MICA: Non-invasive quantitative ventilation imaging by MRI of fluorocarbon gases

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Respiratory diseases are among the leading causes of death worldwide. New treatments for respiratory diseases are increasingly emerging, and tests to determine response to treatments are vital for management of a patient's respiratory disease. Unfortunately, existing measures of assessing lung function and structure have limitations. For example, spirometry cannot provide information on regional change within the lungs, so early localised changes in ventilation properties may pass undetected. Computed tomography (CT) scanning provides images of lung structure, but uses ionising radiation (x-rays) to generate these images and the associated radiation dose means that regular scanning to monitor disease progression or response to therapy is typically impossible. There is therefore a pressing need for new techniques that can perform safe, objective, repeatable and accurate measurement of lung ventilation properties, to better understand how respiratory diseases progress over time and to assess how they respond to therapy strategies.We are developing non-invasive and radiation-free imaging of lung ventilated volume, using new MRI technologies. MRI is a safe and repeatable medical imaging technology that uses strong magnetic fields to generate images of the body. We are using MRI to visualise a gas that can be safely inhaled, allowing us to generate images of the lungs that show areas that are (and that are not) well ventilated. We aim to show that we can measure the differences in lung ventilation properties between people with healthy lungs and those with a respiratory disease, and measure the change in ventilation properties when patients with a respiratory disease take a bronchodilator (a common treatment for asthma).This work is significant because at present there is no imaging measurement with such capabilities in widespread clinical practice. Our overall aim is to develop this technology so that it can be introduced to clinical practice, delivering new measurements to help clinicians care for patients with respiratory disease.In this study we will perform a proof of concept study that tests the reproducibility of our MRI scan methods in a group of healthy volunteers. We will then recruit patients with asthma and patients with chronic obstructive pulmonary disease (COPD) and demonstrate that our MRI scan methods can characterise the impaired ventilation properties associated with these conditions. We will also perform MRI scans before and after these patients receive a bronchodilator, to test whether we can detect a change in ventilation properties due to drug treatment. The study is a clinical trial of an investigational medicinal product, and will be performed with appropriate regulatory approval and oversight.Once we have performed these studies we will be well positioned to further develop our MRI techniques to assess lung ventilation properties. We intend to follow this current project with larger multi-site studies that demonstrate the utility of perfluoropropane MRI in the management of patients with a respiratory disease, and then to further develop the technology such that it is ready for adoption by the NHS and other healthcare providers.This project will be performed at two sites, Newcastle and Sheffield, and is a collaborative project between Newcastle University, The University of Sheffield, the Newcastle upon Tyne Hospitals NHS Foundation Trust, and the Sheffield Teaching Hospitals NHS Foundation Trust.