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Diverse cardiopulmonary diseases are associated with distinct xenon magnetic resonance imaging signatures


Ziyi Wang, Elianna A. Bier, Aparna Swaminathan, Kishan Parikh, John Nouls, Mu He, Joseph G. Mammarappallil, Sheng Luo, Bastiaan Driehuys, Sudarshan Rajagopal

European Respiratory Journal 2019 54: 1900831; DOI: 10.1183/13993003.00831-2019

Diverse cardiopulmonary diseases are associated with distinct xenon magnetic resonance imaging signatures

Abstract

Background As an increasing number of patients exhibit concomitant cardiac and pulmonary disease, limitations of standard diagnostic criteria are more frequently encountered. Here, we apply noninvasive 129Xe magnetic resonance imaging (MRI) and spectroscopy to identify patterns of regional gas transfer impairment and haemodynamics that are uniquely associated with chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), left heart failure (LHF) and pulmonary arterial hypertension (PAH).

Methods Healthy volunteers (n=23) and patients with COPD (n=8), IPF (n=12), LHF (n=6) and PAH (n=10) underwent 129Xe gas transfer imaging and dynamic spectroscopy. For each patient, three-dimensional maps were generated to depict ventilation, barrier uptake (129Xe dissolved in interstitial tissue) and red blood cell (RBC) transfer (129Xe dissolved in RBCs). Dynamic 129Xe spectroscopy was used to quantify cardiogenic oscillations in the RBC signal amplitude and frequency shift.

Results Compared with healthy volunteers, all patient groups exhibited decreased ventilation and RBC transfer (both p≤0.01). Patients with COPD demonstrated more ventilation and barrier defects compared with all other groups (both p≤0.02). In contrast, IPF patients demonstrated elevated barrier uptake compared with all other groups (p≤0.007), and increased RBC amplitude and shift oscillations compared with healthy volunteers (p=0.007 and p≤0.01, respectively). Patients with COPD and PAH both exhibited decreased RBC amplitude oscillations (p=0.02 and p=0.005, respectively) compared with healthy volunteers. LHF was distinguishable from PAH by enhanced RBC amplitude oscillations (p=0.01).

Conclusion COPD, IPF, LHF and PAH each exhibit unique 129Xe MRI and dynamic spectroscopy signatures. These metrics may help with diagnostic challenges in cardiopulmonary disease and increase understanding of regional lung function and haemodynamics at the alveolar–capillary level.

Different heart and lung diseases exhibit unique 129Xe MRI and spectroscopy signatures. These may help differentiate cardiopulmonary disease and increase our understanding of regional lung function and haemodynamics at the alveolar–capillary level.

Footnotes

  • Support statement: This study was funded by NIH/NHLBI R01 HL105643, NIH/NHLBI R01HL126771 and HHSN268201700001C. Sheng Luo's research was supported in part by the National Institutes of Health (R01NS091307 and R56AG062302). Funding information for this article has been deposited with the Crossref Funder Registry.

  • Conflict of interest: Z. Wang has a provisional patent for a diagnostic algorithm based on the findings in this manuscript licensed.

  • Conflict of interest: E.A. Bier reports grants from the National Institutes of Health, during the conduct of the study; and has a provisional patent for a diagnostic algorithm based on the findings in this manuscript licensed.

  • Conflict of interest: A. Swaminathan has nothing to disclose.

  • Conflict of interest: K. Parikh has nothing to disclose.

  • Conflict of interest: J. Nouls has nothing to disclose.

  • Conflict of interest: M. He has nothing to disclose.

  • Conflict of interest: J.G. Mammarappallil has nothing to disclose.

  • Conflict of interest: S. Luo has nothing to disclose.

  • Conflict of interest: B. Driehuys reports grants from the National Institutes of Health, during the conduct of the study; personal fees from and is founder and chief technology officer for Polarean Imaging, a company which produces 129Xe hyperpolarisation equipment, outside the submitted work; and has a provisional patent for a diagnostic algorithm based on the findings in this manuscript licensed.

  • Conflict of interest: S. Rajagopal reports grants from National Institutes of Health, during the conduct of the study; and has a patent “Dynamic 129Xe Gas Exchange Spectroscopy” pending.

  • Received April 29, 2019.
  • Accepted September 12, 2019.
  • Copyright ©ERS 2019

sumber : https://erj.ersjournals.com/content/54/6/1900831

 
 

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