Grzegorz Bauman

MRI of the lung (3/3)—current applications and future perspectives

AbstractBackgroundMRI of the lung is recommended in a number of clinical indications. Having a non-radiation alternative is particularly attractive in children and young subjects, or pregnant women.MethodsProvided there is sufficient expertise, magnetic resonance imaging (MRI) may be considered as the preferential modality in specific clinical conditions such as cystic fibrosis and acute pulmonary embolism, since additional functional information on respiratory mechanics and regional lung perfusion is provided. In other cases, such as tumours and pneumonia in children, lung MRI may be considered an alternative or adjunct to other modalities with at least similar diagnostic value.ResultsIn interstitial lung disease, the clinical utility of MRI remains to be proven, but it could provide additional information that will be beneficial in research, or at some stage in clinical practice. Customised protocols for chest imaging combine fast breath-hold acquisitions from a “buffet” of sequences. Having introduced details of imaging protocols in previous articles, the aim of this manuscript is to discuss the advantages and limitations of lung MRI in current clinical practice.ConclusionNew developments and future perspectives such as motion-compensated imaging with self-navigated sequences or fast Fourier decomposition MRI for non-contrast enhanced ventilation- and perfusion-weighted imaging of the lung are discussed. Main Messages • MRI evolves as a third lung imaging modality, combining morphological and functional information.• It may be considered first choice in cystic fibrosis and pulmonary embolism of young and pregnant patients.• In other cases (tumours, pneumonia in children), it is an alternative or adjunct to X-ray and CT.• In interstitial lung disease, it serves for research, but the clinical value remains to be proven.• New users are advised to make themselves familiar with the particular advantages and limitations.

Lung ventilation- and perfusion-weighted Fourier decomposition magnetic resonance imaging: In vivo validation with hyperpolarized 3He and dynamic contrast-enhanced MRI

The purpose of this work was to validate ventilation‐weighted (VW) and perfusion‐weighted (QW) Fourier decomposition (FD) magnetic resonance imaging (MRI) with hyperpolarized 3He MRI and dynamic contrast‐enhanced perfusion (DCE) MRI in a controlled animal experiment. Three healthy pigs were studied on 1.5‐T MR scanner. For FD MRI, the VW and QW images were obtained by postprocessing of time‐resolved lung image sets. DCE acquisitions were performed immediately after contrast agent injection. 3He MRI data were acquired following the administration of hyperpolarized helium and nitrogen mixture. After baseline MR scans, pulmonary embolism was artificially produced. FD MRI and DCE MRI perfusion measurements were repeated. Subsequently, atelectasis and air trapping were induced, which followed with FD MRI and 3He MRI ventilation measurements. Distributions of signal intensities in healthy and pathologic lung tissue were compared by statistical analysis. Images acquired using FD, 3He, and DCE MRI in all animals before the interventional procedure showed homogeneous ventilation and perfusion. Functional defects were detected by all MRI techniques at identical anatomical locations. Signal intensity in VW and QW images was significantly lower in pathological than in healthy lung parenchyma. The study has shown usefulness of FD MRI as an alternative, noninvasive, and easily implementable technique for the assessment of acute changes in lung function. Magn Reson Med, 2013.

Validation of Fourier decomposition MRI with dynamic contrast-enhanced MRI using visual and automated scoring of pulmonary perfusion in young cystic fibrosis patients

PURPOSE To validate Fourier decomposition (FD) magnetic resonance (MR) imaging in cystic fibrosis (CF) patients with dynamic contrast-enhanced (DCE) MR imaging. MATERIALS AND METHODS Thirty-four CF patients (median age 4.08 years; range 0.16-30) were examined on a 1.5-T MR imager. For FD MR imaging, sets of lung images were acquired using an untriggered two-dimensional balanced steady-state free precession sequence. Perfusion-weighted images were obtained after correction of the breathing displacement and Fourier analysis of the cardiac frequency from the time-resolved data sets. DCE data sets were acquired with a three-dimensional gradient echo sequence. The FD and DCE images were visually assessed for perfusion defects by two readers independently (R1, R2) using a field based scoring system (0-12). Software was used for perfusion impairment evaluation (R3) of segmented lung images using an automated threshold. Both imaging and evaluation methods were compared for agreement and tested for concordance between FD and DCE imaging. RESULTS Good or acceptable intra-reader agreement was found between FD and DCE for visual and automated scoring: R1 upper and lower limits of agreement (ULA, LLA): 2.72, -2.5; R2: ULA, LLA: ± 2.5; R3: ULA: 1.5, LLA: -2. A high concordance was found between visual and automated scoring (FD: 70-80%, DCE: 73-84%). CONCLUSIONS FD MR imaging provides equivalent diagnostic information to DCE MR imaging in CF patients. Automated assessment of regional perfusion defects using FD and DCE MR imaging is comparable to visual scoring but allows for percentage-based analysis.

Functional MRI using Fourier decomposition of lung signal: Reproducibility of ventilation- and perfusion-weighted imaging in healthy volunteers

PURPOSE To assess the reproducibility of Fourier decomposition (FD) based ventilation- and perfusion-weighted lung MRI. METHODS Sixteen healthy volunteers were examined on a 1.5 T whole-body MR-scanner with 4-6 sets of coronal slices over the chest volume with a non-contrast enhanced steady-state free precession sequence. The identical protocol was repeated after 24h. Reconstructed perfusion- and ventilation-weighted images were obtained through non-rigid registration and FD post-processing of images. Analysis of signal in segmented regions of interest was performed for both native and post-processed data. Two blinded chest radiologists rated image quality of perfusion- and ventilation-weighted images using a 3-point scale. RESULTS Reproducibility of signal between the two time points was very good with intra-class correlation coefficients of 0.98, 0.94 and 0.86 for native, perfusion- and ventilation-weighted images, respectively. Perfusion- and ventilation-weighted images were of overall good quality with proportions of diagnostic images of 87-95% and 69-75%, respectively. Lung signal decreased from posterior to anterior slices with image quality of ventilation-weighted images in anterior areas rated worse than in posterior or perfusion-weighted images. Inter- and intra-observer agreement of image quality was good for perfusion and ventilation. CONCLUSIONS The study demonstrates high reproducibility of ventilation- and perfusion-weighted FD lung MRI.

Simultaneous MRI of lung structure and perfusion in a single breathhold

To develop and demonstrate a breathheld 3D radial ultrashort echo time (UTE) acquisition to visualize co‐registered lung perfusion and vascular structure.

Non-contrast-enhanced preoperative assessment of lung perfusion in patients with non-small-cell lung cancer using Fourier decomposition magnetic resonance imaging

OBJECTIVE To investigate non-contrast-enhanced Fourier decomposition MRI (FD MRI) for assessment of regional lung perfusion in patients with Non-Small-Cell Lung Cancer (NSCLC) in comparison to dynamic contrast-enhanced MRI (DCE MRI). METHODS Time-resolved non-contrast-enhanced images of the lungs were acquired prospectively in 15 patients using a 2D balanced steady-state free precession (b-SSFP) sequence. After non-rigid registration of the native image data, perfusion-weighted images were calculated by separating periodic changes of lung proton density at the cardiac frequency using FD. DCE MRI subtraction datasets were acquired as standard of reference. Both datasets were analyzed visually for perfusion defects. Then segmentation analyses were performed to describe perfusion of pulmonary lobes semi-quantitatively as percentages of total lung perfusion. Overall FD MRI perfusion signal was compared to velocity-encoded flow measurements in the pulmonary trunk as an additional fully quantitative reference. RESULTS Image quality ratings of FD MRI were significantly inferior to those of DCE MRI (P<0.0001). Sensitivity, specificity, and accuracy of FD MRI for visual detection of perfusion defects were 84%, 92%, and 91%. Semi-quantitative evaluation of lobar perfusion provided high agreement between FD MRI and DCE MRI for both entire lungs and upper lobes, but less agreement in the lower parts of both lungs. FD perfusion signal showed high linear correlation with pulmonary arterial blood flow. CONCLUSION FD MRI is a promising technique that allows for assessing regional lung perfusion in NSCLC patients without contrast media or ionizing radiation. However, for being applied in clinical routine, image quality and robustness of the technique need to be further improved.

Three-dimensional pulmonary perfusion MRI with radial ultrashort echo time and spatial-temporal constrained reconstruction.

To assess the feasibility of spatial–temporal constrained reconstruction for accelerated regional lung perfusion using highly undersampled dynamic contrast‐enhanced (DCE) three‐dimensional (3D) radial MRI with ultrashort echo time (UTE).

Non‐contrast‐enhanced MRI of the pulmonary blood volume using two‐compartment‐modeled T1‐relaxation

To introduce a novel technique, based on a two‐compartment model and nonselective inversion recovery (TCIR) for the non‐contrast‐enhanced evaluation of the fractional pulmonary blood volume (fPBV).

Pulmonary perfusion imaging: Qualitative comparison of TCIR MRI and SPECT/CT in porcine lung

OBJECTIVES To validate the anatomical accuracy, homogeneity and sensitivity of two-compartment modeled inversion recovery (TCIR) magnetic resonance imaging (MRI) in a multimodal animal experiment as a non-invasive alternative to standard functional imaging techniques. METHODS Seven pigs were studied on a 1.5 T whole-body MR scanner and SPECT/CT. The specimens were intubated and maintained in general anesthesia throughout the experiment. TCIR maps of the fractional pulmonary blood volume were compared to dynamic contrast enhanced MRI and SPECT/CT via a region of interest (ROI) based reader study. A comprehensive statistical analysis was performed on the coefficient of variation to evaluate homogeneity properties. Sensitivity was assessed by detecting gravitation dependent perfusion variation and delineation of pathological areas. RESULTS The fPBV-maps of all examined specimens indicate a superior homogeneity in the computed values (p<1.3×10(-4)). The sensitivity of the TCIR maps to a gravitation effect on the blood distribution was verified and a similar anteroposterior signal and count dependency was observed in DCE MRI and SPECT. Bland-Altman analysis showed no significant intra- or inter-observer difference within the ROI reader study (p>0.06). CONCLUSION Superior information content, significantly higher homogeneity and similar sensitivity of TCIR when compared to DCE and SPECT/CT demonstrated the feasibility of TCIR MRI as an alternative contrast agent-free, non-invasive functional lung imaging approach.

Three-dimensional pulmonary perfusion MRI with radial ultrashort echo time and spatial-temporal constrained reconstruction: Spatial-Temporal 3D UTE Pulmonary Perfusion MRI

To assess the feasibility of spatial–temporal constrained reconstruction for accelerated regional lung perfusion using highly undersampled dynamic contrast‐enhanced (DCE) three‐dimensional (3D) radial MRI with ultrashort echo time (UTE).