Paradoxical Motion of the Hemidiaphragm In Patients With Emphysema

Abstract

The authors evaluate paradoxical diaphragmatic motion using magnetic resonance (MR) imaging in patients with emphysema. The subjects were 12 healthy volunteers and 10 male patients with moderate to severe air flow obstruction. With subjects in the supine position, 30 sequential sagittal images of the bilateral lungs were obtained during quiet and forced breathing using a 1.5T MR unit with a body coil. The sequence was single shot fast spin echo (SSFSE) with half Fourier transformation. Subtraction images were made from the original images (by subtracting a given image from the preceding image), which visualized the chest wall motion as white or black bands on the edge of the lung fields. The authors evaluated both the original and subtraction images. MR imaging showed abnormal hemidiaphragmatic motion during forced breathing: the ventral portion of the hemidiaphragm moved downward while the dorsal part moved upward like a seesaw in 6 patients. MR images also revealed abnormal ribcage motion; the ventral ribcage moved anteriorly when the hemidiaphragm moved upward in 7 patients. No abnormal motion was observed in healthy volunteers. MR is a noninvasive and useful tool for evaluating the asynchronous respiratory motion in patients with emphysema.

Respiratory lung motion analysis using a nonlinear motion correction technique for respiratory-gated lung perfusion SPECT images

“…Furthermore, a paradoxical motion could be observed in which the front part of the lungs moved upward and the back part of the lungs moved downward. Iwasawa et al [11,12] reported that this paradoxical motion is often observed in the case of pulmonary emphysema. From the motion analysis, it was clear that the paradoxical motion was present in the motion of the right lung in this case.…”

“…Suga et al [10] evaluated the extent of ventilation obstruction caused by pulmonary emphysema by measuring the motion of the diaphragm and thoracic wall using dynamic breathing magnetic resonance imaging (MRI). Iwasawa et al [11,12] observed that paradoxical motions exist in the motion of the diaphragm of patients with pulmonary emphysema. From these reports, it is clear that analysis of the motion of the lungs is an effective tool for diagnosing and evaluating pulmonary diseases such as emphysema.…”

Morphological and functional imaging in COPD with CT and MRI: present and future

“…Note only mild emphysema on CT with preserved ventilation in the upper lung but reduced ventilation in left lower and parts of the right lower lung the diaphragm [72]. In some patients, the ventral portion of the hemidiaphragm moved downward while the dorsal part moved upward like a seesaw [73]. The paradoxical diaphragmatic motion correlated with hyperinflation, although severe hyperinflation tended to restrict both normal and paradoxical diaphragmatic motion [74].…”

4D CT lung ventilation images are affected by the 4D CT sorting method

“…Most relevant to this study, the 4D CT images have been acquired during well-controlled tidal breathing with mechanical ventilation in the animal studies, whereas in the human studies most uncontrolled tidal breathing subject to variations throughout a scan. Although audio and/or visual biofeedback respiratory training has been employed by several investigators, 11,14 it has been based on patient's abdominal displacements, which do not necessarily represent internal lung motion, 18 and also there can still be residual variations. Respiratory variations result in artifacts in 4D CT images and also inconsistent lung volumes.…”