Biomedical Engineering; University of Basel; Basel Switzerland
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Mall MA, Stahl M, Graeber SY, Sommerburg O, Kauczor HU, Wielpütz MO. Early detection and sensitive monitoring of CF lung disease: Prospects of improved and safer imaging. Pediatr Pulmonol 2016; 51:S49-S60. [PMID: 27662104 DOI: 10.1002/ppul.23537] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 12/27/2022]
Abstract
Recent imaging studies using chest computed tomography (CT) in presymptomatic infants and young children with cystic fibrosis (CF) diagnosed by newborn screening presented compelling evidence of early onset and progression of structural lung damage in CF. These data argue persuasively that non-invasive outcome measures for early detection and sensitive monitoring of lung disease applicable in the clinical setting will be instrumental for further improvement of clinical care and the development of early intervention therapies that have the potential to prevent irreversible lung damage. In this context, the use of CT imaging for early detection and long-term monitoring has the disadvantage of the risk to induce malignancies due to cumulating ionizing radiation exposure. More recently, magnetic resonance imaging (MRI) has emerged as an alternative radiation-free imaging technique for quantitative assessment of CF lung disease. In addition to structural lung damage, chest MRI enables non-invasive assessment of abnormalities in lung perfusion and ventilation characteristically associated with mucus plugging in CF lung disease. Here, we review recent developments and the prospects of MRI for improved and safer imaging with a focus on recent studies that support its utility as a sensitive non-invasive outcome measure of early lung disease in young children with CF. Pediatr Pulmonol. 2016;51:S49-S60. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marcus A Mall
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany. .,Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany. .,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.
| | - Mirjam Stahl
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany.,Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Simon Y Graeber
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany.,Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Olaf Sommerburg
- Department of Translational Pulmonology, University of Heidelberg, Heidelberg, Germany.,Division of Pediatric Pulmonology and Allergy and Cystic Fibrosis Center, Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
| | - Mark O Wielpütz
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), University of Heidelberg, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
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Yazdani M, Lau CT, Lempel JK, Yadav R, El-Sherief AH, Azok JT, Renapurkar RD. Historical Evolution of Imaging Techniques for the Evaluation of Pulmonary Embolism. Radiographics 2016; 35:1245-62. [PMID: 26172362 DOI: 10.1148/rg.2015140280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As we celebrate the 100th anniversary of the founding of the Radiological Society of North America (RSNA), it seems fitting to look back at the major accomplishments of the radiology community in the diagnosis of pulmonary embolism. Few diseases have so consistently captured the attention of the medical community. Since the first description of pulmonary embolism by Virchow in the 1850s, clinicians have struggled to reach a timely diagnosis of this common condition because of its nonspecific and often confusing clinical picture. As imaging tests started to gain importance in the 1900s, the approach to diagnosing pulmonary embolism also began to change. Rapid improvements in angiography, ventilation-perfusion imaging, and cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging have constantly forced health care professionals to rethink how they diagnose pulmonary embolism. Needless to say, the way pulmonary embolism is diagnosed today is distinctly different from how it was diagnosed in Virchow's era; and imaging, particularly CT, now forms the cornerstone of diagnostic evaluation. Currently, radiology offers a variety of tests that are fast and accurate and can provide anatomic and functional information, thus allowing early diagnosis and triage of cases. This review provides a historical journey into the evolution of these imaging tests and highlights some of the major breakthroughs achieved by the radiology community and RSNA in this process. Also highlighted are areas of ongoing research and development in this field of imaging as radiologists seek to combat some of the newer challenges faced by modern medicine, such as rising health care costs and radiation dose hazards.
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Affiliation(s)
- Milad Yazdani
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Charles T Lau
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Jason K Lempel
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ruchi Yadav
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ahmed H El-Sherief
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Joseph T Azok
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Rahul D Renapurkar
- From the Sections of Thoracic Imaging (M.Y., C.T.L., J.K.L., R.Y., A.H.E., J.T.Z., R.D.R.) and Nuclear Medicine (R.Y., R.D.R.), Imaging Institute, Thoracic Imaging L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
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Leitão Filho FS, Hang Chen H, Ngan DA, Tam A, Kirby M, Sin DD. Current methods to diagnose small airway disease in patients with COPD. Expert Rev Respir Med 2016; 10:417-429. [PMID: 26890226 DOI: 10.1586/17476348.2016.1155455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The small airways are characterized by an internal diameter < 2 mm and absence of cartilage. Approximately 10-25% of total airway resistance in healthy lungs is due to the small airways, with their contribution to total airway resistance increasing substantially in chronic obstructive pulmonary disease (COPD). As the small airways are located in the lung periphery, they are not easily evaluable, which can potentially interfere with the diagnosis (especially at early stages), monitoring, detection of responses to clinical interventions, and prognostic evaluation in COPD. Here, we will discuss the currently available methods in clinical practice to evaluate small airway disease in COPD, focusing on the concept, advantages, and disadvantages of each method.
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Affiliation(s)
- Fernando Sergio Leitão Filho
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Hao Hang Chen
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - David A Ngan
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Anthony Tam
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Miranda Kirby
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
| | - Don D Sin
- a Centre for Heart Lung Innovation, St. Paul´s Hospital, & Department of Medicine , University of British Columbia , Vancouver , British Columbia , Canada
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Hoffman EA, Lynch DA, Barr RG, van Beek EJR, Parraga G. Pulmonary CT and MRI phenotypes that help explain chronic pulmonary obstruction disease pathophysiology and outcomes. J Magn Reson Imaging 2016; 43:544-57. [PMID: 26199216 PMCID: PMC5207206 DOI: 10.1002/jmri.25010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 07/01/2015] [Indexed: 12/12/2022] Open
Abstract
Pulmonary x-ray computed tomographic (CT) and magnetic resonance imaging (MRI) research and development has been motivated, in part, by the quest to subphenotype common chronic lung diseases such as chronic obstructive pulmonary disease (COPD). For thoracic CT and MRI, the main COPD research tools, disease biomarkers are being validated that go beyond anatomy and structure to include pulmonary functional measurements such as regional ventilation, perfusion, and inflammation. In addition, there has also been a drive to improve spatial and contrast resolution while at the same time reducing or eliminating radiation exposure. Therefore, this review focuses on our evolving understanding of patient-relevant and clinically important COPD endpoints and how current and emerging MRI and CT tools and measurements may be exploited for their identification, quantification, and utilization. Since reviews of the imaging physics of pulmonary CT and MRI and reviews of other COPD imaging methods were previously published and well-summarized, we focus on the current clinical challenges in COPD and the potential of newly emerging MR and CT imaging measurements to address them. Here we summarize MRI and CT imaging methods and their clinical translation for generating reproducible and sensitive measurements of COPD related to pulmonary ventilation and perfusion as well as parenchyma morphology. The key clinical problems in COPD provide an important framework in which pulmonary imaging needs to rapidly move in order to address the staggering burden, costs, as well as the mortality and morbidity associated with COPD.
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Affiliation(s)
- Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA
| | - David A Lynch
- Department of Radiology, National Jewish Health Center, Denver, Colorado, USA
| | - R Graham Barr
- Division of General Medicine, Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Columbia University Medical Center, New York, New York, USA
- Department of Epidemiology, Columbia University Medical Center, New York, New York, USA
| | - Edwin J R van Beek
- Clinical Research Imaging Centre, Queen's Medical Research Institute, University of Edinburgh, Scotland, UK
| | - Grace Parraga
- Robarts Research Institute, University of Western Ontario, London, Canada
- Department of Medical Biophysics, University of Western Ontario, London, Canada
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47
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Wielpütz MO, Kauczor HU. Imaging cystic fibrosis lung disease with MRI. IMAGING 2016. [DOI: 10.1183/2312508x.10002415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Bauman G, Bieri O. Matrix pencil decomposition of time-resolved proton MRI for robust and improved assessment of pulmonary ventilation and perfusion. Magn Reson Med 2016; 77:336-342. [PMID: 26757102 DOI: 10.1002/mrm.26096] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/04/2015] [Accepted: 11/27/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE To present an improved and robust method of pulmonary function assessment from time-resolved proton MRI using a matrix pencil (MP) method in combination with a linear least squares analysis. METHODS Simulations of the signal time course in lung parenchyma were performed to compare the accuracy of Fourier decomposition (FD) and MP methods for the estimation of respiratory and cardiac amplitudes. Series of two-dimensional time-resolved lung images were acquired in healthy volunteers at 1.5 T using ultra-fast steady-state free precession. Qualitative lung ventilation- and perfusion-weighted images as well as a quantitative map of fractional ventilation, perfusion, and blood arrival time were calculated using the proposed MP method and compared with the contemporary FD technique. A region-of-interest analysis was performed on the quantitative data. RESULTS The signal analysis performed using MP decomposition resulted in reduced variability of the estimated respiratory and cardiac amplitudes in comparison with FD for both simulated and in vivo data. CONCLUSION MP decomposition provides an automatic, robust, and more accurate estimation of amplitudes of respiratory and cardiac signal modulations in the lung parenchyma than the contemporary FD technique. Magn Reson Med 77:336-342, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Grzegorz Bauman
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Oliver Bieri
- Division of Radiological Physics, Department of Radiology, University of Basel Hospital, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Basel, Switzerland
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Voskrebenzev A, Gutberlet M, Becker L, Wacker F, Vogel-Claussen J. Reproducibility of fractional ventilation derived by Fourier decomposition after adjusting for tidal volume with and without an MRI compatible spirometer. Magn Reson Med 2015; 76:1542-1550. [PMID: 26745750 DOI: 10.1002/mrm.26047] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To reduce the influence of tidal volume on fractional ventilation (FV) derived by Fourier decomposition (FD). METHODS Twelve volunteers were examined on a 1.5 Tesla scanner. Spoiled gradient echo imaging of coronal and sagittal slices of the lung were performed. The tidal volume variations between different acquisitions were studied by reproducibility and repeatability measurements. To adjust the FV derived by FD for tidal volume differences between the measurements, during all acquisitions, the lung volume changes were measured by a spirometer and used to calculate a global FV parameter. As an alternative, using the FD data, the lung area changes were calculated and used for the adjustment. RESULTS Reproducibility analysis of unadjusted coronal FV showed a determination coefficient of R2 = 71% and an intraclass correlation coefficient of ICC = 93%. Differences in the measurements could be ascribed to different tidal volumes. Area adjusted values exhibited an increased R2 of 84% and a higher ICC of 97%. For the coronal middle slice/sagittal slices in free breathing, the inter-volunteer coefficient of variation was reduced from 0.23/0.28 (unadjusted) to 0.16/0.20 (spirometer) or 0.12/0.13 (area). CONCLUSION The calculation of lung area changes is sufficient to increase the reproducibility of FV in a volunteer cohort avoiding the need for an MRI compatible spirometer. Magn Reson Med 76:1542-1550, 2016. © 2015 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Andreas Voskrebenzev
- Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Marcel Gutberlet
- Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Lena Becker
- Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Frank Wacker
- Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany
| | - Jens Vogel-Claussen
- Diagnostic and Interventional Radiology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research, Hannover, Germany.
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