Magnetic resonance T2* measurements of the normal human lung in vivo with ultra-short echo times

Toward Lung Ventilation Imaging Using Hyperpolarized Diethyl Ether Gas Contrast Agent

Hyperpolarized 129Xe gas was FDA-approved as an inhalable contrast agent for magnetic resonance imaging of a wide range of pulmonary diseases in December 2022. Despite the remarkable success in clinical research settings, the widespread clinical translation of HP 129Xe gas faces two critical challenges: the high cost of the relatively low-throughput hyperpolarization equipment and the lack of 129Xe imaging capability on clinical MRI scanners, which have narrow-bandwidth electronics designed only for proton (1H) imaging. To solve this translational grand challenge of gaseous hyperpolarized MRI contrast agents, here we demonstrate the utility of batch-mode production of proton-hyperpolarized diethyl ether gas via heterogeneous pairwise addition of parahydrogen to ethyl vinyl ether. An approximately 0.1-liter bolus of hyperpolarized diethyl ether gas was produced in 1 second and injected in excised rabbit lungs. Lung ventilation imaging was performed using sub-second 2D MRI with up to 2×2 mm2 in-plane resolution using a clinical 0.35 T MRI scanner without any modifications. This feasibility demonstration paves the way for the use of inhalable diethyl ether as a gaseous contrast agent for pulmonary MRI applications using any clinical MRI scanner.

Performance of spiral UTE-MRI of the lung in post-COVID patients

Patients recovered from COVID-19 may develop long-COVID symptoms in the lung. For this patient population (post-COVID patients), they may benefit from longitudinal, radiation-free lung MRI exams for monitoring lung lesion development and progression. The purpose of this study was to investigate the performance of a spiral ultrashort echo time MRI sequence (Spiral-VIBE-UTE) in a cohort of post-COVID patients in comparison with CT and to compare image quality obtained using different spiral MRI acquisition protocols. Lung MRI was performed in 36 post-COVID patients with different acquisition protocols, including different spiral sampling reordering schemes (line in partition or partition in line) and different breath-hold positions (inspiration or expiration). Three experienced chest radiologists independently scored all the MR images for different pulmonary structures. Lung MR images from spiral acquisition protocol that received the highest image quality scores were also compared against corresponding CT images in 27 patients for evaluating diagnostic image quality and lesion identification. Spiral-VIBE-UTE MRI acquired with the line in partition reordering scheme in an inspiratory breath-holding position achieved the highest image quality scores (score range = 2.17-3.69) compared to others (score range = 1.7-3.29). Compared to corresponding chest CT images, three readers found that 81.5% (22 out of 27), 81.5% (22 out of 27) and 37% (10 out of 27) of the MR images were useful, respectively. Meanwhile, they all agreed that MRI could identify significant lesions in the lungs. The Spiral-VIBE-UTE sequence allows for fast imaging of the lung in a single breath hold. It could be a valuable tool for lung imaging without radiation and could provide great value for managing different lung diseases including assessment of post-COVID lesions.

Dynamic pulmonary MRI using motion-state weighted motion-compensation (MostMoCo) reconstruction with ultrashort TE: A structural and functional study

PURPOSE

To improve the quality of structural images and the quantification of ventilation in free-breathing dynamic pulmonary MRI.

METHODS

A 3D radial ultrashort TE (UTE) sequence with superior-inferior navigators was used to acquire pulmonary data during free breathing. All acquired data were binned into different motion states according to the respiratory signal extracted from superior-inferior navigators. Motion-resolved images were reconstructed using eXtra-Dimensional (XD) UTE reconstruction. The initial motion fields were generated by registering images at each motion state to other motion states in motion-resolved images. A motion-state weighted motion-compensation (MostMoCo) reconstruction algorithm was proposed to reconstruct the dynamic UTE images. This technique, termed as MostMoCo-UTE, was compared with XD-UTE and iterative motion-compensation (iMoCo) on a porcine lung and 10 subjects.

RESULTS

MostMoCo reconstruction provides higher peak SNR (37.0 vs. 35.4 and 34.2) and structural similarity (0.964 vs. 0.931 and 0.947) compared to XD-UTE and iMoCo in the porcine lung experiment. Higher apparent SNR and contrast-to-noise ratio are achieved using MostMoCo in the human experiment. MostMoCo reconstruction better preserves the temporal variations of signal intensity of parenchyma compared to iMoCo, shows reduced random noise and improved sharpness of anatomical structures compared to XD-UTE. In the porcine lung experiment, the quantification of ventilation using MostMoCo images is more accurate than that using XD-UTE and iMoCo images.

CONCLUSION

The proposed MostMoCo-UTE provides improved quality of structural images and quantification of ventilation for free-breathing pulmonary MRI. It has the potential for the detection of structural and functional disorders of the lung in clinical settings.

Quantification of lung water density with UTE Yarnball MRI

PURPOSE

An efficient Yarnball ultrashort-TE k-space trajectory, in combination with an optimized pulse sequence design and automated image-processing approach, is proposed for fast and quantitative imaging of water density in the lung parenchyma.

METHODS

Three-dimensional Yarnball k-space trajectories (TE = 0.07 ms) were designed at 3 T for breath-hold and free-breathing navigator acquisitions targeting the lung parenchyma (full torso spatial coverage) with minimal T₁ and T 2 ∗ weighting. A composite of all solid tissues surrounding the lungs (muscle, liver, heart, blood pool) was used for user-independent lung water density signal referencing and B₁ -inhomogeneity correction needed for the calculation of relative lung water density images. Sponge phantom experiments were used to validate absolute water density quantification, and relative lung water density was evaluated in 10 healthy volunteers.

RESULTS

Phantom experiments showed excellent agreement between sponge wet weight and imaging-derived water density. Breath-hold (13 seconds) and free-breathing (~2 minutes) Yarnball acquisitions in volunteers (2.5-mm isotropic resolution) had negligible artifacts and good lung parenchyma SNR (>10). Whole-lung average relative lung water density values with fully automated analysis were 28.2 ± 1.9% and 28.6 ± 1.8% for breath-hold and free-breathing acquisitions, respectively, with good test-retest reproducibility (intraclass correlation coefficient = 0.86 and 0.95, respectively).

CONCLUSIONS

Quantitative lung water density imaging with an optimized Yarnball k-space acquisition approach is possible in a breath-hold or short free-breathing study with automated signal referencing and segmentation.

Modern pulmonary imaging of bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is a complex and serious cardiopulmonary morbidity in infants who are born preterm. Despite advances in clinical care, BPD remains a significant source of morbidity and mortality, due in large part to the increased survival of extremely preterm infants. There are few strong early prognostic indicators of BPD or its later outcomes, and evidence for the usage and timing of various interventions is minimal. As a result, clinical management is often imprecise. In this review, we highlight cutting-edge methods and findings from recent pulmonary imaging research that have high translational value. Further, we discuss the potential role that various radiological modalities may play in early risk stratification for development of BPD and in guiding treatment strategies of BPD when employed in varying severities and time-points throughout the neonatal disease course.

Three-dimensional Ultrashort Echotime Magnetic Resonance Imaging for Combined Morphologic and Ventilation Imaging in Pediatric Patients With Pulmonary Disease

PURPOSE

Ultrashort echotime (UTE) sequences aim to improve the signal yield in pulmonary magnetic resonance imaging (MRI). We demonstrate the initial results of spiral 3-dimensional (3D) UTE-MRI for combined morphologic and functional imaging in pediatric patients.

METHODS

Seven pediatric patients with pulmonary abnormalities were included in this observational, prospective, single-center study, with the patients having the following conditions: cystic fibrosis (CF) with middle lobe atelectasis, CF with allergic bronchopulmonary aspergillosis, primary ciliary dyskinesia, air trapping, congenital lobar overinflation, congenital pulmonary airway malformation, and pulmonary hamartoma.Patients were scanned during breath-hold in 5 breathing states on a 3-Tesla system using a prototypical 3D stack-of-spirals UTE sequence. Ventilation maps and signal intensity maps were calculated. Morphologic images, ventilation-weighted maps, and signal intensity maps of the lungs of each patient were assessed intraindividually and compared with reference examinations.

RESULTS

With a scan time of ∼15 seconds per breathing state, 3D UTE-MRI allowed for sufficient imaging of both "plus" pathologies (atelectasis, inflammatory consolidation, and pulmonary hamartoma) and "minus" pathologies (congenital lobar overinflation, congenital pulmonary airway malformation, and air trapping). Color-coded maps of normalized signal intensity and ventilation increased diagnostic confidence, particularly with regard to "minus" pathologies. UTE-MRI detected new atelectasis in an asymptomatic CF patient, allowing for rapid and successful therapy initiation, and it was able to reproduce atelectasis and hamartoma known from multidetector computed tomography and to monitor a patient with allergic bronchopulmonary aspergillosis.

CONCLUSION

3D UTE-MRI using a stack-of-spirals trajectory enables combined morphologic and functional imaging of the lungs within ~115 second acquisition time and might be suitable for monitoring a wide spectrum of pulmonary diseases.

Short-T2 MRI: Principles and recent advances

Among current modalities of biomedical and diagnostic imaging, MRI stands out by virtue of its versatile contrast obtained without ionizing radiation. However, in various cases, e.g., water protons in tissues such as bone, tendon, and lung, MRI performance is limited by the rapid decay of resonance signals associated with short transverse relaxation times T₂ or T₂*. Efforts to address this shortcoming have led to a variety of specialized short-T₂ techniques. Recent progress in this field expands the choice of methods and prompts fresh considerations with regard to instrumentation, data acquisition, and signal processing. In this review, the current status of short-T₂ MRI is surveyed. In an attempt to structure the growing range of techniques, the presentation highlights overarching concepts and basic methodological options. The most frequently used approaches are described in detail, including acquisition strategies, image reconstruction, hardware requirements, means of introducing contrast, sources of artifacts, limitations, and applications.

Free-breathing quantification of regional ventilation derived by phase-resolved functional lung (PREFUL) MRI

PURPOSE

To test the feasibility of regional fully quantitative ventilation measurement in free breathing derived by phase-resolved functional lung (PREFUL) MRI in the supine and prone positions. In addition, the influence of T₂ * relaxation time on ventilation quantification is assessed.

METHODS

Twelve healthy volunteers underwent functional MRI at 1.5 T using a 2D triple-echo spoiled gradient echo sequence allowing for quantitative measurement of T₂ * relaxation time. Minute ventilation (ΔV) was quantified by conventional fractional ventilation (FV) and the newly introduced regional ventilation (VR), which corrects volume errors due to image registration. ΔV_FV versus ΔV_VR and ΔV_VR versus ΔV_VR with T₂ * correction were compared using Bland-Altman plots and correlation analysis. The repeatability and physiological plausibility of all measurements were tested in the supine and prone positions.

RESULTS

On global and regional scales a strong correlation was observed between ΔV_FV versus ΔV_VR and ΔV_VR versus ΔV_VRT2* (r > 0.93); however, regional Bland-Altman analysis showed systematic differences (p < 0.0001). Unlike ΔV_VRT2* , ΔV_VR and ΔV_FV showed expected physiologic anterior-posterior gradients, which decreased in the supine but not in the prone position at second measurement during 3 min in the same position. For all quantification methods a moderate repeatability (coefficient of variation <20%) of ventilation was found.

CONCLUSION

A fully quantified regional ventilation measurement using ΔV_VR in free breathing is feasible and shows physiologically plausible results. In contrast to conventional ΔV_FV, volume errors due to image registration are eliminated with the ΔV_VR approach. However, correction for the T₂ * effect remains challenging.

Structural and Functional Pulmonary Magnetic Resonance Imaging in Pediatrics-From the Neonate to the Young Adult

The clinical imaging modalities available to investigate pediatric pulmonary conditions such as bronchopulmonary dysplasia, cystic fibrosis, and asthma are limited primarily to chest x-ray radiograph and computed tomography. As the challenges that historically limited the application of magnetic resonance imaging (MRI) to the lung have been overcome, its clinical potential has greatly expanded. In this review article, recent advances in pulmonary MRI including ultrashort echo time and hyperpolarized-gas MRI techniques are discussed with an emphasis on pediatric research and translational applications.

Simultaneous Evaluation of Lung Anatomy and Ventilation Using 4D Respiratory-Motion-Resolved Ultrashort Echo Time Sparse MRI

BACKGROUND

Computed tomography (CT) and spirometry are the current standard methods for assessing lung anatomy and pulmonary ventilation, respectively. However, CT provides limited ventilation information and spirometry only provides global measures of lung ventilation. Thus, a method that can enable simultaneous examination of lung anatomy and ventilation is of clinical interest.

PURPOSE

To develop and test a 4D respiratory-resolved sparse lung MRI (XD-UTE: eXtra-Dimensional Ultrashort TE imaging) approach for simultaneous evaluation of lung anatomy and pulmonary ventilation.

STUDY TYPE

Prospective.

POPULATION

In all, 23 subjects (11 volunteers and 12 patients, mean age = 63.6 ± 8.4).

FIELD STRENGTH/SEQUENCE

3T MR; a prototype 3D golden-angle radial UTE sequence, a Cartesian breath-hold volumetric-interpolated examination (BH-VIBE) sequence.

ASSESSMENT

All subjects were scanned using the 3D golden-angle radial UTE sequence during normal breathing. Ten subjects underwent an additional scan during alternating normal and deep breathing. Respiratory-motion-resolved sparse reconstruction was performed for all the acquired data to generate dynamic normal-breathing or deep-breathing image series. For comparison, BH-VIBE was performed in 12 subjects. Lung images were visually scored by three experienced chest radiologists and were analyzed by two observers who segmented the left and right lung to derive ventilation parameters in comparison with spirometry.

STATISTICAL TESTS

Nonparametric paired two-tailed Wilcoxon signed-rank test; intraclass correlation coefficient, Pearson correlation coefficient.

RESULTS

XD-UTE achieved significantly improved image quality compared both with Cartesian BH-VIBE and radial reconstruction without motion compensation (P < 0.05). The global ventilation parameters (a sum of the left and right lung measures) were in good correlation with spirometry in the same subjects (correlation coefficient = 0.724). There were excellent correlations between the results obtained by two observers (intraclass correlation coefficient ranged from 0.8855-0.9995).

DATA CONCLUSION

Simultaneous evaluation of lung anatomy and ventilation using XD-UTE is demonstrated, which have shown good potential for improved diagnosis and management of patients with heterogeneous lung diseases.

LEVEL OF EVIDENCE

2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:411-422.

Lung liquid clearance in preterm lambs assessed by magnetic resonance imaging

BACKGROUND

Postnatal adaptation requires liquid clearance and lung aeration. However, their relative contribution to the expansion of functional residual capacity (FRC) has not been fully investigated. We studied evolution of lung liquid removal and lung aeration after birth in preterm lambs.

METHODS

Lung liquid content and lung volume were assessed at birth and every 30 min over 2 h using magnetic resonance imaging (MRI) in three groups of lambs delivered by cesarean: preterm, late preterm, and late preterm with antenatal steroids. Lung function and mechanics of the respiratory system were also measured.

RESULTS

Lung liquid content increased by approximately 30% in the preterm group (P < 0.05), whereas it did not change significantly in the late preterm lambs. Antenatal steroids induced a 50% drop in the lung liquid content (P < 0.05). Total lung volume increased in all groups (P < 0.05) but was higher in the late preterm + steroids group relative to other groups (P < 0.05). Compliance and resistances of the respiratory system were significantly correlated with lung liquid content (P < 0.05).

CONCLUSION

FRC expansion results mainly from an increase in lung volume rather than a decrease in lung liquid in preterm and late preterm lambs. Antenatal steroids promote FRC expansion through increases in lung volume and liquid clearance.

Magnetic resonance imaging with hyperpolarized agents: methods and applications

In the past decade, hyperpolarized (HP) contrast agents have been under active development for MRI applications to address the twin challenges of functional and quantitative imaging. Both HP helium (³He) and xenon (¹²⁹Xe) gases have reached the stage where they are under study in clinical research. HP ¹²⁹Xe, in particular, is poised for larger scale clinical research to investigate asthma, chronic obstructive pulmonary disease, and fibrotic lung diseases. With advances in polarizer technology and unique capabilities for imaging of ¹²⁹Xe gas exchange into lung tissue and blood, HP ¹²⁹Xe MRI is attracting new attention. In parallel, HP ¹³C and ¹⁵N MRI methods have steadily advanced in a wide range of pre-clinical research applications for imaging metabolism in various cancers and cardiac disease. The HP [1-¹³C] pyruvate MRI technique, in particular, has undergone phase I trials in prostate cancer and is poised for investigational new drug trials at multiple institutions in cancer and cardiac applications. This review treats the methodology behind both HP gases and HP ¹³C and ¹⁵N liquid state agents. Gas and liquid phase HP agents share similar technologies for achieving non-equilibrium polarization outside the field of the MRI scanner, strategies for image data acquisition, and translational challenges in moving from pre-clinical to clinical research. To cover the wide array of methods and applications, this review is organized by numerical section into (1) a brief introduction, (2) the physical and biological properties of the most common polarized agents with a brief summary of applications and methods of polarization, (3) methods for image acquisition and reconstruction specific to improving data acquisition efficiency for HP MRI, (4) the main physical properties that enable unique measures of physiology or metabolic pathways, followed by a more detailed review of the literature describing the use of HP agents to study: (5) metabolic pathways in cancer and cardiac disease and (6) lung function in both pre-clinical and clinical research studies, concluding with (7) some future directions and challenges, and (8) an overall summary.

Pulmonary MRI of neonates in the intensive care unit using 3D ultrashort echo time and a small footprint MRI system

PURPOSE

To determine the feasibility of pulmonary magnetic resonance imaging (MRI) of neonatal lung structures enabled by combining two novel technologies: first, a 3D radial ultrashort echo time (UTE) pulse sequence capable of high spatial resolution full-chest imaging in nonsedated quiet-breathing neonates; and second, a unique, small-footprint 1.5T MRI scanner design adapted for neonatal imaging and installed within the neonatal intensive care unit (NICU).

MATERIALS AND METHODS

Ten patients underwent MRI within the NICU, in accordance with an approved Institutional Review Board protocol. Five had clinical diagnoses of bronchopulmonary dysplasia (BPD), and five had putatively normal lung function. Pulmonary imaging was performed at 1.5T using 3D radial UTE and standard 3D fast gradient recalled echo (FGRE). Diagnostic quality, presence of motion artifacts, and apparent severity of lung pathology were evaluated by two radiologists. Quantitative metrics were additionally used to evaluate lung parenchymal signal.

RESULTS

UTE images showed significantly higher signal in lung parenchyma (P < 0.0001) and fewer apparent motion artifacts compared to FGRE (P = 0.046). Pulmonary pathology was more severe in patients diagnosed with BPD relative to controls (P = 0.001). Infants diagnosed with BPD also had significantly higher signal in lung parenchyma, measured using UTE, relative to controls (P = 0.002).

CONCLUSION

These results demonstrate the technical feasibility of pulmonary MRI in free-breathing, nonsedated infants in the NICU at high, isotropic resolutions approaching that achievable with computed tomography (CT). There is potential for pulmonary MRI to play a role in improving how clinicians understand and manage care of neonatal and pediatric pulmonary diseases. J. Magn. Reson. Imaging 2016.

LEVEL OF EVIDENCE

2 J. Magn. Reson. Imaging 2017;45:463-471.

Retrospective respiratory self-gating and removal of bulk motion in pulmonary UTE MRI of neonates and adults

PURPOSE

To implement pulmonary three-dimensional (3D) radial ultrashort echo-time (UTE) MRI in non-sedated, free-breathing neonates and adults with retrospective motion tracking of respiratory and intermittent bulk motion, to obtain diagnostic-quality, respiratory-gated images.

METHODS

Pulmonary 3D radial UTE MRI was performed at 1.5 tesla (T) during free breathing in neonates and adult volunteers for validation. Motion-tracking waveforms were obtained from the time course of each free induction decay's initial point (i.e., k-space center), allowing for respiratory-gated image reconstructions that excluded data acquired during bulk motion. Tidal volumes were calculated from end-expiration and end-inspiration images. Respiratory rates were calculated from the Fourier transform of the motion-tracking waveform during quiet breathing, with comparison to physiologic prediction in neonates and validation with spirometry in adults.

RESULTS

High-quality respiratory-gated anatomic images were obtained at inspiration and expiration, with less respiratory blurring at the expense of signal-to-noise for narrower gating windows. Inspiration-expiration volume differences agreed with physiologic predictions (neonates; Bland-Altman bias = 6.2 mL) and spirometric values (adults; bias = 0.11 L). MRI-measured respiratory rates compared well with the observed rates (biases = -0.5 and 0.2 breaths/min for neonates and adults, respectively).

CONCLUSIONS

Three-dimensional radial pulmonary UTE MRI allows for retrospective respiratory self-gating and removal of intermittent bulk motion in free-breathing, non-sedated neonates and adults. Magn Reson Med 77:1284-1295, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Gas Phase UTE MRI of Propane and Propene

Proton magnetic resonance imaging (¹H MRI) of gases can potentially enable functional lung imaging to probe gas ventilation and other functions. Here, ¹H MR images of hyperpolarized (HP) and thermally polarized propane gas were obtained using ultrashort echo time (UTE) pulse sequence. A 2-dimensional (2D) image of thermally polarized propane gas with ∼0.9 × 0.9 mm² spatial resolution was obtained in <2 seconds, showing that even non-HP hydrocarbon gases can be successfully used for conventional proton magnetic resonance imaging. The experiments were also performed with HP propane gas, and high-resolution multislice FLASH 2D images in ∼510 seconds and non-slice-selective 2D UTE MRI images were acquired in ∼2 seconds. The UTE approach adopted in this study can be potentially used for medical lung imaging. Furthermore, the possibility of combining UTE with selective suppression of ¹H signals from 1 of the 2 gases in a mixture is shown in this MRI study. The latter can be useful for visualizing industrially important processes where several gases may be present, eg, gas–solid catalytic reactions.

Ultrashort echo time and zero echo time MRI at 7T

OBJECTIVE

Zero echo time (ZTE) and ultrashort echo time (UTE) pulse sequences for MRI offer unique advantages of being able to detect signal from rapidly decaying short-T2 tissue components. In this paper, we applied 3D ZTE and UTE pulse sequences at 7T to assess differences between these methods.

MATERIALS AND METHODS

We matched the ZTE and UTE pulse sequences closely in terms of readout trajectories and image contrast. Our ZTE used the water- and fat-suppressed solid-state proton projection imaging method to fill the center of k-space. Images from healthy volunteers obtained at 7T were compared qualitatively, as well as with SNR and CNR measurements for various ultrashort, short, and long-T2 tissues.

RESULTS

We measured nearly identical contrast-to-noise and signal-to-noise ratios (CNR/SNR) in similar scan times between the two approaches for ultrashort, short, and long-T2 components in the brain, knee and ankle. In our protocol, we observed gradient fidelity artifacts in UTE, and our chosen flip angle and readout also resulted in shading artifacts in ZTE due to inadvertent spatial selectivity. These can be corrected by advanced reconstruction methods or with different chosen protocol parameters.

CONCLUSION

The applied ZTE and UTE pulse sequences achieved similar contrast and SNR efficiency for volumetric imaging of ultrashort-T2 components. Key differences include that ZTE is limited to volumetric imaging, but has substantially reduced acoustic noise levels during the scan. Meanwhile, UTE has higher acoustic noise levels and greater sensitivity to gradient fidelity, but offers more flexibility in image contrast and volume selection.

Diffusion Weighted Magnetic Resonance Imaging for the Characterization of Solitary Pulmonary Lesions

BACKGROUND

We evaluated the differential diagnosis of solitary pulmonary lesions on magnetic resonance imaging.

AIMS

To investigate the value of diffusion weighted imaging on the differential diagnosis of solitary pulmonary lesions.

STUDY DESIGN

Randomized prospective study.

METHODS

This prospective study included 48 solitary pulmonary nodules and masses (18 benign, 30 malignant). Single shot echo planar spin echo diffusion weighted imaging (DWI) was performed with two b factors (0 and 1000 s/mm(2)). Apparent diffusion coefficients (ADCs) were calculated. On diffusion weighted (DW) trace images, the signal intensities (SI) of the lesions were visually compared to the SI of the thoracic spinal cord using a 5-point scale: 1: hypointense, 2: moderately hypointense, 3: isointense, 4: moderately hyperintense, 5: significantly hyperintense. For the quantitative evaluation, the lesion to thoracic spinal signal intensity ratios and the ADCs of the lesions were compared between groups.

RESULTS

On visual evaluation, taking the density of the spinal cord as a reference, most benign lesions were found to be hypointense, while most of the malignant lesions were evaluated as hyperintense on DWI with a b factor of 1000 s/mm(2). In contrast, on T2 weighted images, it was seen that the distinction of malignant lesions from benign lesions was not statistically significant. The ADCs of the malignant lesions were significantly lower than those of benign lesions (mean ADC was 2.02×10(-3) mm(2)/s for malignant lesions, and 1.195×10(-3)±0.3 mm(2)/s for benign lesions). Setting the cut-off value at 1.5×10(-3), ADC had a sensitivity of 86.7% and a specificity of 88.9% for the differentiation of benign lesions from malignant lesions.

CONCLUSION

DWI may aid in the differential diagnosis of solitary pulmonary lesions. (ClinicalTrials.gov Identifier: NCT02482181).

Noncontrast magnetic resonance angiography: concepts and clinical applications

Many noncontrast magnetic resonance angiography techniques have recently been developed in response to concerns about gadolinium in patients with renal impairment. This article describes the theory behind established and recently described techniques and how and where they can be performed in clinical practice.

T2 mapping of CT remodelling patterns in interstitial lung disease

OBJECTIVES

To evaluate lung T2 mapping for quantitative characterization and differentiation of ground-glass opacity (GGO), reticulation (RE) and honeycombing (HC) in usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP).

METHODS

Twelve patients with stable UIP or NSIP underwent thin-section multislice CT and 1.5-T MRI of the lung. A total of 188 regions were classified at CT into normal (n = 29) and pathological areas, including GGO (n = 48), RE (n = 60) and HC (n = 51) predominant lesions. Entire lung T2 maps based on multi-echo single shot TSE sequence (TE: 20, 40, 79, 140, 179 ms) were generated from each subject with breath-holds at end-expiration and ECG-triggering.

RESULTS

The median T2 relaxation of GGO was 67 ms (range 60-72 ms). RE predominant lesions had a median relaxation of 74 ms (range 69-79 ms), while for HC pattern this was 79 ms (range 74-89 ms). The median T2 relaxation for normal lung areas was 41 ms (ranged 38-49 ms), and showed significant difference to pathological areas (p < 0.001). A statistical difference was found between the T2 relaxation of GGO, RE and HC (p < 0.05).

CONCLUSIONS

The proposed method provides quantitative information for pattern differentiation, potentially allowing for monitoring of progression and response to treatment, in interstitial lung disease.

KEY POINTS

• Multi-echo single shot TSE sequence allows for entire lung T2 mapping. • Lung remodelling patterns in ILD show different T2 relaxation. • Quantitative T2 mapping may provide information for monitoring of ILD.

Translational applications of hyperpolarized 3He and 129Xe

Clinical magnetic resonance imaging of the lung is technologically challenging, yet over the past two decades hyperpolarized noble gas ((3)He and (129)Xe) imaging has demonstrated the ability to measure multiple pulmonary functional biomarkers. There is a growing need for non-ionizing, non-invasive imaging techniques due to increased concern about cancer risk from ionizing radiation, but the translation of hyperpolarized gas imaging to the pulmonary clinic has been stunted by limited access to the technology. New developments may open doors to greater access and more translation to clinical studies. Here we briefly review a few translational applications of hyperpolarized gas MRI in the contexts of ventilation, diffusion, and dissolved-phase imaging, as well as comparing and contrasting (3)He and (129)Xe gases for these applications. Simple static ventilation MRI reveals regions of the lung not participating in normal ventilation, and these defects have been observed in many pulmonary diseases. Biomarkers related to airspace size and connectivity can be quantified by apparent diffusion coefficient measurements of hyperpolarized gas, and have been shown to be more sensitive to small changes in lung morphology than standard clinical pulmonary functional tests and have been validated by quantitative histology. Parameters related to gas uptake and exchange and lung tissue density can be determined using (129)Xe dissolved-phase MRI. In most cases functional biomarkers can be determined via MRI of either gas, but for some applications one gas may be preferred, such as (3)He for long-range diffusion measurements and (129)Xe for dissolved-phase imaging. Greater access to hyperpolarized gas imaging coupled with newly developing therapeutics makes pulmonary medicine poised for a potential revolution, further adding to the prospects of personalized medicine already evidenced by advancements in molecular biology. Hyperpolarized gas researchers have the opportunity to contribute to this revolution, particularly if greater clinical application of hyperpolarized gas imaging is realized.

Free-breathing, zero-TE MR lung imaging. MAGMA. 2015;28:207-215. [PMID: 25200814 DOI: 10.1007/s10334-014-0459-y]

OBJECT

The investigation of three-dimensional radial, zero-echo time (TE) imaging for high-resolution, free-breathing magnetic resonance (MR) lung imaging using prospective and retrospective motion correction.

MATERIALS AND METHODS

Zero-TE was implemented similarly to the rotating-ultra-fast-imaging-sequence, providing 3D, isotropic, radial imaging with proton density contrast. Respiratory motion was addressed using prospective triggering (PT), prospective gating (PG) and retrospective gating (RG) with physiological signals obtained from a respiratory belt and interleaved pencil beam and DC navigators. The methods were demonstrated on four healthy volunteers at 3T.

RESULTS

3D, radial zero-TE imaging with high imaging bandwidth and nominally zero echo-time enables efficient capture of short-lived signals from the lung parenchyma and the vessels. Compared to Cartesian encoding, unaccounted for free-breathing respiration resulted in only benign blurring artifacts confined to the origin of motion. Breath holding froze respiration but achieved only limited image resolution (~1.8 mm, 30 s). PT and PG obtained similar quality expiratory-phase images at 1.2 mm resolution in ~6 min scan time. RG allowed multi-phase imaging in ~15 min, derived from eight individually stored averages.

CONCLUSION

Zero-TE appears to be an attractive pulse sequence for 3D isotropic lung imaging. Prospective and retrospective approaches provide high-quality, free-breathing MR lung imaging within reasonable scan time.

Lung Parenchymal Signal Intensity in MRI: A Technical Review with Educational Aspirations Regarding Reversible Versus Irreversible Transverse Relaxation Effects in Common Pulse Sequences

Lung parenchyma is challenging to image with proton MRI. The large air space results in ~l/5th as many signal-generating protons compared to other organs. Air/tissue magnetic susceptibility differences lead to strong magnetic field gradients throughout the lungs and to broad frequency distributions, much broader than within other organs. Such distributions have been the subject of experimental and theoretical analyses which may reveal aspects of lung microarchitecture useful for diagnosis. Their most immediate relevance to current imaging practice is to cause rapid signal decays, commonly discussed in terms of short T2* values of 1 ms or lower at typical imaging field strengths. Herein we provide a brief review of previous studies describing and interpreting proton lung spectra. We then link these broad frequency distributions to rapid signal decays, though not necessarily the exponential decays generally used to define T2* values. We examine how these decays influence observed signal intensities and spatial mapping features associated with the most prominent torso imaging sequences, including spoiled gradient and spin echo sequences. Effects of imperfect refocusing pulses on the multiple echo signal decays in single shot fast spin echo (SSFSE) sequences and effects of broad frequency distributions on balanced steady state free precession (bSSFP) sequence signal intensities are also provided. The theoretical analyses are based on the concept of explicitly separating the effects of reversible and irreversible transverse relaxation processes, thus providing a somewhat novel and more general framework from which to estimate lung signal intensity behavior in modern imaging practice.

Hyperpolarized 129Xe MRI of the human lung

By permitting direct visualization of the airspaces of the lung, magnetic resonance imaging (MRI) using hyperpolarized gases provides unique strategies for evaluating pulmonary structure and function. Although the vast majority of research in humans has been performed using hyperpolarized (3)He, recent contraction in the supply of (3)He and consequent increases in price have turned attention to the alternative agent, hyperpolarized (129) Xe. Compared to (3)He, (129)Xe yields reduced signal due to its smaller magnetic moment. Nonetheless, taking advantage of advances in gas-polarization technology, recent studies in humans using techniques for measuring ventilation, diffusion, and partial pressure of oxygen have demonstrated results for hyperpolarized (129)Xe comparable to those previously demonstrated using hyperpolarized (3)He. In addition, xenon has the advantage of readily dissolving in lung tissue and blood following inhalation, which makes hyperpolarized (129)Xe particularly attractive for exploring certain characteristics of lung function, such as gas exchange and uptake, which cannot be accessed using (3)He. Preliminary results from methods for imaging (129) Xe dissolved in the human lung suggest that these approaches will provide new opportunities for quantifying relationships among gas delivery, exchange, and transport, and thus show substantial potential to broaden our understanding of lung disease. Finally, recent changes in the commercial landscape of the hyperpolarized-gas field now make it possible for this innovative technology to move beyond the research laboratory.

Ultra-fast steady state free precession and its application to in vivo (1)H morphological and functional lung imaging at 1.5 tesla

PURPOSE

The speed limit for three-dimensional Fourier-encoded steady state free precession (SSFP) imaging is explored on a clinical whole body system and pushed toward a pulse repetition time (TR) close to or even below the 1 ms regime; in the following referred to as ultra-fast SSFP imaging.

METHODS

To this end, contemporary optimization strategies, such as efficient gradient switching patterns, partial echoes, ramp sampling techniques, and a target-related design of excitation pulses were applied to explore the lower boundaries in TR for SSFP-based Cartesian imaging.

RESULTS

Generally, minimal TR was limited in vivo by peripheral nerve stimulation, allowing a TR ∼1 ms for isotropic resolutions down to about 2 mm. As a result, ultra-fast balanced SSFP provides artifact-free images even for targets with severe susceptibility variations, and native high-resolution structural and functional in vivo (1)H imaging of the human lung is demonstrated at 1.5 T.

CONCLUSION

On clinical whole body MRI systems, the TR of SSFP-based Cartesian imaging can be pushed toward the 1 ms regime. As a result, ultra-fast SSFP protocols might represent a promising new powerful approach for SSFP-based imaging, not only for lung but also in a variety of clinical and scientific applications.

Optimized 3D ultrashort echo time pulmonary MRI

PURPOSE

To optimize 3D radial ultrashort echo time MRI for high resolution whole-lung imaging.

METHODS

3D radial ultrashort echo time was implemented on a 3T scanner to investigate the effects of: (1) limited field-of-view excitation, (2) variable density readouts, and (3) radial oversampling. Improvements in noise performance and spatial resolution were assessed through simulation and phantom studies. Their effects on lung and airway visualization in five healthy male human subjects (mean age 32 years) were compared qualitatively through blinded ordinal scoring by two cardiothoracic radiologists using a nonparametric Friedman test (P < 0.05). Relative signal difference between endobronchial air and adjacent lung tissue, normalized to nearby vessel, was used as a surrogate for lung tissue signal. Quantitative measures were compared using the paired Student's t-test (P < 0.05). Finally, clinical feasibility was investigated in a patient with interstitial fibrosis.

RESULTS

Simulation and phantom studies showed up to 67% improvement in SNR and reduced blurring for short T2* species using all three optimizations. In vivo images showed decreased artifacts and improved lung tissue and airway visualization both qualitatively and quantitatively.

CONCLUSION

The use of limited field-of-view excitation, variable readout gradients, and radial oversampling significantly improve the technical quality of 3D radial ultrashort echo time lung images.

Measuring lung water: ex vivo validation of multi-image gradient echo MRI

PURPOSE

To validate a fast gradient echo sequence for rapid (9 s) quantitative imaging of lung water.

MATERIALS AND METHODS

Eleven excised pig lungs were imaged with a fast GRE sequence in triplicate, in the sagittal plane at 2 levels of inflation pressure (5 and 15 cm H(2) O), an intervention that alters T(2) *, but not total lung water. Images were acquired alternating between two closely-spaced echoes and data were fit (voxel-by-voxel) to a single exponential to determine T(2) * and water content, and compared with gravimetric measurements of total water.

RESULTS

T(2) * averaged 1.08 ± 0.02 ms at 5 cm H(2) O and 1.02 ± 0.02 ms at 15 cm H(2) O (P < 0.05). The measure was reliable (R(2) = 0.99), with an average mean error of 1.8%. There was a significant linear relationship between the two measures of water content: The regression equations for the relationship were y = 0.92x + 19 (R(2) = 0.94), and y = 1.04x + 4 (R(2) = 0.96), for 5 and 15 cm H(2) O inflation pressure respectively. Y-intercepts were not statistically different from zero (P = 0.86).

CONCLUSION

The multi-echo GRE sequence is a reliable and valid technique to assess water content in the lung. This technique enables rapid assessment of lung water, which is advantageous for in vivo studies.

Quantitative and o(2) enhanced MRI of the pathologic lung: findings in emphysema, fibrosis, and cystic fibrosis

Purpose: beyond the pure morphological visual representation, MR imaging offers the possibility to quantify parameters in the healthy, as well as, in pathologic lung parenchyma. Gas exchange is the primary function of the lung and the transport of oxygen plays a key role in pulmonary physiology and pathophysiology. The purpose of this review is to present a short overview of the relaxation mechanisms of the lung and the current technical concepts of T1 mapping and methods of oxygen enhanced MR imaging. Material and Methods: molecular oxygen has weak paramagnetic properties so that an increase in oxygen concentration results in shortening of the T1 relaxation time and thus to an increase of the signal intensity in T1 weighted images. A possible way to gain deeper insights into the relaxation mechanisms of the lung is the calculation of parameter Maps. T1 Maps based on a snapshot FLASH sequence obtained during the inhalation of various oxygen concentrations provide data for the creation of the so-called oxygen transfer function (OTF), assigning a measurement for local oxygen transfer. T1 weighted single shot TSE sequences also permit expression of the signal changing effects associated with the inhalation of pure oxygen. Results: the average of the mean T1 values over the entire lung in inspiration amounts to 1199 +/− 117 milliseconds, the average of the mean T1 values in expiration was 1333 +/− 167 milliseconds. T1 Maps of patients with emphysema and lung fibrosis show fundamentally different behavior patterns. Oxygen enhanced MRT is able to demonstrate reduced diffusion capacity and diminished oxygen transport in patients with emphysema and cystic fibrosis. Discussion: results published in literature indicate that T1 mapping and oxygen enhanced MR imaging are promising new methods in functional imaging of the lung and when evaluated in conjunction with the pure morphological images can provide additional valuable information.

Non-contrast-enhanced perfusion and ventilation assessment of the human lung by means of fourier decomposition in proton MRI

Assessment of regional lung perfusion and ventilation has significant clinical value for the diagnosis and follow-up of pulmonary diseases. In this work a new method of non-contrast-enhanced functional lung MRI (not dependent on intravenous or inhalative contrast agents) is proposed. A two-dimensional (2D) true fast imaging with steady precession (TrueFISP) pulse sequence (TR/TE = 1.9 ms/0.8 ms, acquisition time [TA] = 112 ms/image) was implemented on a 1.5T whole-body MR scanner. The imaging protocol comprised sets of 198 lung images acquired with an imaging rate of 3.33 images/s in coronal and sagittal view. No electrocardiogram (ECG) or respiratory triggering was used. A nonrigid image registration algorithm was applied to compensate for respiratory motion. Rapid data acquisition allowed observing intensity changes in corresponding lung areas with respect to the cardiac and respiratory frequencies. After a Fourier analysis along the time domain, two spectral lines corresponding to both frequencies were used to calculate the perfusion- and ventilation-weighted images. The described method was applied in preliminary studies on volunteers and patients showing clinical relevance to obtain non-contrast-enhanced perfusion and ventilation data.

Quantitative MRI measurement of lung density must account for the change in T(2) (*) with lung inflation

PURPOSE

To evaluate lung water density at three different levels of lung inflation in normal lungs using a fast gradient echo sequence developed for rapid imaging.

MATERIALS AND METHODS

Ten healthy volunteers were imaged with a fast gradient echo sequence that collects 12 images alternating between two closely spaced echoes in a single 9-s breathhold. Data were fit to a single exponential to determine lung water density and T(2) (*). Data were evaluated in a single imaging slice at total lung capacity (TLC), functional residual capacity (FRC), and residual volume (RV). Analysis of variance for repeated measures was used to statistically evaluate changes in T(2) (*) and lung water density across lung volumes, imaging plane, and spatial locations in the lung.

RESULTS

In normal subjects (n = 10), T(2) (*) (and [lung density/water density]) was 1.2 +/- 0.1 msec (0.10 +/- 0.02), 1.8 +/- 0.2 ms (0.25 +/- 0.04), and 2.0 +/- 0.2 msec (0.27 +/- 0.03) at TLC, FRC, and RV, respectively. Results also show that there is a considerable intersubject variability in the values of T(2) (*).

CONCLUSION

Data show that T(2) (*) in the lung is very short, and varies considerably with lung volume. Thus, if quantitative assessment of lung density within a breathhold is to be measured accurately, then it is necessary to also determine T(2) (*).

Pulmonary MR angiography techniques and applications

This article discusses the role of magnetic resonance angiography (MRA) in evaluating the pulmonary arterial system. For depiction of pulmonary arterial anatomy and morphology, MRA techniques are compared with CT angiography and digital subtraction x-ray angiography. Perfusion, flow, and function are emphasized, as the integrated MR examination offers a comprehensive assessment of vascular morphology and function. Advances in MR technology that improve spatial and temporal resolution and compensate for potential artifacts are reviewed as they pertain to pulmonary MRA. Current and emerging gadolinium contrast-enhanced and non-contrast-enhanced MRA techniques are discussed. The role of pulmonary MRA, clinical protocols, imaging findings, and interpretation pitfalls are reviewed for clinical indications.

MR elastography of the lung with hyperpolarized 3He

MR elastography (MRE) is a phase contrast-based technique for spatially mapping the mechanical properties of tissue-like materials. While hyperpolarized noble gases such as helium-3 ((3)He) have proven to be an ideal contrast mechanism for imaging of the lung using conventional MR techniques, their applicability for lung MRE is unknown, due to the fact that gases do not support shear. In this study, we report on the application of MRE to an ex vivo porcine lung specimen inflated with a hyperpolarized noble gas. Unlike proton MRE, shear wave propagation is encoded into the gas entrapped within the alveolar spaces rather than the parenchyma itself. These data provide first evidence of the technical feasibility of MRE of the lung using hyperpolarized noble gases.

T1-Maps und O2-verstärkte MRT der erkrankten Lunge

PURPOSE

Gas exchange is the primary function of the lung and the transport of oxygen plays a key role in pulmonary physiology and pathophysiology.

MATERIALS AND METHODS

Molecular oxygen is weakly paramagnetic, so that an increase in oxygen concentration results in shortening T1 relaxation time and thus increasing signal intensity in T1 weighted images. The calculation of parameter maps may allow deeper insights into relaxation mechanisms. T1 maps based on a snapshot FLASH sequence obtained during the inhalation of various oxygen concentrations allow the creation of an oxygen transfer function, providing a measurement of local oxygen transfer. T1 weighted single shot TSE sequences demonstrate the signal changing effects during inhalation of pure oxygen.

RESULTS

The average of the mean T1 values over the entire lung during inspiration was 1,199+/-117 ms, the average of these values during expiration was 1,333+/-167 ms. T1 maps of patients with emphysema and lung fibrosis show fundamentally different values and respiratory dependence compared to healthy individuals. Oxygen enhanced MR has the potential to assess reduced diffusion capacity and decreased transport of oxygen in patients with emphysema and cystic fibrosis.

DISCUSSION

Results published in the literature indicate that T1 mapping and oxygen enhanced MR are promising new methods in functional imaging of the lung.

MRI of normal and pathological fetal lung development

Normal fetal lung development is a complex process influenced by mechanical and many biochemical factors. In addition to ultrasound, fetal magnetic resonance imaging (MRI) constitutes a new method to investigate this process in vivo during the second and third trimester. The techniques of MRI volumetry, assessment of signal intensities, and MRI spectroscopy of the fetal lung have been used to analyze this process and have already been applied clinically to identify abnormal fetal lung growth. Particularly in conditions such as oligohydramnios and congenital diaphragmatic hernia (CDH), pulmonary hypoplasia may be the cause of neonatal death. A precise diagnosis and quantification of compromised fetal lung development may improve post- and perinatal management. The main events in fetal lung development are reviewed and MR volumetric data from 106 normal fetuses, as well as different examples of pathological lung growth, are provided.

Feasibility of combining MR perfusion, angiography, and 3He ventilation imaging for evaluation of lung function in a porcine model

RATIONALE AND OBJECTIVE

To assess the feasibility of combining magnetic resonance (MR) perfusion, angiography, and 3He ventilation imaging for the evaluation of lung function in a porcine model.

MATERIALS AND METHODS

Fourteen consecutive porcine models with externally delivered pulmonary emboli and/or airway occlusions were examined with MR perfusion, angiography, and 3He ventilation imaging. Ultrafast gradient-echo sequences were used for 3D perfusion and angiographic imaging, in conjunction with the use of contrast-agent injections. 2D multiple-section 3He imaging was performed subsequently via the inhalation of hyperpolarized 3He gas. The diagnostic accuracy of MR angiography for detecting pulmonary emboli was determined by two reviewers. The diagnostic confidence for different combinations of MR techniques was rated on the basis of a 5-point grading scale (5 = definite).

RESULTS

The sensitivity, specificity, and accuracy of MR angiography for detecting pulmonary emboli were approximately 85.7%, 90.5%, and 88.1%, respectively. The interobserver agreement was very strong (k = 0.82). There was a clear tendency for confidence to increase when first perfusion and then ventilation imaging were added to the angiographic image (Wilcoxon signed ranks test, P = 0.03).

CONCLUSION

The combination of the three methods of MR perfusion, angiography, and 3H ventilation imaging may provide complementary information on abnormal lung anatomy and function.

Combined MR proton lung perfusion/angiography and helium ventilation: potential for detecting pulmonary emboli and ventilation defects

Three-dimensional (3D) perfusion imaging allows the assessment of pulmonary blood flow in parenchyma and main pulmonary arteries simultaneously. MRI using laser-polarized (3)He gas clearly shows the ventilation distribution with high signal-to-noise ratio (SNR). In this report, the feasibility of combined lung MR angiography, perfusion, and ventilation imaging is demonstrated in a porcine model. Ultrafast gradient-echo sequences have been used for 3D perfusion and angiographic imaging, in conjunction with the use of contrast agent injections. 2D multiple-section (3)He imaging was performed subsequently by inhalation of 450 ml of hyperpolarized (3)He gas. The MR techniques were examined in a series of porcine models with externally delivered pulmonary emboli and/or airway occlusions. With emboli, perfusion deficits without ventilation defects were observed; airway occlusion resulted in matched deficits in perfusion and ventilation. High-resolution MR angiography can unambiguously reveal the location and size of the blood emboli. The combination of the three imaging methods may provide complementary information on abnormal lung anatomy and function.

Ultrafast MR grid-tagging sequence for assessment of local mechanical properties of the lungs

While MR imaging with tagged magnetization has shown great utility in the study of muscle mechanics, the evaluation of pulmonary mechanics has long been hindered by the technical difficulties in MR imaging of lung parenchyma. In this study, a fast MR grid-tagging technique is described for dynamic assessment of regional pulmonary deformation. The method is based on a fast FLASH sequence with short TR and short TE. Tagging was achieved by using double DANTE pulse train or inversion pulses. Our results show that this technique is able to detect changes of the tagging grid caused by physiological deformation of the lung. Quantitative analysis of the data shows that this method is capable of assessing local pulmonary mechanics. The application of this technique could improve our understanding of ventilatory control, and thus provide a unique metric for assessing pulmonary disorders. Magn Reson Med 45:24-28, 2001.