1
|
Kooner HK, Sharma M, McIntosh MJ, Dhaliwal I, Nicholson JM, Kirby M, Svenningsen S, Parraga G. 129Xe MRI Ventilation Textures and Longitudinal Quality-of-Life Improvements in Long-COVID. Acad Radiol 2024:S1076-6332(24)00156-9. [PMID: 38637239 DOI: 10.1016/j.acra.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
RATIONALE AND OBJECTIVES It remains difficult to predict longitudinal outcomes in long-COVID, even with chest CT and functional MRI. 129Xe MRI reflects airway dysfunction, measured using ventilation defect percent (VDP) and in long-COVID patients, MRI VDP was abnormal, suggestive of airways disease. While MRI VDP and quality-of-life improved 15-month post-COVID infection, both remained abnormal. To better understand the relationship of airways disease and quality-of-life improvements in patients with long-COVID, we extracted 129Xe ventilation MRI textures and generated machine-learning models in an effort to predict improved quality-of-life, 15-month post-infection. MATERIALS AND METHODS Long-COVID patients provided written-informed consent to 3-month and 15-month post-infection visits. Pyradiomics was used to extract 129Xe ventilation MRI texture features, which were ranked using a Random-Forest classifier. Top-ranking features were used in classification models to dichotomize patients based on St. George's Respiratory Questionnaire (SGRQ) score improvement greater than the minimal-clinically-important-difference (MCID). Classification performance was evaluated using the area under the receiver-operator-characteristic-curve (AUC), sensitivity, and specificity. RESULTS 120 texture features were extracted from 129Xe ventilation MRI in 44 long-COVID participants (54 ± 14 years), including 30 (52 ± 12 years) with ΔSGRQ≥MCID and 14 (58 ± 18 years) with ΔSGRQ CONCLUSION A machine learning model exclusively trained on 129Xe MRI ventilation textures explained improved SGRQ-scores 12 months later, and outperformed clinical models. Their unique spatial-intensity information helps build our understanding about long-COVID airway dysfunction.
Collapse
Affiliation(s)
- Harkiran K Kooner
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Maksym Sharma
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, Western University, London, Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, Western University, London, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto, Canada
| | - Sarah Svenningsen
- Division of Respirology, Department of Medicine, McMaster University and Firestone Institute for Respiratory Health, St. Joseph's Health Care, Hamilton, Canada
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Division of Respirology, Department of Medicine, Western University, London, Canada.
| |
Collapse
|
2
|
Mozaffaripour A, Kooner HK, Parraga G. Dose Modulation, BMI and CT-Air Trapping. Am J Respir Crit Care Med 2024. [PMID: 38574369 DOI: 10.1164/rccm.202402-0353le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/03/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Ali Mozaffaripour
- Robarts Research Institute, 113611, London, Ontario, Canada
- Western University, 6221, School of Biomedical Engineering, London, Ontario, Canada
| | - Harkiran K Kooner
- Robarts Research Institute, 113611, London, Ontario, Canada
- Western University, 6221, Department of Medical Biophysics, London, Ontario, Canada
| | - Grace Parraga
- University of Western Ontario, 6221, Robarts Research Institute, London, Ontario, Canada
- University of Western Ontario, 6221, Department of Medical Biophysics, London, Ontario, Canada;
| |
Collapse
|
3
|
McIntosh MJ, Hofmann JJ, Kooner HK, Eddy RL, Parraga G, Mackenzie CA. 129Xe MRI and Oscillometry of Irritant-Induced Asthma After Bronchial Thermoplasty. Chest 2024; 165:e27-e31. [PMID: 38336440 DOI: 10.1016/j.chest.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 02/12/2024] Open
Abstract
Irritant-induced asthma (IIA) may develop after acute inhalational exposure in individuals without preexisting asthma. The effect of bronchial thermoplasty to treat intractable, worsening IIA has not yet been described. We evaluated a previously healthy 52-year-old man after inhalation of an unknown white powder. His pulmonary function and symptoms/quality of life worsened over 4 years, despite maximal guidelines-based asthma therapy. We acquired 129Xe MRI and pulmonary function test measurements on three occasions including before and after bronchial thermoplasty treatment. Seven months after bronchial thermoplasty, improved MRI ventilation and oscillometry small airway resistance were observed. Spirometry and asthma control did not improve until 19 months after bronchial thermoplasty, 5.5 years postexposure. Together, oscillometry measurements of the small airways and 129Xe MRI provided effort-independent, sensitive, and objective measurements of response to therapy. Improved MRI and oscillometry small airway resistance measurements temporally preceded improved airflow obstruction and may be considered for complex asthma cases.
Collapse
Affiliation(s)
- Marrissa J McIntosh
- Robarts Research Institute, Western University, London, ON, Canada; Department of Medical Biophysics, Western University, London, ON, Canada
| | - Joseph J Hofmann
- Robarts Research Institute, Western University, London, ON, Canada
| | - Harkiran K Kooner
- Robarts Research Institute, Western University, London, ON, Canada; Department of Medical Biophysics, Western University, London, ON, Canada
| | - Rachel L Eddy
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - 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.
| | - Constance A Mackenzie
- Division of Respirology, Western University, London, ON, Canada; Division of Clinical Pharmacology and Toxicology, Department of Medicine, Western University, London, ON, Canada
| |
Collapse
|
4
|
McIntosh MJ, Biancaniello A, Kooner HK, Bhalla A, Serajeddini H, Yamashita C, Parraga G, Eddy RL. 129Xe MRI Ventilation Defects in Asthma: What is the Upper Limit of Normal and Minimal Clinically Important Difference? Acad Radiol 2023; 30:3114-3123. [PMID: 37032278 DOI: 10.1016/j.acra.2023.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023]
Abstract
RATIONALE AND OBJECTIVES The minimal clinically important difference (MCID) and upper limit of normal (ULN) for MRI ventilation defect percent (VDP) were previously reported for hyperpolarized 3He gas MRI. Hyperpolarized 129Xe VDP is more sensitive to airway dysfunction than 3He, therefore the objective of this study was to determine the ULN and MCID for 129Xe MRI VDP in healthy and asthma participants. MATERIALS AND METHODS We retrospectively evaluated healthy and asthma participants who underwent spirometry and 129XeMRI on a single visit; participants with asthma completed the asthma control questionnaire (ACQ-7). The MCID was estimated using distribution- (smallest detectable difference [SDD]) and anchor-based (ACQ-7) methods. Two observers measured VDP (semiautomated k-means-cluster segmentation algorithm) in 10 participants with asthma, five-times each in random order, to determine SDD. The ULN was estimated based on the 95% confidence interval of the relationships between VDP and age. RESULTS Mean VDP was 1.6 ± 1.2% for healthy (n = 27) and 13.7 ± 12.9% for asthma participants (n = 55). ACQ-7 and VDP were correlated (r = .37, p = .006; VDP = 3.5·ACQ + 4.9). The anchor-based MCID was 1.75% while the mean SDD and distribution-based MCID was 2.25%. VDP was correlated with age for healthy participants (p = .56, p =.003; VDP = .04·Age-.01). The ULN for all healthy participants was 2.0%. By age tertiles, the ULN was 1.3% ages 18-39 years, 2.5% for 40-59 years and 3.8% for 60-79 years. CONCLUSION The 129Xe MRI VDP MCID was estimated in participants with asthma; the ULN was estimated in healthy participants across a range of ages, both of which provide a way to interpret VDP measurements in clinical investigations.
Collapse
Affiliation(s)
- Marrissa J McIntosh
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Alexander Biancaniello
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Harkiran K Kooner
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| | - Anurag Bhalla
- Division of Respirology, Department of Medicine, Western University, London, Canada
| | - Hana Serajeddini
- Robarts Research Institute, Western University, London, Canada; Division of Respirology, Department of Medicine, Western University, London, Canada
| | - Cory Yamashita
- Division of Respirology, Department of Medicine, Western University, London, Canada
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada; Division of Respirology, Department of Medicine, Western University, London, Canada.
| | - Rachel L Eddy
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| |
Collapse
|
5
|
McIntosh MJ, Matheson AM, Kooner HK, Eddy RL, Serajeddini H, Yamashita C, Parraga G. Pulmonary Vascular Differences in Eosinophilic Asthma after 2.5 Years of Anti-IL-5Rα Treatment. Am J Respir Crit Care Med 2023; 208:998-1001. [PMID: 37603773 DOI: 10.1164/rccm.202305-0849le] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/21/2023] [Indexed: 08/23/2023] Open
Affiliation(s)
- Marrissa J McIntosh
- Robarts Research Institute and
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Alexander M Matheson
- Robarts Research Institute and
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Harkiran K Kooner
- Robarts Research Institute and
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Rachel L Eddy
- University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada; and
| | - Hana Serajeddini
- Robarts Research Institute and
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - Cory Yamashita
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - Grace Parraga
- Robarts Research Institute and
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| |
Collapse
|
6
|
Kooner HK, McIntosh MJ, Matheson AM, Svenningsen S, Parraga G. More Data about 129Xe MRI Ventilation Defects in Long COVID-19. Radiology 2023; 307:e230479. [PMID: 37070997 PMCID: PMC10124751 DOI: 10.1148/radiol.230479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Harkiran K Kooner
- Robarts Research Institute, Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7
- Department of Medical Biophysics, Western University, London, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7
- Department of Medical Biophysics, Western University, London, Canada
| | - Alexander M Matheson
- Robarts Research Institute, Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7
- Department of Medical Biophysics, Western University, London, Canada
| | - Sarah Svenningsen
- Division of Respirology, Department of Medicine, Mc-Master University and Firestone Institute for Respiratory Health, St Joseph's Health Care, Hamilton, Canada
| | - Grace Parraga
- Robarts Research Institute, Western University, 1151 Richmond St N, London, ON, Canada N6A 5B7
- Department of Medical Biophysics, Western University, London, Canada
- Division of Respirology, Department of Medicine, Western University, London, Canada
| |
Collapse
|
7
|
Matheson AM, McIntosh MJ, Kooner HK, Abdelrazek M, Albert MS, Dhaliwal I, Nicholson JM, Ouriadov A, Svenningsen S, Parraga G. Longitudinal follow-up of postacute COVID-19 syndrome: DL CO, quality-of-life and MRI pulmonary gas-exchange abnormalities. Thorax 2023; 78:418-421. [PMID: 36596692 PMCID: PMC10086459 DOI: 10.1136/thorax-2022-219378] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023]
Abstract
129Xe MRI red blood cell to alveolar tissue plasma ratio (RBC:TP) abnormalities have been observed in ever-hospitalised and never-hospitalised people with postacute COVID-19 syndrome (PACS). But, it is not known if such abnormalities resolve when symptoms and quality-of-life scores improve. We evaluated 21 participants with PACS, 7±4 months (baseline) and 14±4 months (follow-up) postinfection. Significantly improved diffusing capacity of the lung for carbon monoxide (DLCO, Δ=14%pred ;95%CI 7 to 21, p<0.001), postexertional dyspnoea (Δ=-0.7; 95%CI=-0.2 to -1.2, p=0.019), St George's Respiratory Questionnaire-score (SGRQ Δ=-6; 95% CI=-1 to -11, p=0.044) but not RBC:TP (Δ=0.03; 95% CI=0.01 to 0.05, p=0.051) were observed at 14 months. DLCO correlated with RBC:TP (r=0.60, 95% CI=0.22 to 0.82, p=0.004) at 7 months. While DLCO and SGRQ measurements improved, these values did not normalise 14 months post-infection. ClinicalTrials.gov NCT04584671.
Collapse
Affiliation(s)
- Alexander M Matheson
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Harkiran K Kooner
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.,Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Mohamed Abdelrazek
- Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada
| | - Mitchell S Albert
- Department of Chemistry, Lakehead University, Thunder Bay, Ontario, Canada
| | - Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Alexei Ouriadov
- Department of Physics and Astronomy, University of Western Ontario, London, Ontario, Canada
| | - Sarah Svenningsen
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Grace Parraga
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada .,Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada.,Division of Respirology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.,Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
8
|
McIntosh MJ, Kooner HK, Eddy RL, Wilson A, Serajeddini H, Bhalla A, Licskai C, Mackenzie CA, Yamashita C, Parraga G. CT Mucus Score and 129Xe MRI Ventilation Defects After 2.5 Years' Anti-IL-5Rα in Eosinophilic Asthma. Chest 2023:S0012-3692(23)00189-7. [PMID: 36781102 DOI: 10.1016/j.chest.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND We previously showed in patients with poorly controlled eosinophilic asthma that a single dose of benralizumab resulted in significantly improved asthma-control-questionnaire (ACQ-6) score and 129Xe MRI ventilation defect percent (VDP), 28 days post-injection, and 129Xe MRI VDP and CT airway mucus occlusions were shown to independently predict this early ACQ-6 response to benralizumab. RESEARCH QUESTION Do early VDP responses at 28 days persist, and do FEV1, fractional exhaled nitric oxide (Feno), and mucus plug score improve during a 2.5 year treatment period? STUDY DESIGN AND METHODS Participants with poorly controlled eosinophilic asthma completed spirometry, ACQ-6, and MRI, 28 days, 1, and 2.5 years after benralizumab; chest CT was acquired at enrollment and 2.5 years later. RESULTS Of 29 participants evaluated at 28 days post-benralizumab, 16 participants returned for follow-up while on therapy at 1 year, and 13 participants were evaluable while on therapy at 2.5 years, post-benralizumab initiation. As compared with 28 days post-benralizumab, ACQ-6 score (2.0 ± 1.4) significantly improved after 1 year (0.5 ± 0.6, P = .02; 95% CI, 0.1-1.1) and 2.5 years (0.5 ± 0.5, P = .03; 95% CI, 0.1-1.1). The mean VDP change at 2.5 years (-4% ± 3%) was greater than the minimal clinically important difference, but not significantly different from VDP measured 28 days post-benralizumab. Mucus score (3 ± 4) was significantly improved at 2.5 years (1 ± 1, P = .03; 95% CI, 0.3-5.5). In six of eight participants with previous occlusions, mucus plugs vanished or substantially diminished 2.5 years later. VDP (P < .001) and mucus score (P < .001) measured at baseline, but not Feno or FEV1, independently predicted ACQ score after 2.5 years. INTERPRETATION In poorly controlled eosinophilic asthma, early MRI VDP responses at 28 days post-benralizumab persisted 2.5 years later, alongside significantly improved mucus score and asthma control.
Collapse
Affiliation(s)
- Marrissa J McIntosh
- Robarts Research Institute; Department of Medical Biophysics, Western University, London, ON, Canada
| | - Harkiran K Kooner
- Robarts Research Institute; Department of Medical Biophysics, Western University, London, ON, Canada
| | - Rachel L Eddy
- University of British Columbia Centre for Heart Lung Innovation, St. Paul's Hospital Vancouver, Vancouver, BC, Canada
| | | | | | | | | | - Constance A Mackenzie
- Division of Respirology; Division of Clinical Pharmacology and Toxicology, Department of Medicine, Western University, London, ON, Canada
| | | | - Grace Parraga
- Robarts Research Institute; Department of Medical Biophysics, Western University, London, ON, Canada; Division of Respirology.
| |
Collapse
|
9
|
Kooner HK, McIntosh MJ, Matheson AM, Abdelrazek M, Albert MS, Dhaliwal I, Kirby M, Ouriadov A, Santyr GE, Venegas C, Radadia N, Svenningsen S, Nicholson JM, Parraga G. Post-Acute COVID-19 Syndrome: 129Xe MRI Ventilation Defects and Respiratory Outcomes One Year Later. Radiology 2023; 307:e222557. [PMID: 36749209 PMCID: PMC9926501 DOI: 10.1148/radiol.222557] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background In people with post-acute COVID-19 syndrome (PACS) and normal pulmonary function, 129Xe MRI ventilation defects, abnormal quality-of-life scores, and exercise limitation were reported 3-months after infection; the longitudinal trajectory remains unclear. Purpose To measure and compare pulmonary function, exercise capacity, quality-of-life, and 129Xe MRI ventilation defect percent (VDP) in people with PACS evaluated 3- and 15-months post-infection. Materials and Methods In this prospective study, participants with PACS aged 18-80 years were enrolled between July 2020 and August 2021 from two quaternary care centers. They were evaluated 3-months and 15-months post-infection for: 129Xe MRI VDP, diffusing capacity of the lung for carbon monoxide (DLCO), spirometry, oscillometry, six-minute walk distance (6MWD), and St. George's Respiratory Questionnaire (SGRQ). Differences between time-points were evaluated using paired t-tests. Multivariable models were generated to explain exercise capacity and quality-of-life improvements. Odds ratios (OR) were used to evaluate potential treatment influences. Results Fifty-three participants (mean age, 55 years ±18[SD]; 26 male; 27 female) attended both 3- and 15-month visits and were included in analysis. 129Xe MRI VDP (5.4%, 4.2%; P=.003), forced expiratory volume in 1-second (85%pred, 90%pred; P=.001), DLCO (89%pred, 99%pred; P=.002) and SGRQ (35, 25; P<.001) improved between the 3- and 15-month visit. VDP measured at 3- months post-COVID predicted the change in 6MWD (β=-.643, P=.001) while treatment with respiratory medication at 3-months predicted improved 15-month quality-of-life score (OR=4.0; 95%CI:1.2,13.8, P=.03). Conclusion Pulmonary function, gas-exchange, exercise capacity, quality-of-life, and 129Xe MRI ventilation defect percent (VDP) improved in participants with post-acute COVID-19 syndrome evaluated at 15-months as compared to 3-months post-infection. VDP measured at 3-months post-infection correlated with improved exercise capacity, whilst treatment with respiratory medication was associated with improved quality-of-life score at 15-months post-infection. Clinical Trial Registration: www.clinicaltrials.gov NCT05014516 See also the editorial by Vogel-Claussen in this issue.
Collapse
Affiliation(s)
| | | | | | | | | | - Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, Western University,
London, Canada
| | - Miranda Kirby
- Department of Physics, Toronto Metropolitan University, Toronto,
Canada
| | - Alexei Ouriadov
- Department of Physics and Astronomy, Western University, London,
Canada
| | | | - Carmen Venegas
- Division of Respirology, Department of Medicine, McMaster University
and Firestone Institute for Respiratory Health, St Joseph's Health Care,
Hamilton, Canada
| | - Nisarg Radadia
- Division of Respirology, Department of Medicine, McMaster University
and Firestone Institute for Respiratory Health, St Joseph's Health Care,
Hamilton, Canada
| | - Sarah Svenningsen
- Division of Respirology, Department of Medicine, McMaster University
and Firestone Institute for Respiratory Health, St Joseph's Health Care,
Hamilton, Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, Western University,
London, Canada
| | - Grace Parraga
- Robarts Research Institute,Department of Medical Biophysics,Department of Medical Imaging, Western University, London,
Canada,Division of Respirology, Department of Medicine, Western University,
London, Canada
| |
Collapse
|
10
|
McIntosh MJ, Kooner HK, Eddy RL, Jeimy S, Licskai C, Mackenzie CA, Svenningsen S, Nair P, Yamashita C, Parraga G. Asthma Control, Airway Mucus, and 129Xe MRI Ventilation After a Single Benralizumab Dose. Chest 2022; 162:520-533. [DOI: 10.1016/j.chest.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022] Open
|
11
|
Matheson AM, McIntosh MJ, Kooner HK, Lee J, Desaigoudar V, Bier E, Driehuys B, Svenningsen S, Santyr GE, Kirby M, Albert MS, Shepelytskyi Y, Grynko V, Ouriadov A, Abdelrazek M, Dhaliwal I, Nicholson JM, Parraga G. Persistent 129Xe MRI Pulmonary and CT Vascular Abnormalities in Symptomatic Individuals with Post-Acute COVID-19 Syndrome. Radiology 2022; 305:466-476. [PMID: 35762891 PMCID: PMC9272782 DOI: 10.1148/radiol.220492] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In patients with post-acute COVID-19-syndrome (PACS), abnormal gas-transfer and pulmonary vascular density have been reported, but such findings have not been related to each other, or to symptoms and exercise limitation. The pathophysiological drivers of PACS in ever- and never-hospitalized patients are not well-understood. Purpose To determine the relationship of persistent symptoms and exercise limitation with 129Xe MRI and CT pulmonary vascular measurements in individuals with PACS. Materials and Methods In this prospective study, patients with PACS aged 18-80 years with a positive PCR COVID test were recruited from a quaternary-care COVID-19 clinic between April and October 2021. Participants with PACS underwent spirometry, diffusing-capacity-of-the-lung- for-carbon-monoxide (DLco), 129Xe MRI, and chest CT. Healthy controls had no prior history of COVID-19 underwent spirometry, DLco, and 129Xe MRI. The 129Xe MRI red-blood-cell (RBC) to alveolar-barrier signal ratio, RBC area-under-the-curve (AUC), CT volume-of-pulmonary-vessels with cross-sectional-area <5mm2 (BV5), and total-blood-volume (TBV) were quantified. St. George's Respiratory Questionnaire (SGRQ), International Physical Activity Questionnaire (IPAQ) and modified Borg Dyspnea Scale (mBDS) measured quality-of-life, exercise limitation and dyspnea. Differences between groups were compared using Welch's T-tests or Welch's ANOVA. Relationships were evaluated using Pearson (r) and Spearman (ρ) correlations. Results Forty participants were evaluated including six controls (mean age, 35±15 years[standard deviation], 3 women) and 34 participants with PACS (mean age, 53±13 years[SD], 18 women), of which 22 were never-hospitalized. The 129Xe MRI RBC:barrier ratio was lower in ever- hospitalized participants (P=.04) compared to controls. BV5 correlated with RBC AUC (ρ=.44,P=.03). The 129Xe MRI RBC:barrier ratio was related to DLco (r=.57,P=.002) and FEV1 (ρ=.35,P=.03); RBC AUC was related to dyspnea (ρ=-.35,P=.04) and IPAQ score (ρ=.45,P=.02). Conclusion 129Xe MRI measurements were lower in ever- hospitalized participants with post- acute COVID-19-syndrome, 34±25 weeks post-infection compared to controls. 129Xe MRI measures were associated with CT pulmonary vascular density, DLco, exercise capacity, and dyspnea. ClinicalTrials.gov: NCT04584671 See also the editorial by Wild and Collier.
Collapse
Affiliation(s)
| | | | | | - Justin Lee
- Department of Physiology and Pharmacology, Western University, London Canada
| | | | - Elianna Bier
- Center for In Vivo Microscopy, Duke University Medical Center, Durham NC USA
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Center, Durham NC USA
| | - Sarah Svenningsen
- Division of Respirology, Department of Medicine, McMaster University, Hamilton Canada
| | - Giles E Santyr
- Translational Medicine Program, Hospital for Sick Children, Toronto Canada.,Department of Medical Biophysics, University of Toronto, Toronto Canada
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto Canada
| | - Mitchell S Albert
- Chemistry Department, Lakehead University.,Thunder Bay Regional Health Research Institute.,Northern Ontario School of Medicine, Thunder Bay Canada
| | - Yurii Shepelytskyi
- Chemistry Department, Lakehead University.,Thunder Bay Regional Health Research Institute
| | - Vira Grynko
- Chemistry Department, Lakehead University.,Thunder Bay Regional Health Research Institute
| | | | | | - Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, Western University, London Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, Western University, London Canada
| | - Grace Parraga
- Robarts Research Institute.,Department of Medical Biophysics.,Department of Physiology and Pharmacology, Western University, London Canada.,Department of Medical Imaging.,Division of Respirology, Department of Medicine, Western University, London Canada
| |
Collapse
|
12
|
Kooner HK, McIntosh MJ, Matheson AM, Venegas C, Radadia N, Ho T, Haider EA, Konyer NB, Santyr GE, Albert MS, Ouriadov A, Abdelrazek M, Kirby M, Dhaliwal I, Nicholson JM, Nair P, Svenningsen S, Parraga G. 129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised people with post-acute COVID-19 syndrome. BMJ Open Respir Res 2022; 9:9/1/e001235. [PMID: 35584850 PMCID: PMC9119175 DOI: 10.1136/bmjresp-2022-001235] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients often report persistent symptoms beyond the acute infectious phase of COVID-19. Hyperpolarised 129Xe MRI provides a way to directly measure airway functional abnormalities; the clinical relevance of 129Xe MRI ventilation defects in ever-hospitalised and never-hospitalised patients who had COVID-19 has not been ascertained. It remains unclear if persistent symptoms beyond the infectious phase are related to small airways disease and ventilation heterogeneity. Hence, we measured 129Xe MRI ventilation defects, pulmonary function and symptoms in ever-hospitalised and never-hospitalised patients who had COVID-19 with persistent symptoms consistent with post-acute COVID-19 syndrome (PACS). METHODS Consenting participants with a confirmed diagnosis of PACS completed 129Xe MRI, CT, spirometry, multi-breath inert-gas washout, 6-minute walk test, St. George's Respiratory Questionnaire (SGRQ), modified Medical Research Council (mMRC) dyspnoea scale, modified Borg scale and International Physical Activity Questionnaire. Consenting ever-COVID volunteers completed 129Xe MRI and pulmonary function tests only. RESULTS Seventy-six post-COVID and nine never-COVID participants were evaluated. Ventilation defect per cent (VDP) was abnormal and significantly greater in ever-COVID as compared with never-COVID participants (p<0.001) and significantly greater in ever-hospitalised compared with never-hospitalised participants who had COVID-19 (p=0.048), in whom diffusing capacity of the lung for carbon-monoxide (p=0.009) and 6-minute walk distance (6MWD) (p=0.005) were also significantly different. 129Xe MRI VDP was also related to the 6MWD (p=0.02) and post-exertional SpO2 (p=0.002). Participants with abnormal VDP (≥4.3%) had significantly worse 6MWD (p=0.003) and post-exertional SpO2 (p=0.03). CONCLUSION 129Xe MRI VDP was significantly worse in ever-hospitalised as compared with never-hospitalised participants and was related to 6MWD and exertional SpO2 but not SGRQ or mMRC scores. TRIAL REGISTRATION NUMBER NCT05014516.
Collapse
Affiliation(s)
- Harkiran K Kooner
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Alexander M Matheson
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Carmen Venegas
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nisarg Radadia
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Terence Ho
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Norman B Konyer
- Imaging Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Giles E Santyr
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell S Albert
- Department of Chemistry, Lakehead University, Thunder Bay, Ontario, Canada.,Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
| | - Alexei Ouriadov
- Department of Physics and Astronomy, Western University, London, Ontario, Canada
| | - Mohamed Abdelrazek
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Miranda Kirby
- Department of Physics, Ryerson University, Toronto, Ontario, Canada
| | - Inderdeep Dhaliwal
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - Parameswaran Nair
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Svenningsen
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, Hamilton, Ontario, Canada.,Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Ontario, Canada .,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| |
Collapse
|
13
|
Kooner HK, McIntosh MJ, Desaigoudar V, Rayment JH, Eddy RL, Driehuys B, Parraga G. Pulmonary functional MRI: Detecting the structure-function pathologies that drive asthma symptoms and quality of life. Respirology 2022; 27:114-133. [PMID: 35008127 PMCID: PMC10025897 DOI: 10.1111/resp.14197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/09/2021] [Accepted: 12/12/2021] [Indexed: 12/21/2022]
Abstract
Pulmonary functional MRI (PfMRI) using inhaled hyperpolarized, radiation-free gases (such as 3 He and 129 Xe) provides a way to directly visualize inhaled gas distribution and ventilation defects (or ventilation heterogeneity) in real time with high spatial (~mm3 ) resolution. Both gases enable quantitative measurement of terminal airway morphology, while 129 Xe uniquely enables imaging the transfer of inhaled gas across the alveolar-capillary tissue barrier to the red blood cells. In patients with asthma, PfMRI abnormalities have been shown to reflect airway smooth muscle dysfunction, airway inflammation and remodelling, luminal occlusions and airway pruning. The method is rapid (8-15 s), cost-effective (~$300/scan) and very well tolerated in patients, even in those who are very young or very ill, because unlike computed tomography (CT), positron emission tomography and single-photon emission CT, there is no ionizing radiation and the examination takes only a few seconds. However, PfMRI is not without limitations, which include the requirement of complex image analysis, specialized equipment and additional training and quality control. We provide an overview of the three main applications of hyperpolarized noble gas MRI in asthma research including: (1) inhaled gas distribution or ventilation imaging, (2) alveolar microstructure and finally (3) gas transfer into the alveolar-capillary tissue space and from the tissue barrier into red blood cells in the pulmonary microvasculature. We highlight the evidence that supports a deeper understanding of the mechanisms of asthma worsening over time and the pathologies responsible for symptoms and disease control. We conclude with a summary of approaches that have the potential for integration into clinical workflows and that may be used to guide personalized treatment planning.
Collapse
Affiliation(s)
- Harkiran K Kooner
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Marrissa J McIntosh
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Vedanth Desaigoudar
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Jonathan H Rayment
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel L Eddy
- Centre of Heart Lung Innovation, Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bastiaan Driehuys
- Center for In Vivo Microscopy, Duke University Medical Centre, Durham, North Carolina, USA
| | - Grace Parraga
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
- School of Biomedical Engineering, Western University, London, Ontario, Canada
| |
Collapse
|