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Lee S, Lee HY, Park J, Kim H, Park JY. Assessment of Pulmonary Ventilation Using 3D Ventilation Flow Capacity-Weighted and Ventilation-Weighted Maps From 3D Ultrashort Echo Time (UTE) MRI. J Magn Reson Imaging 2024; 60:483-494. [PMID: 37970646 DOI: 10.1002/jmri.29129] [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: 08/08/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) ventilation flow capacity-weighted (VFCW) maps together with 3D ventilation-weighted (VW) maps may help to better assess pulmonary function. PURPOSE To investigate the use of 3D VFCW and VW maps for evaluating pulmonary ventilation function. STUDY TYPE Prospective. POPULATION Two patients (one male, 85 years old; one female, 64 years old) with chronic obstructive pulmonary disease (COPD) and nine healthy subjects (all male; 23-27 years). FIELD STRENGTH/SEQUENCE 3-T, 3D radial UTE imaging. ASSESSMENT 3D VFCW and VW maps were calculated from 3D UTE MRI by voxel-wise subtraction of respiratory phase images. Their validation was tested in nine healthy volunteers using slow/deep and fast/shallow breathing conditions. Additional validation was performed by comparison with single photon emission computed tomography (SPECT) ventilation maps of one healthy participant. For comparison, gravity dependence of anterior-posterior regional ventilation was assessed by one-dimensional plot of the mean signal intensity for each coronal slice. Structural similarity index measure was also calculated. Finally, VW maps and VFCW maps of two COPD patients were evaluated for emphysema lesions with reference to CT images. STATISTICAL TESTS Wilcoxon sign-rank tests for regional Ventilation and ventilation flow capacity, analysis of variance, post-hoc t-tests and Bonferroni correction, coefficient of variation, Kullback-Liebler divergence. A P-value <0.05 was considered statistically significant. RESULTS The validation of 3D VFCW and VW maps was shown by statistically significant differences in ventilation flow capacity and ventilation between the breathing conditions. Additionally, UTE-MRI and SPECT-based ventilation maps showed gravitational dependence in the anteroposterior direction. When applied to patients with COPD, the use of 3D VFCW and VW maps was able to differentiate between two patients with different phenotypes. DATA CONCLUSION The use of 3D VFCW and VW maps can provide regional information on ventilation function and potentially contribute to assessment of COPD subtypes and disease progression. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Seokwon Lee
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Ho Yun Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jinil Park
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hyeonha Kim
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
| | - Jang-Yeon Park
- Department of Biomedical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
- Department of Intelligent Precision Healthcare Convergence, Sungkyunkwan University, Suwon, Republic of Korea
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2
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Elbehairy AF, Marshall H, Naish JH, Wild JM, Parraga G, Horsley A, Vestbo J. Advances in COPD imaging using CT and MRI: linkage with lung physiology and clinical outcomes. Eur Respir J 2024; 63:2301010. [PMID: 38548292 DOI: 10.1183/13993003.01010-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 03/16/2024] [Indexed: 05/04/2024]
Abstract
Recent years have witnessed major advances in lung imaging in patients with COPD. These include significant refinements in images obtained by computed tomography (CT) scans together with the introduction of new techniques and software that aim for obtaining the best image whilst using the lowest possible radiation dose. Magnetic resonance imaging (MRI) has also emerged as a useful radiation-free tool in assessing structural and more importantly functional derangements in patients with well-established COPD and smokers without COPD, even before the existence of overt changes in resting physiological lung function tests. Together, CT and MRI now allow objective quantification and assessment of structural changes within the airways, lung parenchyma and pulmonary vessels. Furthermore, CT and MRI can now provide objective assessments of regional lung ventilation and perfusion, and multinuclear MRI provides further insight into gas exchange; this can help in structured decisions regarding treatment plans. These advances in chest imaging techniques have brought new insights into our understanding of disease pathophysiology and characterising different disease phenotypes. The present review discusses, in detail, the advances in lung imaging in patients with COPD and how structural and functional imaging are linked with common resting physiological tests and important clinical outcomes.
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Affiliation(s)
- Amany F Elbehairy
- Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Helen Marshall
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Josephine H Naish
- MCMR, Manchester University NHS Foundation Trust, Manchester, UK
- Bioxydyn Limited, Manchester, UK
| | - Jim M Wild
- POLARIS, Imaging, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for in silico Medicine, Sheffield, UK
| | - Grace Parraga
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Division of Respirology, Western University, London, ON, Canada
| | - Alexander Horsley
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Bayat S, Wild J, Winkler T. Lung functional imaging. Breathe (Sheff) 2023; 19:220272. [PMID: 38020338 PMCID: PMC10644108 DOI: 10.1183/20734735.0272-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Pulmonary functional imaging modalities such as computed tomography, magnetic resonance imaging and nuclear imaging can quantitatively assess regional lung functional parameters and their distributions. These include ventilation, perfusion, gas exchange at the microvascular level and biomechanical properties, among other variables. This review describes the rationale, strengths and limitations of the various imaging modalities employed for lung functional imaging. It also aims to explain some of the most commonly measured parameters of regional lung function. A brief review of evidence on the role and utility of lung functional imaging in early diagnosis, accurate lung functional characterisation, disease phenotyping and advancing the understanding of disease mechanisms in major respiratory disorders is provided.
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Affiliation(s)
- Sam Bayat
- Department of Pulmonology and Physiology, CHU Grenoble Alpes, Grenoble, France
- Univ. Grenoble Alpes, STROBE Laboratory, INSERM UA07, Grenoble, France
| | - Jim Wild
- POLARIS, Imaging Group, Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute, University of Sheffield, Sheffield, UK
| | - Tilo Winkler
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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4
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Foo CT, Langton D, Thompson BR, Thien F. Functional lung imaging using novel and emerging MRI techniques. Front Med (Lausanne) 2023; 10:1060940. [PMID: 37181360 PMCID: PMC10166823 DOI: 10.3389/fmed.2023.1060940] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Respiratory diseases are leading causes of death and disability in the world. While early diagnosis is key, this has proven difficult due to the lack of sensitive and non-invasive tools. Computed tomography is regarded as the gold standard for structural lung imaging but lacks functional information and involves significant radiation exposure. Lung magnetic resonance imaging (MRI) has historically been challenging due to its short T2 and low proton density. Hyperpolarised gas MRI is an emerging technique that is able to overcome these difficulties, permitting the functional and microstructural evaluation of the lung. Other novel imaging techniques such as fluorinated gas MRI, oxygen-enhanced MRI, Fourier decomposition MRI and phase-resolved functional lung imaging can also be used to interrogate lung function though they are currently at varying stages of development. This article provides a clinically focused review of these contrast and non-contrast MR imaging techniques and their current applications in lung disease.
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Affiliation(s)
- Chuan T. Foo
- Department of Respiratory Medicine, Eastern Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David Langton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Department of Thoracic Medicine, Peninsula Health, Frankston, VIC, Australia
| | - Bruce R. Thompson
- Melbourne School of Health Science, Melbourne University, Melbourne, VIC, Australia
| | - Francis Thien
- Department of Respiratory Medicine, Eastern Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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5
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Zhou Q, Li H, Rao Q, Zhang M, Zhao X, Shen L, Fang Y, Li H, Liu X, Xiao S, Shi L, Han Y, Ye C, Zhou X. Assessment of pulmonary morphometry using hyperpolarized 129 Xe diffusion-weighted MRI with variable-sampling-ratio compressed sensing patterns. Med Phys 2023; 50:867-878. [PMID: 36196039 DOI: 10.1002/mp.16018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/26/2022] [Accepted: 09/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hyperpolarized (HP) 129 Xe multiple b-values diffusion-weighted magnetic resonance imaging (DW-MRI) has been widely used for quantifying pulmonary microstructural morphometry. However, the technique requires long acquisition times, making it hard to apply in patients with severe pulmonary diseases, who cannot sustain long breath holds. PURPOSE To develop and evaluate the technique of variable-sampling-ratio compressed sensing (VCS) patterns for accelerating HP 129 Xe multiple b-values DW-MRI in humans. METHODS Optimal variable sampling ratios and corresponding k-space undersampling patterns for each b-value were obtained by retrospective simulations based on the fully sampled (FS) DW-MRI dataset acquired from six young healthy volunteers. Then, the FS datasets were retrospectively undersampled using both VCS patterns and conventional compressed sensing (CS) pattern with a similar average acceleration factor. The quality of reconstructed images with retrospective VCS (rVCS) and CS (rCS) datasets were quantified using mean absolute error (MAE) and structural similarity (SSIM). Pulmonary morphometric parameters were also evaluated between rVCS and FS datasets. In addition, prospective VCS multiple b-values 129 Xe DW-MRI datasets were acquired from 14 cigarette smokers and 13 age-matched healthy volunteers. The differences of lung morphological parameters obtained with the proposed method were compared between the groups using independent samples t-test. Pearson correlation coefficient was also utilized for evaluating the correlation of the pulmonary physiological parameters obtained with VCS DW-MRI and pulmonary function tests. RESULTS Lower MAE and higher SSIM values were found in the reconstructed images with rVCS measurement when compared to those using conventional rCS measurement. The details and quality of the images obtained with rVCS and FS measurements were found to be comparable. The mean values of the morphological parameters derived from rVCS and FS datasets showed no significant differences (p > 0.05), and the mean differences of measured acinar duct radius, mean linear intercept, surface-to-volume ratio, and apparent diffusion coefficient with cylinder model were -0.87%, -2.42%, 2.04%, and -0.50%, respectively. By using the VCS technique, significant differences were delineated between the pulmonary morphometric parameters of healthy volunteers and cigarette smokers (p < 0.001), while the acquisition time was reduced by four times. CONCLUSION A fourfold reduction in acquisition time was achieved using the proposed VCS method while preserving good image quality. Our preliminary results demonstrated that the proposed method can be used for evaluating pulmonary injuries caused by cigarette smoking and may prove to be helpful in diagnosing lung diseases in clinical practice.
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Affiliation(s)
- Qian Zhou
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Haidong Li
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qiuchen Rao
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Ming Zhang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiuchao Zhao
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Luyang Shen
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Yuan Fang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China
| | - Hongchuang Li
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiaoling Liu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Sa Xiao
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Lei Shi
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Yeqing Han
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Chaohui Ye
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xin Zhou
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, China.,University of Chinese Academy of Sciences, Beijing, China
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6
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Ahookhosh K, Vanoirbeek J, Vande Velde G. Lung function measurements in preclinical research: What has been done and where is it headed? Front Physiol 2023; 14:1130096. [PMID: 37035677 PMCID: PMC10073442 DOI: 10.3389/fphys.2023.1130096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
Due to the close interaction of lung morphology and functions, repeatable measurements of pulmonary function during longitudinal studies on lung pathophysiology and treatment efficacy have been a great area of interest for lung researchers. Spirometry, as a simple and quick procedure that depends on the maximal inspiration of the patient, is the most common lung function test in clinics that measures lung volumes against time. Similarly, in the preclinical area, plethysmography techniques offer lung functional parameters related to lung volumes. In the past few decades, many innovative techniques have been introduced for in vivo lung function measurements, while each one of these techniques has their own advantages and disadvantages. Before each experiment, depending on the sensitivity of the required pulmonary functional parameters, it should be decided whether an invasive or non-invasive approach is desired. On one hand, invasive techniques offer sensitive and specific readouts related to lung mechanics in anesthetized and tracheotomized animals at endpoints. On the other hand, non-invasive techniques allow repeatable lung function measurements in conscious, free-breathing animals with readouts related to the lung volumes. The biggest disadvantage of these standard techniques for lung function measurements is considering the lung as a single unit and providing only global readouts. However, recent advances in lung imaging modalities such as x-ray computed tomography and magnetic resonance imaging opened new doors toward obtaining both anatomical and functional information from the same scan session, without the requirement for any extra pulmonary functional measurements, in more regional and non-invasive manners. Consequently, a new field of study called pulmonary functional imaging was born which focuses on introducing new techniques for regional quantification of lung function non-invasively using imaging-based techniques. This narrative review provides first an overview of both invasive and non-invasive conventional methods for lung function measurements, mostly focused on small animals for preclinical research, including discussions about their advantages and disadvantages. Then, we focus on those newly developed, non-invasive, imaging-based techniques that can provide either global or regional lung functional readouts at multiple time-points.
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Affiliation(s)
- Kaveh Ahookhosh
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Jeroen Vanoirbeek
- Centre of Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Greetje Vande Velde
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
- *Correspondence: Greetje Vande Velde,
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7
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Stewart NJ, Smith LJ, Chan HF, Eaden JA, Rajaram S, Swift AJ, Weatherley ND, Biancardi A, Collier GJ, Hughes D, Klafkowski G, Johns CS, West N, Ugonna K, Bianchi SM, Lawson R, Sabroe I, Marshall H, Wild JM. Lung MRI with hyperpolarised gases: current & future clinical perspectives. Br J Radiol 2022; 95:20210207. [PMID: 34106792 PMCID: PMC9153706 DOI: 10.1259/bjr.20210207] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The use of pulmonary MRI in a clinical setting has historically been limited. Whilst CT remains the gold-standard for structural lung imaging in many clinical indications, technical developments in ultrashort and zero echo time MRI techniques are beginning to help realise non-ionising structural imaging in certain lung disorders. In this invited review, we discuss a complementary technique - hyperpolarised (HP) gas MRI with inhaled 3He and 129Xe - a method for functional and microstructural imaging of the lung that has great potential as a clinical tool for early detection and improved understanding of pathophysiology in many lung diseases. HP gas MRI now has the potential to make an impact on clinical management by enabling safe, sensitive monitoring of disease progression and response to therapy. With reference to the significant evidence base gathered over the last two decades, we review HP gas MRI studies in patients with a range of pulmonary disorders, including COPD/emphysema, asthma, cystic fibrosis, and interstitial lung disease. We provide several examples of our experience in Sheffield of using these techniques in a diagnostic clinical setting in challenging adult and paediatric lung diseases.
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Affiliation(s)
- Neil J Stewart
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Laurie J Smith
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Ho-Fung Chan
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James A Eaden
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Smitha Rajaram
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andrew J Swift
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Nicholas D Weatherley
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alberto Biancardi
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Guilhem J Collier
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David Hughes
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | | | - Christopher S Johns
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Noreen West
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Kelechi Ugonna
- Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Stephen M Bianchi
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Rod Lawson
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Ian Sabroe
- Directorate of Respiratory Medicine, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Helen Marshall
- POLARIS, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
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8
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Nguyen AAT, Onishi N, Carmona-Bozo J, Li W, Kornak J, Newitt DC, Hylton NM. Post-Processing Bias Field Inhomogeneity Correction for Assessing Background Parenchymal Enhancement on Breast MRI as a Quantitative Marker of Treatment Response. Tomography 2022; 8:891-904. [PMID: 35448706 PMCID: PMC9027600 DOI: 10.3390/tomography8020072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Background parenchymal enhancement (BPE) of breast fibroglandular tissue (FGT) in dynamic contrast-enhanced breast magnetic resonance imaging (MRI) has shown an association with response to neoadjuvant chemotherapy (NAC) in patients with breast cancer. Fully automated segmentation of FGT for BPE calculation is a challenge when image artifacts are present. Low spatial frequency intensity nonuniformity due to coil sensitivity variations is known as bias or inhomogeneity and can affect FGT segmentation and subsequent BPE measurement. In this study, we utilized the N4ITK algorithm for bias correction over a restricted bilateral breast volume and compared the contralateral FGT segmentations based on uncorrected and bias-corrected images in three MRI examinations at pre-treatment, early treatment and inter-regimen timepoints during NAC. A retrospective analysis of 2 cohorts was performed: one with 735 patients enrolled in the multi-center I-SPY 2 TRIAL and the sub-cohort of 340 patients meeting a high-quality benchmark for segmentation. Bias correction substantially increased the FGT segmentation quality for 6.3–8.0% of examinations, while it substantially decreased the quality for no examination. Our results showed improvement in segmentation quality and a small but statistically significant increase in the resulting BPE measurement after bias correction at all timepoints in both cohorts. Continuing studies are examining the effects on pCR prediction.
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Affiliation(s)
- Alex Anh-Tu Nguyen
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
| | - Natsuko Onishi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
- Correspondence: ; Tel.: +1-415-885-7511
| | - Julia Carmona-Bozo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
| | - Wen Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA;
| | - David C. Newitt
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
| | - Nola M. Hylton
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA; (A.A.-T.N.); (J.C.-B.); (W.L.); (D.C.N.); (N.M.H.)
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9
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Perron S, Ouriadov A, Wawrzyn K, Hickling S, Fox MS, Serrai H, Santyr G. Application of a 2D frequency encoding sectoral approach to hyperpolarized 129Xe MRI at low field. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2022; 336:107159. [PMID: 35183921 DOI: 10.1016/j.jmr.2022.107159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Inhaled hyperpolarized 129Xe MRI is a non-invasive and radiation risk free lung imaging method, which can directly measure the business unit of the lung where gas exchange occurs: the alveoli and acinar ducts (lung function). Currently, three imaging approaches have been demonstrated to be useful for hyperpolarized 129Xe MR in lungs: Fast Gradient Recalled Echo (FGRE), Radial Projection Reconstruction (PR), and spiral/cones. Typically, non-Cartesian acquisitions such as PR and spiral/cones require specific data post-processing, such as interpolating, regridding, and density-weighting procedures for image reconstruction, which often leads to smoothing effects and resolution degradation. On the other hand, Cartesian methods such as FGRE are not short-echo time (TE) methods; they suffer from imaging gradient-induced diffusion-weighting of the k-space center, and employ a significant number of radio-frequency (RF) pulses. Due to the non-renewable magnetization of the hyperpolarized media, the use of a large number of RF pulses (FGRE/PR) required for full k-space coverage is a significant limitation, especially for low field (<0.5 T) hyperpolarized gas MRI. We demonstrate an ultra-fast, purely frequency-encoded, Cartesian pulse sequence called Frequency-Encoding Sectoral (FES), which takes advantage of the long T2* of hyperpolarized 129Xe gas at low field strength (0.074 T). In contrast to PR/FGRE, it uses a much smaller number of RF pulses, and consequently maximizes image Signal-to-Noise Ratio (SNR) while shortening acquisition time. Additionally, FES does not suffer from non-uniform T2* decay leading to image blurring; a common issue with interleaved spirals/cones. The Cartesian k-space coverage of the proposed FES method does not require specific k-space data post-processing, unlike PR/FGRE and spiral/cones methods. Proton scans were used to compare the FES sequence to both FGRE and Phase Encoding Sectoral, in terms of their SNR values and imaging efficiency estimates. Using FES, proton and hyperpolarized 129Xe images were acquired from a custom hollow acrylic phantom (0.04L) and two normal rats (129Xe only), utilizing both single-breath and multiple-breath schemes. For the 129Xe phantom images, the apparent diffusion coefficient, T1, and T2* relaxation maps were acquired and generated. Blurring due to the T2* decay and B0 field variation were simulated to estimate dependence of the image resolution on the duration of the data acquisition windows (i.e. sector length), and temperature-induced resonance frequency shift from the low field magnet hardware.
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Affiliation(s)
- Samuel Perron
- Department of Physics and Astronomy, The University of Western Ontario, London, Ontario, Canada
| | - Alexei Ouriadov
- Department of Physics and Astronomy, The University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON, Canada.
| | - Krzysztof Wawrzyn
- Department of Physics and Astronomy, The University of Western Ontario, London, Ontario, Canada
| | | | - Matthew S Fox
- Department of Physics and Astronomy, The University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Hacene Serrai
- Department of Physics and Astronomy, The University of Western Ontario, London, Ontario, Canada
| | - Giles Santyr
- Translational Medicine Program, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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10
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Meng XF, Lin QY, Yin H, Li ZQ. Hyperpolarized 3 helium MRI measured apparent diffusion coefficient and its correlations with pulmonary functions tests in patients with chronic obstructive pulmonary disease: A meta-analysis. THE CLINICAL RESPIRATORY JOURNAL 2021; 15:1185-1193. [PMID: 34288505 DOI: 10.1111/crj.13425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/01/2021] [Accepted: 07/15/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study evaluates role of hyperpolarized 3 helium (3 He) MRI measured apparent diffusion coefficient (ADC) in examining pulmonary function of chronic obstructive pulmonary disease (COPD) patients. METHODS After literature search in electronic databases, studies were selected by following precise eligibility criteria. Meta-analyses were performed to estimate mean difference in ADC between COPD patients and healthy individuals and to seek correlations between lung ADC and pulmonary function. Metaregression analyses were performed to seek relationships between ADC and age, gender, BMI, cigarette pack-years, and pulmonary function tests. RESULTS Twenty-five studies (622 COPD patients and 469 healthy controls) were included. Lung ADC was 0.402 (95% confidence interval [CI]: 0.374, 0.429) in COPD patients and 0.228 (95% CI: 0.205, 0.252) in healthy individuals (mean difference 0.160 [95% CI: 0.127, 0.193]; p < 0.001). In metaregression, age (coefficient: 0.006; p = 0.004), pack-years (coefficient: 0.005; p = 0.018), forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (coefficient: -1.815; p = 0.007), percent predicted diffusion capacity of carbon monoxide (DLCO) (coefficient: -0.004; p = 0.008), and percent predicted inspiratory capacity (coefficient: -0.004; p = 0.012) were significantly associated with ADC in COPD patients. In meta-analysis of correlation coefficients, ADC was significantly correlated with FEV1 (r = -0.62; p < 0.00001), FEV1/FVC (r = -0.80; p < 0.00001), DLCO (r = -0.85; p < 0.00001), functional residual capacity (r = 0.71; p < 0.00001), reserve volume (r = 0.53; p = 0.0001), and emphysema index (r = 0.89; p < 0.00001). CONCLUSION Hyperpolarized 3 He MRI measured ADC was higher in COPD patients than in healthy individuals and was inversely associated with FEV1, FEV1/FVC, DLCO, and inspiratory capacity.
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Affiliation(s)
- Xian-Feng Meng
- Department of Medical Imaging, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Qing-Yan Lin
- Department of Respiratory and Critical Care Medicine, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Honglei Yin
- Department of Respiratory and Critical Care Medicine, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Zeng-Qi Li
- Department of Stomatology, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
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11
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Abstract
This commentary reviews the contribution of imaging by CT and MRI to functional assessment in chronic obstructive pulmonary disease (COPD). CT can help individualize the assessment of COPD by quantifying emphysema, air trapping and airway wall thickening, potentially leading to more specific treatments for these distinct components of COPD. Longitudinal changes in these metrics can help assess progression or improvement. On hyperpolarized gas MRI, the apparent diffusion coefficient of provides an index of airspace enlargement reflecting emphysema. Perfusion imaging and measurement of pulmonary vascular volume on non-contrast CT provide insight into the contribution of pulmonary vascular disease to pulmonary impairment. Functional imaging is particularly valuable in detecting early lung dysfunction in subjects with inhalational exposures.
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Affiliation(s)
- David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, United States
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12
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Puddu C, Rao M, Xu X, Deppe MH, Collier G, Maunder A, Chan HF, De Zanche N, Robb F, Wild JM. An asymmetrical whole-body birdcage RF coil without RF shield for hyperpolarized 129 Xe lung MR imaging at 1.5 T. Magn Reson Med 2021; 86:3373-3381. [PMID: 34268802 DOI: 10.1002/mrm.28915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE This study describes the development and testing of an asymmetrical xenon-129 (129 Xe) birdcage radiofrequency (RF) coil for 129 Xe lung ventilation imaging at 1.5 Tesla, which allows proton (1 H) system body coil transmit-receive functionality. METHODS The 129 Xe RF coil is a whole-body asymmetrical elliptical birdcage constructed without an outer RF shield to enable 1 H imaging. B 1 + field homogeneity and flip angle mapping of the 129 Xe birdcage RF coil and 1 H system body RF coil with the 129 Xe RF coil in situ were evaluated in the MR scanner. The functionality of the 129 Xe birdcage RF coil was demonstrated through hyperpolarized 129 Xe lung ventilation imaging with the birdcage in both transceiver configuration and transmit-only configuration when combined with an 8-channel 129 Xe receive-only RF coil array. The functionality of 1 H system body coil with the 129 Xe RF coil in situ was demonstrated by acquiring coregistered 1 H lung anatomical MR images. RESULTS The asymmetrical birdcage produced a homogeneous B 1 + field (±10%) in agreement with electromagnetic simulations. Simulations indicated an optimal detuning configuration with 4 diodes. The obtained g-factor of 1.4 for acceleration factor of R = 2 indicates optimal array configuration. Coregistered 1 H anatomical images from the system body coil along with 129 Xe lung images demonstrated concurrent and compatible arrangement of the RF coils. CONCLUSION A large asymmetrical birdcage for homogenous B 1 + transmission with high sensitivity reception for 129 Xe lung MRI at 1.5 Tesla has been demonstrated. The unshielded asymmetrical birdcage design enables 1 H structural lung MR imaging in the same exam.
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Affiliation(s)
- Claudio Puddu
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Madhwesha Rao
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Xiaojun Xu
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Martin H Deppe
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Guilhem Collier
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Adam Maunder
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Ho-Fung Chan
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Nicola De Zanche
- Department of Medical Physics, Cross Cancer Institute and University of Alberta, Alberta, Canada
| | - Fraser Robb
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.,GE Healthcare, Aurora, Ohio, USA
| | - Jim M Wild
- POLARIS, Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
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13
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CT Pulmonary Vessels and MRI Ventilation in Chronic Obstructive Pulmonary Disease: Relationship with worsening FEV 1 in the TINCan cohort study. Acad Radiol 2021; 28:495-506. [PMID: 32303446 DOI: 10.1016/j.acra.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The relationships between computed tomography (CT) pulmonary vascularity and MRI ventilation is not well-understood in chronic obstructive pulmonary disease (COPD) patients. Our objective was to evaluate CT pulmonary vascular and MRI ventilation measurements in ex-smokers and to investigate their associations and how such measurements change over time. MATERIALS AND METHODS Ninety ex-smokers (n = 41 without COPD 71 ± 10 years and n = 49 COPD 71 ± 8 years) provided written informed-consent to an ethics-board approved protocol and underwent imaging and pulmonary-function-tests twice, 31 ± 7 months apart. 3He MRI was acquired to generate ventilation-defect-percent (VDP). CT measurements of the relative area-of-the-lung with attenuation <-950 Hounsfield units (RA950), pulmonary vascular total-blood-volume (TBV) and percent of vessels with radius < one voxel (PV1) were evaluated. RESULTS At baseline, there were significant differences in RA950 (p = 0.0001), VDP (p = 0.0001), total-blood-volume (p = 0.0001) and PV1 (p = 0.01) between ex-smokers and COPD participants as well as for VDP (p = 0.0001) in COPD participants with and without emphysema. The annual FEV1 change (-40 ± 93 mL/year) was not different among participant subgroups (p = 0.87), but the annual RA950 (p = 0.01) and PV1 (p = 0.007) changes were significantly different in participants with an accelerated annual FEV1 decline as compared to participants with a diminished annual FEV1 decline. There were significant but weak relationships for PV1 with FEV1%pred (p = 0.02), FEV1/FVC (p = 0.001), and log RA950 (p = 0.0001), but not VDP (p=0.20). The mean change in PV1 was also weakly but significantly related to the change in RA950 (p = 0.02). CONCLUSION CT pulmonary vascular measurements were significantly different in ex-smokers and participants with COPD and related to RA950 but not VDP worsening over 2.5 years.
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14
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Airspace Dimension Assessment (AiDA) by inhaled nanoparticles: benchmarking with hyperpolarised 129Xe diffusion-weighted lung MRI. Sci Rep 2021; 11:4721. [PMID: 33633165 PMCID: PMC7907057 DOI: 10.1038/s41598-021-83975-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/10/2021] [Indexed: 11/26/2022] Open
Abstract
Enlargements of distal airspaces can indicate pathological changes in the lung, but accessible and precise techniques able to measure these regions are lacking. Airspace Dimension Assessment with inhaled nanoparticles (AiDA) is a new method developed for in vivo measurement of distal airspace dimensions. The aim of this study was to benchmark the AiDA method against quantitative measurements of distal airspaces from hyperpolarised 129Xe diffusion-weighted (DW)-lung magnetic resonance imaging (MRI). AiDA and 129Xe DW-MRI measurements were performed in 23 healthy volunteers who spanned an age range of 23–70 years. The relationship between the 129Xe DW-MRI and AiDA metrics was tested using Spearman’s rank correlation coefficient. Significant correlations were observed between AiDA distal airspace radius (rAiDA) and mean 129Xe apparent diffusion coefficient (ADC) (p < 0.005), distributed diffusivity coefficient (DDC) (p < 0.001) and distal airspace dimension (LmD) (p < 0.001). A mean bias of − 1.2 µm towards rAiDA was observed between 129Xe LmD and rAiDA, indicating that rAiDA is a measure of distal airspace dimension. The AiDA R0 intercept correlated with MRI 129Xe α (p = 0.02), a marker of distal airspace heterogeneity. This study demonstrates that AiDA has potential to characterize the distal airspace microstructures and may serve as an alternative method for clinical examination of the lungs.
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15
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Goldin JG. The Emerging Role of Quantification of Imaging for Assessing the Severity and Disease Activity of Emphysema, Airway Disease, and Interstitial Lung Disease. Respiration 2021; 100:277-290. [PMID: 33621969 DOI: 10.1159/000513642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
There has been an explosion of use for quantitative image analysis in the setting of lung disease due to advances in acquisition protocols and postprocessing technology, including machine and deep learning. Despite the plethora of published papers, it is important to understand which approach has clinical validation and can be used in clinical practice. This paper provides an introduction to quantitative image analysis techniques being used in the investigation of lung disease and focusses on the techniques that have a reasonable clinical validation for being used in clinical trials and patient care.
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Affiliation(s)
- Jonathan Gerald Goldin
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA,
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16
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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: 16] [Impact Index Per Article: 5.3] [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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17
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Kaireit TF, Kern A, Voskrebenzev A, Pöhler GH, Klimes F, Behrendt L, Gutberlet M, Moher-Alsady T, Dittrich AM, Wacker F, Hohlfeld J, Vogel-Claussen J. Flow Volume Loop and Regional Ventilation Assessment Using Phase-Resolved Functional Lung (PREFUL) MRI: Comparison With 129 Xenon Ventilation MRI and Lung Function Testing. J Magn Reson Imaging 2020; 53:1092-1105. [PMID: 33247456 DOI: 10.1002/jmri.27452] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Regional flow volume loop ventilation-weighted noncontrast-enhanced proton lung MRI in free breathing has emerged as a novel technique for assessment of regional lung ventilation, but has yet not been validated with 129 Xenon MRI (129 Xe-MRI), a direct visualization of ventilation in healthy volunteers, cystic fibrosis (CF), and chronic obstructive pulmonary disease (COPD) patients. PURPOSE To compare regional ventilation and regional flow volume loops measured by noncontrast-enhanced ventilation-weighted phase-resolved functional lung MRI (PREFUL-MRI) with 129 Xe-MRI ventilation imaging and with lung function test parameters. STUDY TYPE Retrospective study. POPULATION Twenty patients with COPD, eight patients with CF, and six healthy volunteers. FIELD STRENGTH/SEQUENCE PREFUL and 129 Xe-MRI gradient echo sequences were acquired at 1.5T. ASSESSMENT Coronal slices of PREFUL-MRI (free breathing) and 129 Xe-MRI (single breath-hold) were acquired on the same day, matched by their ventrodorsal position and coregistered for evaluation. Ventilation defect percentage (VDP) was calculated based on regional ventilation (RV), regional flow volume loops (RFVL), or 129 Xe-MRI with two different threshold methods. A combined VDP was calculated for RV and RFVL. Additionally, lung function testing was performed (such as the forced expiratory volume in 1 second [FEV1 ]) was used. STATISTICAL TESTS The obtained parameters were compared using Wilcoxon tests, correlated using Spearman's correlation coefficient (r), and agreement between PREFUL and 129 Xe-MRI parameters was assessed using Bland-Altman analysis and Dice coefficients. RESULTS VDP measured by PREFUL and 129 Xe were significantly correlated with both thresholding techniques (r = 0.62-0.69, P < 0.05 for all) and with lung function test parameters. Combined RV and RFVL PREFUL defect maps correlated with lung function testing (eg, with FEV1 r = -0.87 P < 0.05), and showed better regional agreement to 129 Xe-MRI ventilation defects (Dice coefficient defect 0.413) with significantly higher VDP values (10.2 ± 27.3, P = 0.04) than either PREFUL defect map alone. DATA CONCLUSION Combined RV and RFVL PREFUL defect maps likely increase sensitivity to mild airway obstruction with increased VDP values compared to 129 Xe-MRI, and correlate strongly with lung function test parameters. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Till F Kaireit
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Agilo Kern
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Andreas Voskrebenzev
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Gesa H Pöhler
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Filip Klimes
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Lea Behrendt
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Marcel Gutberlet
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Tawfik Moher-Alsady
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Anna-Maria Dittrich
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany.,Department for Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
| | - Jens Hohlfeld
- Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany.,Clinic of Pneumology, Hannover Medical School, Hannover, Germany.,Fraunhofer Institute for T oxicology and Experimental Medicine, Hannover, Germany
| | - Jens Vogel-Claussen
- Department for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Lung Research Center (DZL), Hannover, Germany
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18
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Hatabu H, Ohno Y, Gefter WB, Parraga G, Madore B, Lee KS, Altes TA, Lynch DA, Mayo JR, Seo JB, Wild JM, van Beek EJR, Schiebler ML, Kauczor HU. Expanding Applications of Pulmonary MRI in the Clinical Evaluation of Lung Disorders: Fleischner Society Position Paper. Radiology 2020; 297:286-301. [PMID: 32870136 DOI: 10.1148/radiol.2020201138] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pulmonary MRI provides structural and quantitative functional images of the lungs without ionizing radiation, but it has had limited clinical use due to low signal intensity from the lung parenchyma. The lack of radiation makes pulmonary MRI an ideal modality for pediatric examinations, pregnant women, and patients requiring serial and longitudinal follow-up. Fortunately, recent MRI techniques, including ultrashort echo time and zero echo time, are expanding clinical opportunities for pulmonary MRI. With the use of multicoil parallel acquisitions and acceleration methods, these techniques make pulmonary MRI practical for evaluating lung parenchymal and pulmonary vascular diseases. The purpose of this Fleischner Society position paper is to familiarize radiologists and other interested clinicians with these advances in pulmonary MRI and to stratify the Society recommendations for the clinical use of pulmonary MRI into three categories: (a) suggested for current clinical use, (b) promising but requiring further validation or regulatory approval, and (c) appropriate for research investigations. This position paper also provides recommendations for vendors and infrastructure, identifies methods for hypothesis-driven research, and suggests opportunities for prospective, randomized multicenter trials to investigate and validate lung MRI methods.
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Affiliation(s)
- Hiroto Hatabu
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Yoshiharu Ohno
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Warren B Gefter
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Grace Parraga
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Bruno Madore
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Kyung Soo Lee
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Talissa A Altes
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - David A Lynch
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - John R Mayo
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Joon Beom Seo
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Jim M Wild
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Edwin J R van Beek
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Mark L Schiebler
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
| | - Hans-Ulrich Kauczor
- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
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- From the Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115 (H.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan (Y.O.); Department of Radiology, Penn Medicine, University of Pennsylvania, Philadelphia, Pa (W.B.G.); Department of Medical Biophysics, Western University, London, Canada (G.P.); Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (B.M.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM), Seoul, Korea (K.S.L.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.A.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Vancouver General Hospital and University of British Colombia, Vancouver, Canada (J.R.M.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (J.B.S.); Section of Academic Radiology, University of Sheffield, Sheffield, England, United Kingdom (J.M.W.); Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom (E.J.R.v.B.); Department of Radiology, UW Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); and Diagnostic and Interventional Radiology, University Hospital Heidelberg, Translational Lung Research Center Heidelberg, member of the German Center of Lung Research, Heidelberg, Germany (H.U.K.)
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MacNeil JL, Capaldi DPI, Westcott AR, Eddy RL, Barker AL, McCormack DG, Kirby M, Parraga G. Pulmonary Imaging Phenotypes of Chronic Obstructive Pulmonary Disease Using Multiparametric Response Maps. Radiology 2020; 295:227-236. [PMID: 32096708 DOI: 10.1148/radiol.2020191735] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Pulmonary imaging of chronic obstructive pulmonary disease (COPD) has focused on CT or MRI measurements, but these have not been evaluated in combination. Purpose To generate multiparametric response map (mPRM) measurements in ex-smokers with or without COPD by using volume-matched CT and hyperpolarized helium 3 (3He) MRI. Materials and Methods In this prospective study (https://clinicaltrials.gov, NCT02279329), participants underwent MRI and CT and completed pulmonary function tests, questionnaires, and the 6-minute walk test between December 2010 and January 2019. Disease status was determined by using Global initiative for chronic Obstructive Lung Disease (GOLD) criteria. The mPRM voxel values were generated by using co-registered MRI and CT labels. Kruskal-Wallis and Bonferroni tests were used to determine differences across disease severity, and correlations were determined by using Spearman coefficients. Results A total of 175 ex-smokers (mean age, 69 years ± 9 [standard deviation], 108 men) with or without COPD were evaluated. Ex-smokers without COPD had a larger fraction of normal mPRM voxels (60% vs 37%, 20%, and 7% for GOLD I, II, and III/IV disease, respectively; all P ≤ .001) and a smaller fraction of abnormal voxels, including small airways disease (normal CT, not ventilated: 5% vs 6% [not significant], 11%, and 19% [P ≤ .001 for both] for GOLD I, II, and III/IV disease, respectively) and mild emphysema (normal CT, abnormal apparent diffusion coefficient [ADC]: 33% vs 54%, 56%, and 54% for GOLD I, II, and III/IV disease respectively; all P ≤ .001). Normal mPRM measurements were positively correlated with forced expiratory volume in 1 second (FEV1) (r = 0.65, P < .001), the FEV1-to-forced vital capacity ratio (r = 0.81, P < .001), and diffusing capacity (r = 0.75, P < .001) and were negatively correlated with worse quality of life (r = -0.48, P < .001). Abnormal mPRM measurements of small airways disease (normal CT, not ventilated) and mild emphysema (normal CT, abnormal ADC) were negatively correlated with FEV1 (r = -0.65 and -0.42, respectively; P < .001) and diffusing capacity (r = -0.53 and -0.60, respectively; P < .001) and were positively correlated with worse quality of life (r = 0.45 and r = 0.33, respectively; P < .001), both of which were present in ex-smokers without COPD. Conclusion Multiparametric response maps revealed two abnormal structure-function results related to emphysema and small airways disease, both of which were unexpectedly present in ex-smokers with normal spirometry and CT findings. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Jonathan L MacNeil
- From the Robarts Research Institute (J.L.M., A.R.W., R.L.E., A.L.B., G.P.), School of Biomedical Engineering (J.L.M., G.P.), Department of Medical Biophysics (A.R.W., R.L.E., A.L.B., G.P.), and Division of Respirology, Department of Medicine (D.G.M., G.P.), Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calif (D.P.I.C.); and Department of Physics, Ryerson University, Toronto, Ontario, Canada (M.K.)
| | - Dante P I Capaldi
- From the Robarts Research Institute (J.L.M., A.R.W., R.L.E., A.L.B., G.P.), School of Biomedical Engineering (J.L.M., G.P.), Department of Medical Biophysics (A.R.W., R.L.E., A.L.B., G.P.), and Division of Respirology, Department of Medicine (D.G.M., G.P.), Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calif (D.P.I.C.); and Department of Physics, Ryerson University, Toronto, Ontario, Canada (M.K.)
| | - Andrew R Westcott
- From the Robarts Research Institute (J.L.M., A.R.W., R.L.E., A.L.B., G.P.), School of Biomedical Engineering (J.L.M., G.P.), Department of Medical Biophysics (A.R.W., R.L.E., A.L.B., G.P.), and Division of Respirology, Department of Medicine (D.G.M., G.P.), Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calif (D.P.I.C.); and Department of Physics, Ryerson University, Toronto, Ontario, Canada (M.K.)
| | - Rachel L Eddy
- From the Robarts Research Institute (J.L.M., A.R.W., R.L.E., A.L.B., G.P.), School of Biomedical Engineering (J.L.M., G.P.), Department of Medical Biophysics (A.R.W., R.L.E., A.L.B., G.P.), and Division of Respirology, Department of Medicine (D.G.M., G.P.), Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calif (D.P.I.C.); and Department of Physics, Ryerson University, Toronto, Ontario, Canada (M.K.)
| | - Andrea L Barker
- From the Robarts Research Institute (J.L.M., A.R.W., R.L.E., A.L.B., G.P.), School of Biomedical Engineering (J.L.M., G.P.), Department of Medical Biophysics (A.R.W., R.L.E., A.L.B., G.P.), and Division of Respirology, Department of Medicine (D.G.M., G.P.), Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calif (D.P.I.C.); and Department of Physics, Ryerson University, Toronto, Ontario, Canada (M.K.)
| | - David G McCormack
- From the Robarts Research Institute (J.L.M., A.R.W., R.L.E., A.L.B., G.P.), School of Biomedical Engineering (J.L.M., G.P.), Department of Medical Biophysics (A.R.W., R.L.E., A.L.B., G.P.), and Division of Respirology, Department of Medicine (D.G.M., G.P.), Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calif (D.P.I.C.); and Department of Physics, Ryerson University, Toronto, Ontario, Canada (M.K.)
| | - Miranda Kirby
- From the Robarts Research Institute (J.L.M., A.R.W., R.L.E., A.L.B., G.P.), School of Biomedical Engineering (J.L.M., G.P.), Department of Medical Biophysics (A.R.W., R.L.E., A.L.B., G.P.), and Division of Respirology, Department of Medicine (D.G.M., G.P.), Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calif (D.P.I.C.); and Department of Physics, Ryerson University, Toronto, Ontario, Canada (M.K.)
| | - Grace Parraga
- From the Robarts Research Institute (J.L.M., A.R.W., R.L.E., A.L.B., G.P.), School of Biomedical Engineering (J.L.M., G.P.), Department of Medical Biophysics (A.R.W., R.L.E., A.L.B., G.P.), and Division of Respirology, Department of Medicine (D.G.M., G.P.), Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7; Department of Radiation Oncology, Stanford University School of Medicine, Stanford, Calif (D.P.I.C.); and Department of Physics, Ryerson University, Toronto, Ontario, Canada (M.K.)
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S. Fox M, V. Ouriadov A. High Resolution 3He Pulmonary MRI. Magn Reson Imaging 2019. [DOI: 10.5772/intechopen.84756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lonzetti L, Zanon M, Pacini GS, Altmayer S, Martins de Oliveira D, Rubin AS, Gazzoni FF, Barros MC, Hochhegger B. Magnetic resonance imaging of interstitial lung diseases: A state-of-the-art review. Respir Med 2019; 155:79-85. [PMID: 31323528 DOI: 10.1016/j.rmed.2019.07.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/31/2019] [Accepted: 07/05/2019] [Indexed: 02/08/2023]
Abstract
Magnetic resonance imaging (MRI) has been emerging as an imaging modality to assess interstitial lung diseases (ILD). An optimal chest MRI protocol for ILDs should include non-contrast breath-holding sequences, steady-state free-precession sequences, and contrast-enhanced sequences. One of the main MRI applications in ILDs is the differentiation between areas of active inflammation (i.e. reversible stage) and fibrosis. Alveolitis presents high signal intensity on T2-weighted sequences (WS) and early-enhancement on contrast-enhanced MR sequences, while fibrotic-predominant lesions present low signal and late-enhancement in these sequences, respectively. MRI can be useful in connective tissue diseases, idiopathic pulmonary fibrosis, and sarcoidosis. The aim of this state-of-the-art review was to perform a state-of-the-art review on the use of MRI in ILDs, and propose the optimal MRI protocols for imaging ILDs.
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Affiliation(s)
- Lilian Lonzetti
- Department of Rheumatology, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, R. Sarmento Leite, 245, 90050-170, Brazil.
| | - Matheus Zanon
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Gabriel Sartori Pacini
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Stephan Altmayer
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil; School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Av. Ipiranga, 6681, 90619-900, Brazil.
| | - Diogo Martins de Oliveira
- School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Av. Ipiranga, 6681, 90619-900, Brazil.
| | - Adalberto Sperb Rubin
- Department of Pulmonology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Fernando Ferreira Gazzoni
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Marcelo Cardoso Barros
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil; School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Av. Ipiranga, 6681, 90619-900, Brazil; Department of Pulmonology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
| | - Bruno Hochhegger
- Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil; School of Medicine, Postgraduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Av. Ipiranga, 6681, 90619-900, Brazil; Department of Pulmonology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Av. Independência, 75, 90020160, Brazil.
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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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Doganay O, Matin T, Chen M, Kim M, McIntyre A, McGowan DR, Bradley KM, Povey T, Gleeson FV. Time-series hyperpolarized xenon-129 MRI of lobar lung ventilation of COPD in comparison to V/Q-SPECT/CT and CT. Eur Radiol 2018; 29:4058-4067. [PMID: 30552482 PMCID: PMC6610266 DOI: 10.1007/s00330-018-5888-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/08/2018] [Accepted: 11/13/2018] [Indexed: 12/23/2022]
Abstract
Purpose To derive lobar ventilation in patients with chronic obstructive pulmonary disease (COPD) using a rapid time-series hyperpolarized xenon-129 (HPX) magnetic resonance imaging (MRI) technique and compare this to ventilation/perfusion single-photon emission computed tomography (V/Q-SPECT), correlating the results with high-resolution computed tomography (CT) and pulmonary function tests (PFTs). Materials and methods Twelve COPD subjects (GOLD stages I–IV) participated in this study and underwent HPX-MRI, V/Q-SPECT/CT, high-resolution CT, and PFTs. HPX-MRI was performed using a novel time-series spiral k-space sampling approach. Relative percentage ventilations were calculated for individual lobe for comparison to the relative SPECT lobar ventilation and perfusion. The absolute HPX-MRI percentage ventilation in each lobe was compared to the absolute CT percentage emphysema score calculated using a signal threshold method. Pearson’s correlation and linear regression tests were performed to compare each imaging modality. Results Strong correlations were found between the relative lobar percentage ventilation with HPX-MRI and percentage ventilation SPECT (r = 0.644; p < 0.001) and percentage perfusion SPECT (r = 0.767; p < 0.001). The absolute CT percentage emphysema and HPX percentage ventilation correlation was also statistically significant (r = 0.695, p < 0.001). The whole lung HPX percentage ventilation correlated with the PFT measurements (FEV1 with r = − 0.886, p < 0.001*, and FEV1/FVC with r = − 0.861, p < 0.001*) better than the whole lung CT percentage emphysema score (FEV1 with r = − 0.635, p = 0.027; and FEV1/FVC with r = − 0.652, p = 0.021). Conclusion Lobar ventilation with HPX-MRI showed a strong correlation with lobar ventilation and perfusion measurements derived from SPECT/CT, and is better than the emphysema score obtained with high-resolution CT. Key Points • The ventilation hyperpolarized xenon-129 MRI correlates well with ventilation and perfusion with SPECT/CT with the advantage of higher temporal and spatial resolution. • The hyperpolarized xenon-129 MRI correlates with the PFT measurements better than the high-resolution CT with the advantage of avoiding the use of ionizing radiation. Electronic supplementary material The online version of this article (10.1007/s00330-018-5888-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ozkan Doganay
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK.
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK.
| | - Tahreema Matin
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Mitchell Chen
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Minsuok Kim
- Department of Engineering Science, University of Oxford, OX1 3PJ, Oxford, UK
| | - Anthony McIntyre
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Daniel R McGowan
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK
- Radiation Physics and Protection, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Kevin M Bradley
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
| | - Thomas Povey
- Department of Engineering Science, University of Oxford, OX1 3PJ, Oxford, UK
| | - Fergus V Gleeson
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, OX3 7DQ, Oxford, UK
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Rd, OX3 7LE, Oxford, UK
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25
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Chan HF, Collier GJ, Weatherley ND, Wild JM. Comparison of in vivo lung morphometry models from 3D multiple b-value3He and129Xe diffusion-weighted MRI. Magn Reson Med 2018; 81:2959-2971. [DOI: 10.1002/mrm.27608] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Ho-Fung Chan
- POLARIS, Academic Unit of Radiology, Infection, Immunity & Cardiovascular Disease; University of Sheffield; Sheffield United Kingdom
| | - Guilhem J. Collier
- POLARIS, Academic Unit of Radiology, Infection, Immunity & Cardiovascular Disease; University of Sheffield; Sheffield United Kingdom
| | - Nicholas D. Weatherley
- POLARIS, Academic Unit of Radiology, Infection, Immunity & Cardiovascular Disease; University of Sheffield; Sheffield United Kingdom
- Academic Directorate of Respiratory Medicine; Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield United Kingdom
| | - Jim M. Wild
- POLARIS, Academic Unit of Radiology, Infection, Immunity & Cardiovascular Disease; University of Sheffield; Sheffield United Kingdom
- Insigneo, Institute for in Silico Medicine; University of Sheffield; Sheffield United Kingdom
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26
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Bell AS, Lawrence PJ, Singh D, Horsley A. Feasibility and challenges of using multiple breath washout in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:2113-2119. [PMID: 30022817 PMCID: PMC6044337 DOI: 10.2147/copd.s164285] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Lung clearance index (LCI), derived from multiple-breath washout (MBW), is a well-established assessment of ventilation inhomogeneity in cystic fibrosis but has not been widely applied in other conditions characterized by heterogeneous airways disease, such as COPD. The aim of this study was to evaluate the sensitivity, repeatability, and practicality of LCI in patients with COPD. Methods Fifty-four COPD patients completed MBW using nitrogen as the washout tracer gas (MBWN2, measured using an Exhalyzer™ device), spirometry, and plethysmography. Twenty patients repeated MBWN2, MBWSF6 (using a separate Innocor™ gas analyzer to measure washout of the exogenous trace sulphur hexafluoride), and spirometry at a second visit ≥24 hours later. Results Mean (SD) COPD LCI measured by nitrogen washout (LCIN2) was 12.1 (2.2); mean (SD) LCI Z-score 5.8 (2.0). LCIN2 increased across Global Initiative for Obstructive Lung Disease stages 1 to 3 and was abnormal (Z-score >1.65) in all COPD patients, including those with forced expiratory volume in 1 second (FEV1) ≥80% predicted. LCI was repeatable (median intra-test coefficient of variation 4.1%) and reproducible (limits of agreement -1.8 to 1.6) after mean of 16 days. Functional residual capacity (FRC) measurements were significantly greater using nitrogen than SF6 or plethysmography: mean FRC measured by nitrogen washout (FRCN2) 139% predicted versus FRC measured by plethysmography 125% predicted, p<0.0001. Conclusion LCI is most suitable as a measure of early airways disease in COPD in those with well-preserved FEV1, with similar repeatability and limitations to that observed in cystic fibrosis. Using the Exhalyzer system to perform MBWN2, however, appeared to substantially over-read FRC. This discrepancy needs addressing before FRCN2 measurements made using this device can be reliably deployed.
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Affiliation(s)
- Alan S Bell
- The Medicines Evaluation Unit, Wythenshawe Hospital, Manchester, UK.,Division of Infection Immunity and Respiratory Medicine, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK,
| | | | - Dave Singh
- The Medicines Evaluation Unit, Wythenshawe Hospital, Manchester, UK.,Division of Infection Immunity and Respiratory Medicine, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK, .,Manchester Academic Health Science Centre, Manchester, UK,
| | - Alexander Horsley
- Division of Infection Immunity and Respiratory Medicine, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK, .,Manchester Academic Health Science Centre, Manchester, UK, .,Manchester Adult Cystic Fibrosis Centre, Manchester University NHS Foundation Trust, Manchester, UK,
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27
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Kinematic Magnetic Resonance Imaging of the Thorax Using 2-Dimensional Balanced Subsecond Steady-state Free Precession Sequence During Forced Breathing in Comparison With Spirometry. J Thorac Imaging 2018; 33:184-190. [DOI: 10.1097/rti.0000000000000314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Kern AL, Vogel-Claussen J. Hyperpolarized gas MRI in pulmonology. Br J Radiol 2018; 91:20170647. [PMID: 29271239 PMCID: PMC5965996 DOI: 10.1259/bjr.20170647] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/12/2017] [Accepted: 12/08/2017] [Indexed: 01/20/2023] Open
Abstract
Lung diseases have a high prevalence amongst the world population and their early diagnosis has been pointed out to be key for successful treatment. However, there is still a lack of non-invasive examination methods with sensitivity to early, local deterioration of lung function. Proton-based lung MRI is particularly challenging due to short T2* times and low proton density within the lung tissue. Hyperpolarized gas MRI is aan emerging technology providing a richness of methodologies which overcome the aforementioned problems. Unlike proton-based MRI, lung MRI of hyperpolarized gases may rely on imaging of spins in the lung's gas spaces or inside the lung tissue and thereby add substantial value and diagnostic potential to lung MRI. This review article gives an introduction to the MR physics of hyperpolarized media and presents the current state of hyperpolarized gas MRI of 3Headvasd and 129Xe in pulmonology. Key applications, ranging from static and dynamic ventilation imaging as well as oxygen-pressure mapping to 129Xe dissolved-phase imaging and spectroscopy are presented. Hyperpolarized gas MRI is compared to alternative examination methods based on MRI and future directions of hyperpolarized gas MRI are discussed.
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Abascal JFPJ, Desco M, Parra-Robles J. Incorporation of Prior Knowledge of Signal Behavior Into the Reconstruction to Accelerate the Acquisition of Diffusion MRI Data. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:547-556. [PMID: 29408783 DOI: 10.1109/tmi.2017.2765281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Diffusion MRI data are generally acquired using hyperpolarized gases during patient breath-hold, which yields a compromise between achievable image resolution, lung coverage, and number of -values. In this paper, we propose a novel method that accelerates the acquisition of diffusion MRI data by undersampling in both the spatial and -value dimensions and incorporating knowledge about signal decay into the reconstruction (SIDER). SIDER is compared with total variation (TV) reconstruction by assessing its effect on both the recovery of ventilation images and the estimated mean alveolar dimensions (MADs). Both methods are assessed by retrospectively undersampling diffusion data sets ( =8) of healthy volunteers and patients with Chronic Obstructive Pulmonary Disease (COPD) for acceleration factors between x2 and x10. TV led to large errors and artifacts for acceleration factors equal to or larger than x5. SIDER improved TV, with a lower solution error and MAD histograms closer to those obtained from fully sampled data for acceleration factors up to x10. SIDER preserved image quality at all acceleration factors, although images were slightly smoothed and some details were lost at x10. In conclusion, we developed and validated a novel compressed sensing method for lung MRI imaging and achieved high acceleration factors, which can be used to increase the amount of data acquired during breath-hold. This methodology is expected to improve the accuracy of estimated lung microstructure dimensions and provide more options in the study of lung diseases with MRI.
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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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Non-invasive methods for estimating mPAP in COPD using cardiovascular magnetic resonance imaging. Eur Radiol 2017; 28:1438-1448. [PMID: 29147768 PMCID: PMC5834560 DOI: 10.1007/s00330-017-5143-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/12/2017] [Accepted: 10/18/2017] [Indexed: 11/30/2022]
Abstract
Purpose Pulmonary hypertension (PH) is associated with a poor outcome in chronic obstructive pulmonary disease (COPD) and is diagnosed invasively. We aimed to assess the diagnostic accuracy and prognostic value of non-invasive cardiovascular magnetic resonance (CMR) models. Methods Patients with COPD and suspected PH, who underwent CMR and right heart catheter (RHC) were identified. Three candidate models were assessed: 1, CMR-RV model, based on right ventricular (RV) mass and interventricular septal angle; 2, CMR PA/RV includes RV mass, septal angle and pulmonary artery (PA) measurements; 3, the Alpha index, based on RV ejection fraction and PA size. Results Of 102 COPD patients, 87 had PH. The CMR-PA/RV model had the strongest diagnostic accuracy (sensitivity 92%, specificity 80%, positive predictive value 96% and negative predictive value 63%, AUC 0.93, p<0.0001). Splitting RHC-mPAP, CMR-RV and CMR-PA/RV models by 35mmHg gave a significant difference in survival, with log-rank chi-squared 5.03, 5.47 and 7.10. RV mass and PA relative area change were the independent predictors of mortality at multivariate Cox regression (p=0.002 and 0.030). Conclusion CMR provides diagnostic and prognostic information in PH-COPD. The CMR-PA/RV model is useful for diagnosis, the RV mass index and PA relative area change are useful to assess prognosis. Key Points • Pulmonary hypertension is a marker of poor outcome in COPD. • MRI can predict invasively measured mean pulmonary artery pressure. • Cardiac MRI allows for estimation of survival in COPD. • Cardiac MRI may be useful for follow up or future trials. • MRI is potentially useful to assess pulmonary hypertension in patients with COPD.
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Gutberlet M, Kaireit TF, Voskrebenzev A, Lasch F, Freise J, Welte T, Wacker F, Hohlfeld JM, Vogel-Claussen J. Free-breathing Dynamic 19F Gas MR Imaging for Mapping of Regional Lung Ventilation in Patients with COPD. Radiology 2017; 286:1040-1051. [PMID: 28972817 DOI: 10.1148/radiol.2017170591] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To quantify regional lung ventilation in patients with chronic obstructive pulmonary disease (COPD) by using free-breathing dynamic fluorinated (fluorine 19 [19F]) gas magnetic resonance (MR) imaging. Materials and Methods In this institutional review board-approved prospective study, 27 patients with COPD were examined by using breath-hold 19F gas wash-in MR imaging during inhalation of a normoxic fluorinated gas mixture (perfluoropropane) and by using free-breathing dynamic 19F gas washout MR imaging after inhalation of the gas mixture was finished for a total of 25-30 L. Regional lung ventilation was quantified by using volume defect percentage (VDP), washout time, number of breaths, and fractional ventilation (FV). To compare different lung function parameters, Pearson correlation coefficient and Fisher z transformation were used, which were corrected for multiple comparisons with the Bonferroni method. Results Statistically significant correlations were observed for all evaluated lung function test parameters compared with median and interquartile range of 19F washout parameters. An inverse linear correlation of median number of breaths (r = -0.82; P < .0001) and median washout times (r = -0.77; P < .0001) with percentage predicted of forced expiratory volume in 1 second (FEV1) was observed; correspondingly median FV (r = 0.86; P < .0001) correlated positively with percentage predicted FEV1. Comparing initial with late phase, median VDP of all subjects decreased from 49% (25th-75th percentile, 35%-62%) to 6% (25th-75th percentile, 2%-10%; P < .0001). VDP at the beginning of the gas wash-in phase (VDPinitial) significantly correlated with percentage predicted FEV1 (r = -0.74; P = .0028) and FV (r = 0.74; P = .0002). Median FV was significantly increased in ventilated regions (11.1% [25th-75th percentile, 6.8%-14.5%]) compared with the defect regions identified by VDPinitial (5.8% [25th-75th percentile, 4.0%-7.4%]; P < .0001). Conclusion Quantification of regional lung ventilation by using dynamic 19F gas washout MR imaging in free breathing is feasible at 1.5 T even in obstructed lung segments. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Marcel Gutberlet
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
| | - Till F Kaireit
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
| | - Andreas Voskrebenzev
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
| | - Florian Lasch
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
| | - Julia Freise
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
| | - Tobias Welte
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
| | - Frank Wacker
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
| | - Jens M Hohlfeld
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
| | - Jens Vogel-Claussen
- From the Institute for Diagnostic and Interventional Radiology (M.G., T.F.K., A.V., F.W., J.V.C.), Institute of Biometry (F.L.), and Clinic of Pneumology (J.F., T.W., J.M.H.), Hannover Medical School, Carl-Neuberg Str 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover, the German Center for Lung Research, Hannover, Germany (M.G., T.F.K., A.V., J.F., T.W., F.W., J.M.H., J.V.C.); and Fraunhofer Institute for Toxicology and Experimental Medicine, Clinical Airway Research, Hannover, Germany (J.M.H.)
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Crossley D, Turner A, Subramanian D. Phenotyping emphysema and airways disease: Clinical value of quantitative radiological techniques. World J Respirol 2017; 7:1-16. [DOI: 10.5320/wjr.v7.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 01/14/2017] [Indexed: 02/06/2023] Open
Abstract
The pathophysiology of chronic obstructive pulmonary disease (COPD) and Alpha one antitrypsin deficiency is increasingly recognised as complex such that lung function alone is insufficient for early detection, clinical categorisation and dictating management. Quantitative imaging techniques can detect disease earlier and more accurately, and provide an objective tool to help phenotype patients into predominant airways disease or emphysema. Computed tomography provides detailed information relating to structural and anatomical changes seen in COPD, and magnetic resonance imaging/nuclear imaging gives functional and regional information with regards to ventilation and perfusion. It is likely imaging will become part of routine clinical practice, and an understanding of the implications of the data is essential. This review discusses technical and clinical aspects of quantitative imaging in obstructive airways disease.
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Yablonskiy DA, Sukstanskii AL, Quirk JD. Diffusion lung imaging with hyperpolarized gas MRI. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3448. [PMID: 26676342 PMCID: PMC4911335 DOI: 10.1002/nbm.3448] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 05/28/2023]
Abstract
Lung imaging using conventional 1 H MRI presents great challenges because of the low density of lung tissue, lung motion and very fast lung tissue transverse relaxation (typical T2 * is about 1-2 ms). MRI with hyperpolarized gases (3 He and 129 Xe) provides a valuable alternative because of the very strong signal originating from inhaled gas residing in the lung airspaces and relatively slow gas T2 * relaxation (typical T2 * is about 20-30 ms). However, in vivo human experiments should be performed very rapidly - usually during a single breath-hold. In this review, we describe the recent developments in diffusion lung MRI with hyperpolarized gases. We show that a combination of the results of modeling of gas diffusion in lung airspaces and diffusion measurements with variable diffusion-sensitizing gradients allows the extraction of quantitative information on the lung microstructure at the alveolar level. From an MRI scan of less than 15 s, this approach, called in vivo lung morphometry, allows the provision of quantitative values and spatial distributions of the same physiological parameters as measured by means of 'standard' invasive stereology (mean linear intercept, surface-to-volume ratio, density of alveoli, etc.). In addition, the approach makes it possible to evaluate some advanced Weibel parameters characterizing lung microstructure: average radii of alveolar sacs and ducts, as well as the depth of their alveolar sleeves. Such measurements, providing in vivo information on the integrity of pulmonary acinar airways and their changes in different diseases, are of great importance and interest to a broad range of physiologists and clinicians. We also discuss a new type of experiment based on the in vivo lung morphometry technique combined with quantitative computed tomography measurements, as well as with gradient echo MRI measurements of hyperpolarized gas transverse relaxation in the lung airspaces. Such experiments provide additional information on the blood vessel volume fraction, specific gas volume and length of the acinar airways, and allow the evaluation of lung parenchymal and non-parenchymal tissue. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - James D Quirk
- Department of Radiology, Washington University, St. Louis, MO, USA
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Ouriadov AV, Santyr GE. High spatial resolution hyperpolarized3He MRI of the rodent lung using a single breath X-centric gradient-recalled echo approach. Magn Reson Med 2017; 78:2334-2341. [DOI: 10.1002/mrm.26602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/22/2016] [Accepted: 12/14/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Alexei V. Ouriadov
- Imaging Research Laboratories, Robarts Research Institute; London Canada
- Department of Medical Biophysics; The University of Western Ontario; London Canada
| | - Giles E. Santyr
- Department of Medical Biophysics; University of Toronto; Toronto Canada
- Physiology & Experimental Medicine Program, Peter Gilgan Centre for Research and Learning, the Hospital for Sick Children; Toronto Canada
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Stewart NJ, Parra-Robles J, Wild JM. Finite element modeling of (129)Xe diffusive gas exchange NMR in the human alveoli. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2016; 271:21-33. [PMID: 27526397 DOI: 10.1016/j.jmr.2016.07.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/18/2016] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Abstract
Existing models of (129)Xe diffusive exchange for lung microstructural modeling with time-resolved MR spectroscopy data have considered analytical solutions to one-dimensional, homogeneous models of the lungs with specific assumptions about the alveolar geometry. In order to establish a model system for simulating the effects of physiologically-realistic changes in physical and microstructural parameters on (129)Xe exchange NMR, we have developed a 3D alveolar capillary model for finite element analysis. To account for the heterogeneity of the alveolar geometry across the lungs, we have derived realistic geometries for finite element analysis based on 2D histological samples and 3D micro-CT image volumes obtained from ex vivo biopsies of lung tissue from normal subjects and patients with interstitial lung disease. The 3D alveolar capillary model permits investigation of the impact of alveolar geometrical parameters and diffusion and perfusion coefficients on the in vivo measured (129)Xe CSSR signal response. The heterogeneity of alveolar microstructure that is accounted for in image-based models resulted in considerable alterations to the shape of the (129)Xe diffusive uptake curve when compared to 1D models. Our findings have important implications for the future design and optimization of (129)Xe MR experiments and in the interpretation of lung microstructural changes from this data.
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Affiliation(s)
- Neil J Stewart
- POLARIS, Academic Unit of Radiology, University of Sheffield, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Juan Parra-Robles
- POLARIS, Academic Unit of Radiology, University of Sheffield, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom
| | - Jim M Wild
- POLARIS, Academic Unit of Radiology, University of Sheffield, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, United Kingdom.
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Balbinot F, da Costa Batista Guedes Á, Nascimento DZ, Zampieri JF, Alves GRT, Marchiori E, Rubin AS, Hochhegger B. Advances in Imaging and Automated Quantification of Pulmonary Diseases in Non-neoplastic Diseases. Lung 2016; 194:871-879. [PMID: 27663257 DOI: 10.1007/s00408-016-9940-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/03/2016] [Indexed: 10/21/2022]
Abstract
Histological examination has always been the gold standard for the detection and quantification of lung remodeling. However, this method has some limitations regarding the invasiveness of tissue acquisition. Quantitative imaging methods enable the acquisition of valuable information on lung structure and function without the removal of tissue from the body; thus, they are useful for disease identification and follow-up. This article reviews the various quantitative imaging modalities used currently for the non-invasive study of chronic obstructive pulmonary disease, asthma, and interstitial lung diseases. Some promising computer-aided diagnosis methods are also described.
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Affiliation(s)
- Fernanda Balbinot
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil. .,, Rua Coronel Vicente, 451, Centro, Porto Alegre, RS, 90030041, Brazil. .,Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil.
| | - Álvaro da Costa Batista Guedes
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
| | - Douglas Zaione Nascimento
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
| | - Juliana Fischman Zampieri
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
| | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rua Thomaz Cameron, 43, Valparaíso, Petrópolis, RJ, 25685120, Brazil
| | - Adalberto Sperb Rubin
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
| | - Bruno Hochhegger
- Irmandade Santa Casa de Misericórdia de Porto Alegre, LABIMED - Laboratório de Pesquisas em Imagens Médicas, Rua Prof. Annes Dias, 28, Centro, Porto Alegre, RS, 90020090, Brazil
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Cheng J, Pike D, Chow TWS, Kirby M, Parraga G, Chiu B. Three-dimensional ultrasound measurements of carotid vessel wall and plaque thickness and their relationship with pulmonary abnormalities in ex-smokers without airflow limitation. Int J Cardiovasc Imaging 2016; 32:1391-1402. [DOI: 10.1007/s10554-016-0931-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/21/2016] [Indexed: 11/29/2022]
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Capaldi DPI, Zha N, Guo F, Pike D, McCormack DG, Kirby M, Parraga G. Pulmonary Imaging Biomarkers of Gas Trapping and Emphysema in COPD:3He MR Imaging and CT Parametric Response Maps. Radiology 2016; 279:597-608. [DOI: 10.1148/radiol.2015151484] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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40
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Spoel M, Marshall H, IJsselstijn H, Parra-Robles J, van der Wiel E, Swift AJ, Rajaram S, Tibboel D, Tiddens HAWM, Wild JM. Pulmonary ventilation and micro-structural findings in congenital diaphragmatic hernia. Pediatr Pulmonol 2016; 51:517-24. [PMID: 26451536 DOI: 10.1002/ppul.23325] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND With increasing survival of patients with more severe forms of congenital diaphragmatic hernia (CDH) and risk of long-term respiratory morbidity, studies on lung morphology are needed. We used hyperpolarised (3) He MRI and anatomical (1) H MRI in a cohort of young adult CDH patients to image regional lung ventilation and microstructure, focusing on morphological and micro-structural (alveolar) abnormalities. METHODS Nine patients with left-sided CDH, born 1975-1993, were studied. Regional ventilation was imaged with hyperpolarised (3) He MRI, and the (3) He apparent diffusion coefficient (ADC) was computed separately for the ipsilateral and contralateral lungs. (1) H MRI was used to image lung anatomy, total lung volume and motion during free-breathing. RESULTS (3) He MRI showed ventilation abnormalities in six patients, ranging from a single ipsilateral ventilation defect (3 patients) to multiple ventilation defects in both lungs (one patient treated with extra corporeal membrane oxygenation). In eight patients, (3) He ADC values for the ipsilateral lung were significantly higher than those for the contralateral lung. CONCLUSIONS Functional and micro-structural changes persist into adulthood in most CDH patients. Ipsilateral elevated (3) He ADC values are consistent with enlargement of mean dimensions of the confining lung micro-structure at the alveolar level.
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Affiliation(s)
- Marjolein Spoel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Helen Marshall
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Hanneke IJsselstijn
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Juan Parra-Robles
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Els van der Wiel
- Department of Paediatrics-Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Andrew J Swift
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Smitha Rajaram
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC-Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Harm A W M Tiddens
- Department of Paediatrics-Respiratory Medicine and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jim M Wild
- Department of Academic Radiology, University of Sheffield, Sheffield, United Kingdom
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Yamashiro T, Moriya H, Tsubakimoto M, Matsuoka S, Murayama S. Continuous quantitative measurement of the proximal airway dimensions and lung density on four-dimensional dynamic-ventilation CT in smokers. Int J Chron Obstruct Pulmon Dis 2016; 11:755-64. [PMID: 27110108 PMCID: PMC4835141 DOI: 10.2147/copd.s100658] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Four-dimensional dynamic-ventilation computed tomography (CT) imaging demonstrates continuous movement of the airways and lungs, which cannot be depicted with conventional CT. We aimed to investigate continuous changes in lung density and airway dimensions and to assess the correlation with spirometric values in smokers. Materials and methods This retrospective study was approved by the Institutional Review Board, and informed consent was waived. Twenty-one smokers including six patients with COPD underwent four-dimensional dynamic-ventilation CT during free breathing (160 mm in length). The mean lung density (MLD) of the scanned lung and luminal areas (Ai) of fixed points in the trachea and the right proximal bronchi (main bronchus, upper bronchus, bronchus intermedius, and lower bronchus) were continuously measured. Concordance between the time curve of the MLD and that of the airway Ai values was expressed by cross-correlation coefficients. The associations between these quantitative measurements and the forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) values were assessed by Spearman’s rank correlation analysis. Results On the time curve for the MLD, the Δ-MLD1.05 values between the peak inspiratory frame to the later third frame (1.05 seconds later) were strongly correlated with the FEV1/FVC (ρ=0.76, P<0.0001). The cross-correlation coefficients between the airway Ai and MLD values were significantly correlated with the FEV1/FVC (ρ=−0.56 to −0.66, P<0.01), except for the right upper bronchus. This suggested that the synchrony between the airway and lung movement was lost in patients with severe airflow limitation. Conclusion Respiratory changes in the MLD and synchrony between the airway Ai and the MLD measured with dynamic-ventilation CT were correlated with patient’s spirometric values.
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Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima-shi, Fukushima, Japan
| | - Maho Tsubakimoto
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Shin Matsuoka
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
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Roos JE, McAdams HP, Kaushik SS, Driehuys B. Hyperpolarized Gas MR Imaging: Technique and Applications. Magn Reson Imaging Clin N Am 2016; 23:217-29. [PMID: 25952516 DOI: 10.1016/j.mric.2015.01.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional imaging offers information more sensitive to changes in lung structure and function. Hyperpolarized helium ((3)He) and xenon ((129)Xe) MR imaging of the lungs provides sensitive contrast mechanisms to probe changes in pulmonary ventilation, microstructure, and gas exchange. Gas imaging has shifted to the use of (129)Xe. Xenon is well-tolerated. (129)Xe is soluble in pulmonary tissue, which allows exploring specific lung function characteristics involved in gas exchange and alveolar oxygenation. Hyperpolarized gases and (129)Xe in particular stand to be an excellent probe of pulmonary structure and function, and provide sensitive and noninvasive biomarkers for pulmonary diseases.
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Affiliation(s)
- Justus E Roos
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
| | - Holman P McAdams
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA
| | - S Sivaram Kaushik
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
| | - Bastiaan Driehuys
- Department of Radiology, Center for In Vivo Microscopy, Duke University Medical Center, Durham, NC, USA
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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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44
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Stewart NJ, Wild JM. MRI methods for structural and functional assessment of the lungs: proton and multinuclear. IMAGING 2016. [DOI: 10.1183/2312508x.10002115] [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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45
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Pike D, Kirby M, Eddy RL, Guo F, Capaldi DPI, Ouriadov A, McCormack DG, Parraga G. Regional Heterogeneity of Chronic Obstructive Pulmonary Disease Phenotypes: Pulmonary (3)He Magnetic Resonance Imaging and Computed Tomography. COPD 2016; 13:601-9. [PMID: 26788765 DOI: 10.3109/15412555.2015.1123682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary ventilation may be visualized and measured using hyperpolarized (3)He magnetic resonance imaging (MRI) while emphysema and its distribution can be quantified using thoracic computed tomography (CT). Our objective was to phenotype ex-smokers with COPD based on the apical-to-basal distribution of ventilation abnormalities and emphysema to better understand how these phenotypes change regionally as COPD progresses. We evaluated 100 COPD ex-smokers who provided written informed consent and underwent spirometry, CT and (3)He MRI. (3)He MRI ventilation imaging was used to quantify the ventilation defect percent (VDP) for whole-lung and individual lung lobes. Regional VDP was used to generate the apical-lung (AL)-to-basal-lung (BL) difference (ΔVDP); a positive ΔVDP indicated AL-predominant and negative ΔVDP indicated BL-predominant ventilation defects. Emphysema was quantified using the relative-area-of-the-lung ≤-950HU (RA950) of the CT density histogram for whole-lung and individual lung lobes. The AL-to-BL RA950 difference (ΔRA950) was generated with a positive ΔRA950 indicating AL-predominant emphysema and a negative ΔRA950 indicating BL-predominant emphysema. Seventy-two ex-smokers reported BL-predominant MRI ventilation defects and 71 reported AL-predominant CT emphysema. BL-predominant ventilation defects (AL/BL: GOLD I = 18%/82%, GOLD II = 24%/76%) and AL-predominant emphysema (AL/BL: GOLD I = 84%/16%, GOLD II = 72%/28%) were the major phenotypes in mild-moderate COPD. In severe COPD there was a more uniform distribution for ventilation defects (AL/BL: GOLD III = 40%/60%, GOLD IV = 43%/57%) and emphysema (AL/BL: GOLD III = 64%/36%, GOLD IV = 43%/57%). Basal-lung ventilation defects predominated in mild-moderate GOLD grades, and a more homogeneous distribution of ventilation defects was observed in more advanced grade COPD; these differences suggest that over time, regional ventilation abnormalities become more homogenously distributed during disease progression.
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Affiliation(s)
- Damien Pike
- a Robarts Research Institute, The University of Western Ontario , London , Canada.,b Department of Medical Biophysics , The University of Western Ontario , London , Canada
| | - Miranda Kirby
- c James Hogg Research Centre, St. Paul's Hospital, University of British Columbia , Vancouver , Canada
| | - Rachel L Eddy
- a Robarts Research Institute, The University of Western Ontario , London , Canada.,b Department of Medical Biophysics , The University of Western Ontario , London , Canada
| | - Fumin Guo
- a Robarts Research Institute, The University of Western Ontario , London , Canada.,d Graduate Program in Biomedical Engineering, The University of Western Ontario , London , Canada
| | - Dante P I Capaldi
- a Robarts Research Institute, The University of Western Ontario , London , Canada.,b Department of Medical Biophysics , The University of Western Ontario , London , Canada
| | - Alexei Ouriadov
- a Robarts Research Institute, The University of Western Ontario , London , Canada
| | - David G McCormack
- e Division of Respirology, Department of Medicine , The University of Western Ontario , London , Canada
| | - Grace Parraga
- a Robarts Research Institute, The University of Western Ontario , London , Canada.,b Department of Medical Biophysics , The University of Western Ontario , London , Canada.,d Graduate Program in Biomedical Engineering, The University of Western Ontario , London , Canada
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Yablonskiy DA, Sukstanskii AL, Quirk JD, Woods JC, Conradi MS. Probing lung microstructure with hyperpolarized noble gas diffusion MRI: theoretical models and experimental results. Magn Reson Med 2016; 71:486-505. [PMID: 23554008 DOI: 10.1002/mrm.24729] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The introduction of hyperpolarized gases ((3)He and (129)Xe) has opened the door to applications for which gaseous agents are uniquely suited-lung MRI. One of the pulmonary applications, diffusion MRI, relies on measuring Brownian motion of inhaled hyperpolarized gas atoms diffusing in lung airspaces. In this article we provide an overview of the theoretical ideas behind hyperpolarized gas diffusion MRI and the results obtained over the decade-long research. We describe a simple technique based on measuring gas apparent diffusion coefficient (ADC) and an advanced technique, in vivo lung morphometry, that quantifies lung microstructure both in terms of Weibel parameters (acinar airways radii and alveolar depth) and standard metrics (mean linear intercept, surface-to-volume ratio, and alveolar density) that are widely used by lung researchers but were previously available only from invasive lung biopsy. This technique has the ability to provide unique three-dimensional tomographic information on lung microstructure from a less than 15 s MRI scan with results that are in good agreement with direct histological measurements. These safe and sensitive diffusion measurements improve our understanding of lung structure and functioning in health and disease, providing a platform for monitoring the efficacy of therapeutic interventions in clinical trials.
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Walkup LL, Woods JC. Advances in Imaging Cystic Fibrosis Lung Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2015; 28:220-229. [DOI: 10.1089/ped.2015.0588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Laura L. Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jason C. Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Clapp J, Hamedani H, Kadlecek S, Xin Y, Shaghaghi H, Siddiqui S, Rossman MD, Rizi RR. Multibreath alveolar oxygen tension imaging. Magn Reson Med 2015; 76:1092-101. [PMID: 26467179 DOI: 10.1002/mrm.26001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE This study tested the ability of a multibreath hyperpolarized HP (3) He MRI protocol to increase the accuracy of regional alveolar oxygen tension (PA O2 ) measurements by lessening the influence of gas-flow artifacts. Conventional single-breath PA O2 measurement has been susceptible to error induced by intervoxel gas flow, particularly when used to study subjects with moderate-to-severe chronic obstructive pulmonary disease (COPD). METHODS Both single-breath and multibreath PA O2 imaging schemes were implemented in seven human subjects (one healthy, three asymptomatic smokers, and three COPD). The number and location of voxels with nonphysiologic PA O2 values generated by intervoxel gas flow were compared between the two protocols. RESULTS The multibreath scheme resulted in a significantly lower total percentage of nonphysiologic PA O2 values (6.0%) than the single-breath scheme (13.7%) (P = 0.006). PA O2 maps showed several patterns of gas-flow artifacts that were present in the single-breath protocol but mitigated by the multibreath approach. Multibreath imaging also allowed for the analysis of slow-filling areas that presented no signal after a single breath. CONCLUSION A multibreath approach enhances the accuracy and completeness of noninvasive PA O2 measurement by significantly lessening the proportion of nonphysiologic values generated by intervoxel gas flow. Magn Reson Med 76:1092-1101, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Justin Clapp
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hooman Hamedani
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen Kadlecek
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yi Xin
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hoora Shaghaghi
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarmad Siddiqui
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Milton D Rossman
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rahim R Rizi
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Paulin GA, Ouriadov A, Lessard E, Sheikh K, McCormack DG, Parraga G. Noninvasive quantification of alveolar morphometry in elderly never- and ex-smokers. Physiol Rep 2015; 3:3/10/e12583. [PMID: 26462748 PMCID: PMC4632953 DOI: 10.14814/phy2.12583] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Diffusion-weighted magnetic resonance imaging (MRI) provides a way to generate in vivo lung images with contrast sensitive to the molecular displacement of inhaled gas at subcellular length scales. Here, we aimed to evaluate hyperpolarized 3He MRI estimates of the alveolar dimensions in 38 healthy elderly never-smokers (73 ± 6 years, 15 males) and 21 elderly ex-smokers (70 ± 10 years, 14 males) with (n = 8, 77 ± 6 years) and without emphysema (n = 13, 65 ± 10 years). The ex-smoker and never-smoker subgroups were significantly different for FEV1/FVC (P = 0.0001) and DLCO (P = 0.009); while ex-smokers with emphysema reported significantly diminished FEV1/FVC (P = 0.02) and a trend toward lower DLCO (P = 0.05) than ex-smokers without emphysema. MRI apparent diffusion coefficients (ADC) and CT measurements of emphysema (relative area–CT density histogram, RA950) were significantly different (P = 0.001 and P = 0.007) for never-smoker and ex-smoker subgroups. In never-smokers, the MRI estimate of mean linear intercept (260 ± 27 μm) was significantly elevated as compared to the results previously reported in younger never-smokers (210 ± 30 μm), and trended smaller than in the age-matched ex-smokers (320 ± 72 μm, P = 0.06) evaluated here. Never-smokers also reported significantly smaller internal (220 ± 24 μm, P = 0.01) acinar radius but greater alveolar sheath thickness (120 ± 4 μm, P < 0.0001) than ex-smokers. Never-smokers were also significantly different than ex-smokers without emphysema for alveolar sheath thickness but not ADC, while ex-smokers with emphysema reported significantly different ADC but not alveolar sheath thickness compared to ex-smokers without CT evidence of emphysema. Differences in alveolar measurements in never- and ex-smokers demonstrate the sensitivity of MRI measurements to the different effects of smoking and aging on acinar morphometry.
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Affiliation(s)
- Gregory A Paulin
- Imaging Research Laboratories, Robarts Research Institute The University of Western Ontario, London, Ontario, Canada Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
| | - Alexei Ouriadov
- Imaging Research Laboratories, Robarts Research Institute The University of Western Ontario, London, Ontario, Canada
| | - Eric Lessard
- Imaging Research Laboratories, Robarts Research Institute The University of Western Ontario, London, Ontario, Canada Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
| | - Khadija Sheikh
- Imaging Research Laboratories, Robarts Research Institute The University of Western Ontario, London, Ontario, Canada Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
| | - David G McCormack
- Division of Respirology, Department of Medicine, The University of Western Ontario, London, Ontario, Canada
| | - Grace Parraga
- Imaging Research Laboratories, Robarts Research Institute The University of Western Ontario, London, Ontario, Canada Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
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