Mucus Plugs in Asthma at CT Associated with Regional Ventilation                     Defects at <sup>3</sup>He MRI

Mummy, David; Dunican, Eleanor M.; Carey, K.J.; Evans, Michael D.; Elicker, Brett M.; Newell, John D.; Gierada, David S.; Nagle, Scott K.; Schiebler, Mark L.; Sorkness, Ronald L.; Jarjour, Nizar N.; Denlinger, Loren C.; Fahy, John V.; Fain, S.B.

doi:10.1148/radiol.2021204616

Cited by 29 publications

(18 citation statements)

References 31 publications

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“…There is normally a wide range of age- and sex-dependent expiratory tracheal collapse ( 159 , 160 ). Airway segmental mucus plugs have been visually counted, correlating with pulmonary function, oxygen saturation, MRI-derived ventilation heterogeneity ( 161 – 163 ), and locally reduced 3 He MRI signal ( 164 ). Caveats: Static imaging may underestimate tracheobronchial collapse and not predict dynamic expiratory collapse ( 158 – 160 , 165 ).…”

Section: Assessing Airway Structure and Functionmentioning

confidence: 99%

Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report

Hsia¹,

Bates²,

Driehuys³

et al. 2023

Annals ATS

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Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort–echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation–perfusion–diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)–derived endpoints have been developed to identify structure–function phenotypes, including air–blood–tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental “good practice” stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.

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Section: Assessing Airway Structure and Functionmentioning

confidence: 99%

Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report

Hsia¹,

Bates²,

Driehuys³

et al. 2023

Annals ATS

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“…The notion that airway eosinophil depletion may result in improved VDP via a reduction in mucus occlusions agrees with previous results that showed the relationship between eosinophils and mucus plugs 3 and studies that showed the association between ventilation defects with eosinophils 19 and mucus plugs. 21,22 In multivariate models, VDP and mucus score both explained the change in ACQ 6 score on day 28, which suggests that patients with worse ventilation heterogeneity and more mucus occlusions may expect greater ACQ 6 score improvements after benralizumab injection. Improved mean VDP could be explained by greater baseline FENO and mucus score, as well as diminished bronchodilator reversibility, which suggests that the benralizumab effect on airway function is linked mechanistically to eosinophilic inflammation and mucus plug changes or destabilization, and not to smooth muscle dysfunction.…”

Section: Discussionmentioning

confidence: 96%

“…Asthma investigations that harness the unique capabilities of hyperpolarized 3 He and 129 Xe MRI [15][16][17] have shown that ventilation defects 17,18 are related to airway inflammation 18,19 and remodeling 20 and are related spatially to lobar 21 and segmental 22 mucus occlusions. Moreover, MRI ventilation defect percentage (VDP) 23 is uniquely predictive of asthma control, 24 is related to airway inflammation and sputum eosinophilia, 19 and sensitively responds to asthma interventions including bronchodilator, 17 bronchial thermoplasty, 15 and antitype 2 therapy.…”

mentioning

confidence: 99%

Asthma Control, Airway Mucus, and 129Xe MRI Ventilation After a Single Benralizumab Dose

McIntosh

Kooner

Eddy

et al. 2022

CHEST

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“…Using computed tomography (CT), bronchial wall thickening, a hallmark of airway remodeling, and gas trapping, an indirect measure of airflow obstruction, can be directly assessed, and found to correlate spatially and quantitatively with ventilation defects on HP-MRI ( 109 , 110 ). Likewise, a correlation between higher mucus plugs quantified using CT ( 111 ), increased markers of gas trapping, and greater VDP have similarly been reported in asthmatics ( 112–114 ), raising the possibility that ventilation defects may be a consequence of proximal airway mucus occlusion with distal gas trapping.…”

Section: Clinical Applicationsmentioning

confidence: 87%

Functional lung imaging using novel and emerging MRI techniques

et al. 2023

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Respiratory diseases are leading causes of death and disability in the world. While early diagnosis is key, this has proven difficult due to the lack of sensitive and non-invasive tools. Computed tomography is regarded as the gold standard for structural lung imaging but lacks functional information and involves significant radiation exposure. Lung magnetic resonance imaging (MRI) has historically been challenging due to its short T2 and low proton density. Hyperpolarised gas MRI is an emerging technique that is able to overcome these difficulties, permitting the functional and microstructural evaluation of the lung. Other novel imaging techniques such as fluorinated gas MRI, oxygen-enhanced MRI, Fourier decomposition MRI and phase-resolved functional lung imaging can also be used to interrogate lung function though they are currently at varying stages of development. This article provides a clinically focused review of these contrast and non-contrast MR imaging techniques and their current applications in lung disease.

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Mucus Plugs in Asthma at CT Associated with Regional Ventilation Defects at ³He MRI

Cited by 29 publications

References 31 publications

Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report

Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report

Asthma Control, Airway Mucus, and 129Xe MRI Ventilation After a Single Benralizumab Dose

Functional lung imaging using novel and emerging MRI techniques

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Mucus Plugs in Asthma at CT Associated with Regional Ventilation Defects at 3He MRI

Cited by 29 publications

References 31 publications

Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report

Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report

Asthma Control, Airway Mucus, and 129Xe MRI Ventilation After a Single Benralizumab Dose

Functional lung imaging using novel and emerging MRI techniques

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Product

Resources

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Mucus Plugs in Asthma at CT Associated with Regional Ventilation Defects at ³He MRI