Pulmonary functional MRI: Detecting the structure-function pathologies that drive asthma symptoms and quality of life.
Pulmonary functional MRI: Detecting the structure-function pathologies that drive asthma symptoms and quality of life.
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DOI：
10.1111/resp.14197
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发表时间：
2022-02
期刊：
影响因子：
6.9
通讯作者：
Parraga, Grace
中科院分区：
文献类型：
--
作者：
Kooner, Harkiran K.;McIntosh, Marrissa J.;Desaigoudar, Vedanth;Rayment, Jonathan H.;Eddy, Rachel L.;Driehuys, Bastiaan;Parraga, Grace
肺功能磁共振成像（PfMRI）使用吸入超极化，无辐射气体（如3 He和129 He）提供了一种直接可视化吸入气体分布和通气缺陷（或通气异质性）在真实的时间与高空间分辨率（~ mm 3）。这两种气体都可以定量测量末端气道形态，而129 μ l可以对吸入气体穿过肺泡-毛细血管组织屏障到红细胞的转移进行成像。在哮喘患者中，肺功能MRI异常已显示反映气道平滑肌功能障碍、气道炎症和重塑、管腔阻塞和气道修剪。该方法快速（8- 15秒），成本效益高（约300美元/次扫描），患者耐受性良好，即使是非常年轻或病情严重的患者，因为与计算机断层扫描，正电子发射断层扫描和单光子发射计算机断层扫描不同，没有电离辐射，检查只需几秒钟。然而，PfMRI并非没有限制，包括需要复杂的图像分析，专业设备以及额外的培训和质量控制。我们概述了超极化惰性气体MRI在哮喘研究中的三个主要应用，包括：1）吸入气体分布或通气成像，2）肺泡微结构，以及最后，3）气体转移到肺泡毛细血管组织空间和从组织屏障进入肺微血管中的红细胞。我们强调的证据，支持更深入地了解哮喘恶化的机制，随着时间的推移和负责症状和疾病控制的病理。最后，我们总结了有可能整合到临床工作流程中的方法，并可用于指导个性化治疗计划。
Pulmonary functional magnetic resonance imaging (PfMRI) using inhaled hyperpolarised, radiation-free gases (such as 3He and 129Xe) provides a way to directly visualise inhaled gas distribution and ventilation defects (or ventilation heterogeneity) in real time with high spatial (~mm3) resolution. Both gases enable quantitative measurement of terminal airway morphology, while 129Xe uniquely enables imaging the transfer of inhaled gas across the alveolar-capillary tissue barrier to the red blood cells. In patients with asthma, pulmonary functional MRI abnormalities have been shown reflect airway smooth muscle dysfunction, airway inflammation and remodelling, luminal occlusions and airway pruning. The method is rapid (8-15s), cost-effective (~$300/scan) and very well-tolerated in patients, even those who are very young or very ill, because unlike computed tomography, positron emission tomography and single-photon emission computed tomography, there is no ionising radiation and the examination takes only a few seconds. However, PfMRI is not without limitations, which include the requirement of complex image analysis, specialised equipment, and additional training and quality-control. We provide an overview of the three main applications of hyperpolarised noble gas MRI in asthma research including: 1) inhaled gas distribution or ventilation imaging, 2) alveolar microstructure, and finally, 3) gas transfer into the alveolar-capillary tissue space and from the tissue barrier into red blood cells in the pulmonary microvasculature. We highlight the evidence that supports a deeper understanding of the mechanisms of asthma worsening over time and the pathologies responsible for symptoms and disease control. We conclude with a summary of approaches that have the potential for integration into clinical workflows and that may be used to guide personalised treatment planning.
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