Changes in Regional Airflow Obstruction over Time in the Lungs of Patients with Asthma: Evaluation with 3He MR Imaging
Changes in Regional Airflow Obstruction over Time in the Lungs of Patients with Asthma: Evaluation with 3He MR Imaging
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DOI：
10.1148/radiol.2502080188
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发表时间：
2009-02-01
期刊：
影响因子：
19.7
通讯作者：
Platts-Mills, Thomas A.
中科院分区：
文献类型：
--
作者：
de Lange, Eduard E.;Altes, Talissa A.;Platts-Mills, Thomas A.
目的：确定哮喘患者肺部局部气流阻塞随时间的变化，如超极化氦 3 (He-3) 磁共振 (MR) 成像所示，并评估与疾病严重程度和哮喘药物使用的相关性。 材料和方法：这项符合 HIPAA 的研究获得了机构审查委员会的批准和书面知情同意书。 He-3 的使用已获得美国食品和药物管理局的批准。 43 名患者总共接受了 103 次 MR 成像研究； 26 人在 42-82 分钟（同一天）内成像两次，17 人在 1 至 476 天（多日）之间的 3 天成像。每天进行肺活量测定，确定疾病严重程度，并记录哮喘药物的使用情况。以成对方式审查图像，以确定总通气缺陷数量、成像研究之间同一位置的缺陷以及大小。使用参数和非参数统计方法。 结果：对于当天检查，每个图像切片的平均缺陷数在基线和重复成像时相似（分别为 1.8 +/- 1.9 [标准差] vs 1.6 +/- 1.9；P = 0.15），其中 75% 的缺陷保留在同一位置，其中 71% 的缺陷大小未改变。对于多日检查，研究 2 的每个切片的平均缺陷数 (2.4 +/- 1.5) 高于研究 1 (1.7 +/- 0.9，P = .02)，研究 3 的平均缺陷数 (1.5 +/- 1.1) 低于研究 2 (P < .01)，并且研究 1 和 3 相似 (P = .56)。检查之间的时间与每个切片的平均缺陷数变化（中位受试者内相关性 [r(m)] = 0.01，P = .64）或肺量测定值的变化（r(m) 值范围：-0.56 至 -0.31；P 值范围：0.09-.71）无关。同一位置的缺陷随着时间的推移而减少 (r(m) = -0.83，P < .01），其中 67% 在研究 1 和 2 之间持续存在（中位间隔，31 天），43% 在研究 2 和 3 之间持续存在（中位间隔，41 天），38% 在研究 1 和 3 之间持续存在（中位间隔，85 天）； 46%-58%的缺陷尺寸保持不变。无论疾病严重程度或药物使用情况如何，这些趋势都是相同的。结论：在哮喘中，无论疾病严重程度或治疗如何，肺部内的局灶性气流障碍可能会随着时间的推移而明显持续存在。(C) RSNA，2009
Purpose:To determine changes in regional airflow obstruction over time in the lungs of patients with asthma, as demonstrated with hyperpolarized helium 3 (He-3) magnetic resonance (MR) imaging, and to assess correlations with disease severity and use of asthma medications.Materials and Methods:Institutional review board approval and written informed consent were obtained for this HIPAA-compliant study. Use of He-3 was approved by the U. S. Food and Drug Administration. Forty-three patients underwent 103 MR imaging studies in total; 26 were imaged twice within 42-82 minutes (same day), and 17 were imaged on 3 days between 1 and 476 days (multiday). Each day, spirometry was performed, disease severity was determined, and the use of asthma medications was recorded. Images were reviewed in a pairwise fashion to determine total ventilation defect number, defects in same location between imaging studies, and size. Parametric and nonparametric statistical methods were used.Results:For the same-day examinations, the mean number of defects per image section was similar at baseline and repeat imaging (1.8 +/- 1.9 [standard deviation] vs 1.6 +/- 1.9, respectively; P = .15), with 75% of defects remaining in the same location and 71% of these not changing size. For the multiday examinations, the mean number of defects per section was higher for study 2 (2.4 +/- 1.5) than study 1 (1.7 +/- 0.9, P = .02), was lower for study 3 (1.5 +/- 1.1) than for study 2 (P < .01), and was similar for studies 1 and 3 (P = .56). Time between examinations was not associated with change in mean number of defects per section (median intrasubject correlation [r(m)] = 0.01, P = .64) or change in spirometric values (range of r(m) values: -0.56 to -0.31; range of P values: .09-.71). Defects in the same location decreased with time (r(m) = -0.83, P < .01), with 67% persisting between studies 1 and 2 (median interval, 31 days), 43% persisting between studies 2 and 3 (median interval, 41 days), and 38% persisting between studies 1 and 3 (median interval, 85 days); 46%-58% of defects remained unchanged in size. These trends were the same regardless of disease severity or medication use.Conclusion:In asthma, focal airflow impediment within the lungs can be markedly persistent over time, regardless of disease severity or treatment.(C) RSNA, 2009