Free-breathing MRI for monitoring ventilation changes following antibiotic treatment of pulmonary exacerbations in paediatric cystic fibrosis

Munidasa, Samal; Couch, Marcus J.; Rayment, Jonathan H.; Voskrebenzev, Andreas; Seethamraju, Ravi; Vogel‐Claussen, Jens; Ratjen, Félix; Santyr, Giles

doi:10.1183/13993003.03104-2020

Cited by 16 publications

(28 citation statements)

References 17 publications

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“…However, in the Kaireit et al study a threshold of 90th percentile × 0.4 was used to determine VDP from RVent distributions, whereas a k-means clustering was used in the present study to stay consistent with previous work in pediatric CF. 11,26,28 VDP parameters derived from PREFUL MRI showed high intravisit repeatability, comparable to VDP Xe-MS and VDP Xe-SS in the pediatric CF group; however, factors affecting the variability of the two methods differ. Variability in Xe-MRI ventilation distributions could be attributed to the differences in the breath-hold performed by the patient (i.e., more or less the gas volume inhaled relative to the prescribed dose), whereas for PREFUL MRI previous studies have shown that changes in breathing frequency and tidal volumes can influence RVent values.…”

Section: Discussionmentioning

confidence: 80%

Inter‐ and intravisit repeatability of free‐breathing MRI in pediatric cystic fibrosis lung disease

Munidasa

Zanette

Couch

et al. 2022

Magnetic Resonance in Med

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Purpose The purpose of this study is to assess the intra‐ and interscan repeatability of free‐breathing phase‐resolved functional lung (PREFUL) MRI in stable pediatric cystic fibrosis (CF) lung disease in comparison to static breath‐hold hyperpolarized 129‐xenon MRI (Xe‐MRI) and pulmonary function tests. Methods Free‐breathing 1‐hydrogen MRI and Xe‐MRI were acquired from 15 stable pediatric CF patients and seven healthy age‐matched participants on two visits, 1 month apart. Same‐visit MRI scans were also performed on a subgroup of the CF patients. Following the PREFUL algorithm, regional ventilation (RVent) and regional flow volume loop cross‐correlation maps were determined from the free‐breathing data. Ventilation defect percentage (VDP) was determined from RVent maps (VDPRVent), regional flow volume loop cross‐correlation maps (VDPCC), VDPRVent ∪ VDPCC, and multi‐slice Xe‐MRI. Repeatability was evaluated using Bland–Altman analysis, coefficient of repeatability (CR), and intraclass correlation. Results Minimal bias and no significant differences were reported for all PREFUL MRI and Xe‐MRI VDP parameters between intra‐ and intervisits (all P > 0.05). Repeatability of VDPRVent, VDPCC, VDPRVent ∪ VDPCC, and multi‐slice Xe‐MRI were lower between the two‐visit scans (CR = 14.81%, 15.36%, 16.19%, and 9.32%, respectively) in comparison to the same‐day scans (CR = 3.38%, 2.90%, 1.90%, and 3.92%, respectively). pulmonary function tests showed high interscan repeatability relative to PREFUL MRI and Xe‐MRI. Conclusion PREFUL MRI, similar to Xe‐MRI, showed high intravisit repeatability but moderate intervisit repeatability in CF, which may be due to inherent disease instability, even in stable patients. Thus, PREFUL MRI may be considered a suitable outcome measure for future treatment response studies.

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Section: Discussionmentioning

confidence: 80%

Inter‐ and intravisit repeatability of free‐breathing MRI in pediatric cystic fibrosis lung disease

Munidasa

Zanette

Couch

et al. 2022

Magnetic Resonance in Med

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“…A previous study has also indicated the ventilation defect calculated with PREFUL correlates with ventilation defect measured with HP 129 Xe in children with CF 24 . There is also recent work demonstrating the detection of antibiotic treatment‐related improvements in ventilation with PREFUL, similar to HP 129 Xe in pediatric CF 32 . Therefore, PREFUL MRI holds promise for future neonatal and infant functional lung imaging.…”

Section: Discussionmentioning

confidence: 91%

“…24 There is also recent work demonstrating the detection of antibiotic treatment-related improvements in ventilation with PREFUL, similar to HP 129 Xe in pediatric CF. 32 Therefore, PREFUL MRI holds promise for future neonatal and infant functional lung imaging. The low barrier to PREFUL implementation, requiring only standard scanner hardware and common GRE pulse sequences makes PREFUL MRI more readily adaptable for evaluation in infants without the need for exogenous contrast or dedicated infrastructure.…”

Section: Discussionmentioning

confidence: 99%

Clinical Feasibility of Structural and Functional MRI in Free‐Breathing Neonates and Infants

Zanette

Schrauben

Munidasa

et al. 2022

Magnetic Resonance Imaging

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Background: Evaluation of structural lung abnormalities with magnetic resonance imaging (MRI) has previously been shown to be predictive of clinical neonatal outcomes in preterm birth. MRI during free-breathing with phase-resolved functional lung (PREFUL) may allow for complimentary functional information without exogenous contrast. Purpose: To investigate the feasibility of structural and functional pulmonary MRI in a cohort of neonates and infants with no cardiorespiratory disease. Macrovascular pulmonary blood flows were also evaluated. Study Type: Prospective. Population: Ten term infants with no clinically defined cardiorespiratory disease were imaged. Infants recruited from the general population and neonatal intensive care unit (NICU) were studied. Field Strength/Sequence: T 1 -weighted VIBE, T 2 -weighted BLADE uncorrected for motion. Ultrashort echo time (UTE) and 3D-flow data were acquired during free-breathing with self-navigation and retrospective reconstruction. Single slice 2Dgradient echo (GRE) images were acquired during free-breathing for PREFUL analysis. Imaging was performed at 3 T. Assessment: T 1 , T 2 , and UTE images were scored according to the modified Ochiai scheme by three pediatric body radiologists. Ventilation/perfusion-weighted maps were extracted from free-breathing GRE images using PREFUL analysis. Ventilation and perfusion defect percent (VDP, QDP) were calculated from the segmented ventilation and perfusion-weighted maps. Time-averaged cardiac blood velocities from three-dimensional-flow were evaluated in major pulmonary arteries and veins. Statistical Test: Intraclass correlation coefficient (ICC). Results: The ICC of replicate structural scores was 0.81 (95% CI: 0.45-0.95) across three observers. Elevated Ochiai scores, VDP, and QDP were observed in two NICU participants. Excluding these participants, mean AE standard deviation structural scores were 1.2 AE 0.8, while VDP and QDP were 1.0% AE 1.1% and 0.4% AE 0.5%, respectively. Main pulmonary arterial blood flows normalized to body surface area were 3.15 AE 0.78 L/min/m 2 . Data Conclusion: Structural and functional pulmonary imaging is feasible using standard clinical MRI hardware (commercial whole-body 3 T scanner, table spine array, and flexible thoracic array) in free-breathing infants.

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“…Moreover, Fourier decomposition (FD) MRI and derivations such as Phase-Resolved FUnctional Lung (PREFUL) MRI sequences, both ventilation and perfusion can be assessed without intravenous or gaseous inhaled contrast administration ( 96 ). PREFUL MRI is also feasible in uncooperative patients, since it is performed in free-breathing conditions ( Figure 10 ).…”

Section: Imaging Techniquesmentioning

confidence: 99%

“…Moreover, PREFUL-MRI does not use gadolinium, the use of which is debated because of concerns regarding potential tissue deposition ( 97 ). Munisada et al demonstrated that, during RTE, the ventilation distribution obtained with FD is correlated with hyperpolarized gas imaging and both can monitor functional improvement after therapy ( 96 ).…”

Section: Imaging Techniquesmentioning

confidence: 99%

Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging

Landini

Ciet²,

Janssens³

et al. 2023

Front. Pediatr.

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Respiratory tract exacerbations play a crucial role in progressive lung damage of people with cystic fibrosis, representing a major determinant in the loss of functional lung tissue, quality of life and patient survival. Detection and monitoring of respiratory tract exacerbations are challenging for clinicians, since under- and over-treatment convey several risks for the patient. Although various diagnostic and monitoring tools are available, their implementation is hampered by the current definition of respiratory tract exacerbation, which lacks objective “cut-offs” for clinical and lung function parameters. In particular, the latter shows a large variability, making the current 10% change in spirometry outcomes an unreliable threshold to detect exacerbation. Moreover, spirometry cannot be reliably performed in preschool children and new emerging tools, such as the forced oscillation technique, are still complementary and need more validation. Therefore, lung imaging is a key in providing respiratory tract exacerbation-related structural and functional information. However, imaging encompasses several diagnostic options, each with different advantages and limitations; for instance, conventional chest radiography, the most used radiological technique, may lack sensitivity and specificity in respiratory tract exacerbations diagnosis. Other methods, including computed tomography, positron emission tomography and magnetic resonance imaging, are limited by either radiation safety issues or the need for anesthesia in uncooperative patients. Finally, lung ultrasound has been proposed as a safe bedside option but it is highly operator-dependent and there is no strong evidence of its possible use during respiratory tract exacerbation. This review summarizes the clinical challenges of respiratory tract exacerbations in patients with cystic fibrosis with a special focus on imaging. Firstly, the definition of respiratory tract exacerbation is examined, while diagnostic and monitoring tools are briefly described to set the scene. This is followed by advantages and disadvantages of each imaging technique, concluding with a diagnostic imaging algorithm for disease monitoring during respiratory tract exacerbation in the cystic fibrosis patient.

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Free-breathing MRI for monitoring ventilation changes following antibiotic treatment of pulmonary exacerbations in paediatric cystic fibrosis

Abstract: It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online.

Cited by 16 publications

References 17 publications

Inter‐ and intravisit repeatability of free‐breathing MRI in pediatric cystic fibrosis lung disease

Inter‐ and intravisit repeatability of free‐breathing MRI in pediatric cystic fibrosis lung disease

Clinical Feasibility of Structural and Functional MRI in Free‐Breathing Neonates and Infants

Management of respiratory tract exacerbations in people with cystic fibrosis: Focus on imaging

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