Self-gated Non–Contrast-enhanced Functional Lung MR Imaging for Quantitative Ventilation Assessment in Patients with Cystic Fibrosis

Abstract

Purpose To assess the clinical feasibility of self-gated non-contrast-enhanced functional lung (SENCEFUL) magnetic resonance (MR) imaging for quantitative ventilation (QV) imaging in patients with cystic fibrosis (CF). Materials and Methods Twenty patients with CF and 20 matched healthy volunteers underwent functional 1.5-T lung MR imaging with the SENCEFUL imaging approach, in which a two-dimensional fast low-angle shot sequence is used with quasi-random sampling. The lungs were manually segmented on the ventilation-weighted images to obtain QV measurements, which were compared between groups. QV values of the patients were correlated with results of pulmonary function testing. Three radiologists rated the images for presence of ventilation deficits by means of visual inspection. Mann-Whitney U tests, receiver operating characteristic analyses, Spearman correlations, and Gwet agreement coefficient analyses were used for statistical analysis. Results QV of the entire lungs was lower for patients with CF than for control subjects (mean ± standard deviation, 0.09 mL/mL ± 0.03 vs 0.11 mL/mL ± 0.03, respectively; P = .007). QV ratios of upper to lower lung halves were lower in patients with CF than in control subjects (right, 0.84 ± 0.2 vs 1.16 ± 0.2, respectively [P < .001]; left, 0.88 ± 0.3 vs 1.11 ± 0.1, respectively [P = .017]). Accordingly, ventilation differences between the groups were larger in the upper halves (Δ = 0.04 mL/mL, P ≤ .001-.002). QV values of patients with CF correlated with forced vital capacity (r = 0.7; 95% confidence interval [CI]: 0.21, 0.91), residual volume (static hyperinflation, r = -0.8; 95% CI: -0.94, 0.42), and forced expiratory volume in 1 second (airway obstruction, r = 0.7; 95% CI: 0.21, 0.91). Disseminated small ventilation deficits were the most frequent involvement pattern, present in 40% of the functional maps in CF versus 8% in the control subjects (P < .001). Conclusion SENCEFUL MR imaging is feasible for QV assessment. Less QV, especially in upper lung parts, and correlation to vital capacity and to markers for hyperinflation and airway obstruction were found in patients with CF. RSNA, 2016.

Comparison of quantitative regional ventilation‐weighted fourier decomposition MRI with dynamic fluorinated gas washout MRI and lung function testing in COPD patients

“…10,20,27 In the present study we also showed significant correlations of FD-FV with clinical lung function test parameters such as FEV1. 15 A limitation of this study was the fact that no chest CT data were available in this cohort. While pulmonary function testing is still the clinical gold standard for grading COPD severity and treatment recommendations, assessment of regional lung ventilation may play an import role in phenotyping of COPD patients in the future.…”

“…[13][14][15] FD-MRI is radiation-and contrast-agent free, cost-efficient, and patient-friendly, but has yet not been validated in COPD patients for its potential properties to measure regional lung ventilation. [13][14][15] FD-MRI is radiation-and contrast-agent free, cost-efficient, and patient-friendly, but has yet not been validated in COPD patients for its potential properties to measure regional lung ventilation.…”

UTE‐SENCEFUL: first results for 3D high‐resolution lung ventilation imaging

“…The mean QV values of the group of healthy subjects were compared between UTE‐SENCEFUL (with the 3D image registration) and 2D‐SENCEFUL using a 2‐tailed Mann Whitney test. The regional QV was also evaluated for the patient and compared to a previous study …”

“…The latter is used to separate the acquired data into individual respiratory and cardiac phases, ultimately yielding representative respiratory and cardiac cycles. After image registration, the signal amplitude of the first harmonic in the frequency domain is selected to depict the functional contrast in the lung …”

“…In comparison to Fourier decomposition MRI and the subtraction method proposed by Ref. 13, SENCEFUL has presented images with higher spatial and temporal resolution . Yet, the 2D‐FLASH acquisition suffers from the fast T2*‐induced signal decay in the lung parenchyma and does not offer real 3D coverage .…”