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Luis A. Torres, Kristine E. Lee, Gregory P. Barton, Andrew D. Hahn,Nathan Sandbo, Mark L. Schiebler, Sean B. Fain

European Respiratory Journal 2022; DOI: 10.1183/13993003.02058-2021

Abstract

Objectives The objective of this work was to apply quantitative and semi-quantitative dynamic contrast enhanced MRI (DCE-MRI) methods to evaluate lung perfusion in idiopathic pulmonary fibrosis (IPF).

Materials and Methods In this prospective trial 41 subjects, including healthy control (control) and IPF subjects, were studied using DCE-MRI at baseline. IPF subjects were then followed for 1 year, progressive IPF (IPFprog) were distinguished from stable IPF (IPFstable) subjects based on a decline in percent predicted FVC (FVC%p) or DLCO (DLCO%p) measured during followup visits. 35/41 subjects were retained for final baseline analysis at (control: N=15; IPFstable: N=14; IPFprog: N=6). Seven measures and their coefficients of variation (CV) were derived using temporally resolved DCE-MRI. Two sets of global and regional comparisons were made: control versus IPF groups, and control versus IPFstable versus IPFprog groups, using linear regression analysis. Each measure was compared to FVC%p, DLCO%p, and the lung clearance index (LCI%p) using a Spearman rank correlation.

Results DCE-MRI identified regional perfusion differences between control and IPF subjects using first moment transit time (FMTT), contrast uptake slope (SLOPE), and pulmonary blood flow (PBF) (p≤0.05), while global averages did not. FMTT was shorter for IPFprog compared to both IPFstable (p=0.004) and control groups (p=0.023). Correlations were observed between PBF CV and DLCO%p (rs=−0.48, p=0.022) and %LCI (rs=+0.47, p=0.015). Significant group differences were detected in age (p<0.001), DLCO%p (p<0.001), FVC%p (p=0.001), and LCI%p (p=0.007).

Conclusions Global analysis obscures regional changes in pulmonary hemodynamics in IPF using DCE-MRI in IPF. Decreased FMTT may be a candidate marker for IPF progression.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Schiebler reports grant funding from the National Heart, Lung, and Blood Institute (NHLBI SARPIII - RFA-HL-11-018 and SARP IV 4P01HL088594-09, R01 HL080414) and ownership of Elucida Oncology Inc., Elucida Medical Inc., Healthmyne Inc., Stemina Biomarker Discovery Inc., and X-Vax, Inc.

Conflict of interest: Dr. Fain reports grant funding from NHLBI (NHLBI R01HL126771, NHLBI RO1 HL146689), GE Healthcare, American Lung Association, as well as compensation from Caladarius Biosciences, Polarean PLC, and Sanofi/Regeneron. All other authors have nothing to disclose.

Conflict of interest: Dr. Torres has nothing to disclose.

Conflict of interest: Dr. Lee has nothing to disclose.

Conflict of interest: Dr. Barton has nothing to disclose.

Conflict of interest: Dr. Hahn has nothing to disclose.

Conflict of interest: Dr. Sandbo has nothing to disclose.

• Received July 24, 2021.
• Accepted February 24, 2022.

• Copyright ©The authors 2022. For reproduction rights and permissions contact