Defect distribution index: A novel metric for functional lung MRI in cystic fibrosis

Valk, Anne; Willers, Corin; Shahim, K.; Pusterla, Orso; Bauman, Grzegorz; Sandkühler, Robin; Bieri, Oliver; Wyler, F; Latzin, Philipp

doi:10.1002/mrm.28947

Cited by 13 publications

(7 citation statements)

References 40 publications

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“…This could be explained by the use of a static global threshold that was optimized for the original algorithm. A more sophisticated thresholding method to calculate the VDP from the correlation maps, for example using defect distribution index, might further improve the accuracy of PREFUL derived VDP 26 . This needs to be proven in the future by comparison to a reference standard.…”

Section: Discussionmentioning

confidence: 99%

Estimating ventilation correlation coefficients in the lungs using PREFUL‐MRI in chronic obstructive pulmonary disease patients and healthy adults

Moher Alsady,

Ruschepaul,

Voskrebenzev

et al. 2024

Magnetic Resonance in Med

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PurposeVarious parameters of regional lung ventilation can be estimated using phase‐resolved functional lung (PREFUL)‐MRI. The parameter “ventilation correlation coefficient (Vent‐CC)” was shown advantageous because it assesses the dynamics of regional air flow. Calculating Vent‐CC depends on a voxel‐wise comparison to a healthy reference flow curve. This work examines the effect of placing a reference region of interest (ROI) in various lung quadrants or in different coronal slices. Furthermore, algorithms for automated ROI selection are presented and compared in terms of test–retest repeatability.MethodsTwenty‐eight healthy subjects and 32 chronic obstructive pulmonary disease (COPD) patients were scanned twice using PREFUL‐MRI. Retrospective analyses examined the homogeneity of air flow curves of various reference ROIs using cross‐correlation. Vent‐CC and ventilation defect percentage (VDP) calculated using various reference ROIs were compared using one‐way analysis of variance (ANOVA). The coefficient of variation was calculated for Vent‐CC and VDP when using different reference selection algorithms.ResultsFlow‐volume curves were highly correlated between ROIs placed at various lung quadrants in the same coronal slice (r > 0.97) with no differences in Vent‐CC and VDP (ANOVA: p > 0.5). However, ROIs placed at different coronal slices showed lower correlation coefficients and resulted in significantly different Vent‐CC and VDP values (ANOVA: p < 0.001). Vent‐CC and VDP showed higher repeatability when calculated using the presented new algorithm.ConclusionIn COPD and healthy cohorts, assessing regional ventilation dynamics using PREFUL‐MRI in terms of the Vent‐CC metric showed higher repeatability using a new algorithm for selecting a homogenous reference ROI from the same slice.

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Section: Discussionmentioning

confidence: 99%

Estimating ventilation correlation coefficients in the lungs using PREFUL‐MRI in chronic obstructive pulmonary disease patients and healthy adults

Moher Alsady,

Ruschepaul,

Voskrebenzev

et al. 2024

Magnetic Resonance in Med

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“…Chest radiographs have poor sensitivity with detecting early lung disease and even spirometry may not identify early disease. Therefore, new strategies to study and monitor lung function in infants and young children are being evaluated, such as magnetic resonance imaging (MRI) and lung clearance index (LCI) [29][30][31]. We hope these new modalities can help assess HEMT's efficacy in early lung disease and guide therapies in children.…”

Section: Emerging Priorities and Questions In The Era Of Highly Effec...mentioning

confidence: 99%

Highly effective cystic fibrosis transmembrane conductance (regulator) modulator therapy: shifting the curve for most while leaving some further behind

Chun,

Somers,

Burgener

2024

Current Opinion in Pediatrics

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Purpose of review Traditional cystic fibrosis (CF) care had been focused on early intervention and symptom mitigation. With the advent of highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy (HEMT), in particular, the approval of elexacaftor/tezacaftor/ivacaftor in 2019, there has been a dramatic improvement in outcomes in CF. The purpose of this article is to review the benefits, limitations, and impact of HEMT as well as discuss the new implications, challenges, and hope that modulators bring to people with CF (pwCF). Recent findings HEMT has demonstrated sustained improvement in lung function, nutrition, quality of life, and survival for over 90% of pwCF. As HEMT has delivered such promise, there is a small but significant portion of pwCF who do not benefit from HEMT due to ineligible mutations, intolerance, or lack of accessibility to modulators. Summary HEMT has significantly improved outcomes, but continued research is needed to understand the new challenges and implications the era of HEMT will bring, as well as how to provide equitable care to those who are unable to benefit from HEMT.

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“…Other metrics such as defect distribution index have been proposed to assess the spatial clustering or scattering of the defects. 81 Over the last years, the contrast-agent-free techniques have been validated in numerous studies with other goldstandard imaging techniques such as DCE-MRI, 43,64-66 hyperpolarized 3 He-MRI 50,64 or 129 Xe-MRI, 82 SPECT/ CT, 63,83 as well as with pulmonary lung function tests and nitrogen multiple breath-washout technique. 80,84,85 Different groups of patients have been enrolled in those studies including: CF, 65,80,81,85,86 primary ciliary dyskinesia, 84 chronic obstructive pulmonary disease, 43,50 asthma, 87 COVID-19, 88 or lung cancer.…”

Section: Quantification Of Techniques Based Onmentioning

confidence: 99%

“…81 Over the last years, the contrast-agent-free techniques have been validated in numerous studies with other goldstandard imaging techniques such as DCE-MRI, 43,64-66 hyperpolarized 3 He-MRI 50,64 or 129 Xe-MRI, 82 SPECT/ CT, 63,83 as well as with pulmonary lung function tests and nitrogen multiple breath-washout technique. 80,84,85 Different groups of patients have been enrolled in those studies including: CF, 65,80,81,85,86 primary ciliary dyskinesia, 84 chronic obstructive pulmonary disease, 43,50 asthma, 87 COVID-19, 88 or lung cancer. 66 More recently, MP MRI has demonstrated its utility as a tool for monitoring of the therapeutic response of salbumatol and elexacaftor/tezacaftor/ivacaftor (ETI) in CF patients, 89,90 and examining the short-term effects of electronic nicotine delivery systems and tobacco smoke on the lung function.…”

Section: Quantification Of Techniques Based Onmentioning

confidence: 99%

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Magnetic Resonance Imaging of Lung Perfusion

Triphan

Bauman

Konietzke

et al. 2023

Magnetic Resonance Imaging

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“Lung perfusion” in the context of imaging conventionally refers to the delivery of blood to the pulmonary capillary bed through the pulmonary arteries originating from the right ventricle required for oxygenation. The most important physiological mechanism in the context of imaging is the so‐called hypoxic pulmonary vasoconstriction (HPV, also known as “Euler‐Liljestrand‐Reflex”), which couples lung perfusion to lung ventilation. In obstructive airway diseases such as asthma, chronic‐obstructive pulmonary disease (COPD), cystic fibrosis (CF), and asthma, HPV downregulates pulmonary perfusion in order to redistribute blood flow to functional lung areas in order to conserve optimal oxygenation. Imaging of lung perfusion can be seen as a reflection of lung ventilation in obstructive airway diseases. Other conditions that primarily affect lung perfusion are pulmonary vascular diseases, pulmonary hypertension, or (chronic) pulmonary embolism, which also lead to inhomogeneity in pulmonary capillary blood distribution. Several magnetic resonance imaging (MRI) techniques either dependent on exogenous contrast materials, exploiting periodical lung signal variations with cardiac action, or relying on intrinsic lung voxel attributes have been demonstrated to visualize lung perfusion. Additional post‐processing may add temporal information and provide quantitative information related to blood flow. The most widely used and robust technique, dynamic‐contrast enhanced MRI, is available in clinical routine assessment of COPD, CF, and pulmonary vascular disease. Non‐contrast techniques are important research tools currently requiring clinical validation and cross‐correlation in the absence of a viable standard of reference. First data on many of these techniques in the context of observational studies assessing therapy effects have just become available.Level of Evidence5Technical EfficacyStage 5

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Defect distribution index: A novel metric for functional lung MRI in cystic fibrosis

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 13 publications

References 40 publications

Estimating ventilation correlation coefficients in the lungs using PREFUL‐MRI in chronic obstructive pulmonary disease patients and healthy adults

Estimating ventilation correlation coefficients in the lungs using PREFUL‐MRI in chronic obstructive pulmonary disease patients and healthy adults

Highly effective cystic fibrosis transmembrane conductance (regulator) modulator therapy: shifting the curve for most while leaving some further behind

Magnetic Resonance Imaging of Lung Perfusion

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