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

呼吸道疾病是世界范围内的主要死亡原因之一。呼吸系统疾病的新治疗方法日益涌现，确定治疗反应的测试对于管理患者的呼吸系统疾病至关重要。不幸的是，现有的评估肺功能和结构的方法有局限性。例如，肺活量测定法不能提供有关肺部局部变化的信息，因此呼吸特性的早期局部变化可能不会被发现。计算机断层扫描(CT)提供肺部结构的图像，但使用电离辐射(x射线)来生成这些图像和相关的辐射剂量，这意味着通常不可能通过定期扫描来监测疾病进展或治疗反应。因此，迫切需要能够安全、客观、可重复和准确地测量肺通气量的新技术，以更好地了解呼吸系统疾病如何随着时间的推移而发展，并评估它们对治疗策略的反应。我们正在利用新的核磁共振技术开发无创和无辐射的肺通气量成像。核磁共振成像是一种安全、可重复使用的医学成像技术，它使用强磁场来生成人体图像。我们正在使用核磁共振成像来可视化一种可以安全吸入的气体，从而使我们能够生成肺部图像，显示通风良好(和通风不好)的区域。我们的目标是表明我们可以测量肺部健康的人和患有呼吸系统疾病的人之间的肺通风特性的差异，并测量呼吸系统疾病患者服用支气管扩张剂(一种常见的哮喘治疗方法)时呼吸特性的变化。这项工作具有重要意义，因为目前还没有在广泛的临床实践中具有这种能力的成像测量。我们的总体目标是开发这项技术，以便将其引入临床实践，提供新的测量方法，帮助临床医生护理呼吸系统疾病患者。在这项研究中，我们将进行概念验证研究，在一组健康志愿者中测试我们的MRI扫描方法的重复性。然后，我们将招募哮喘患者和慢性阻塞性肺疾病(COPD)患者，并证明我们的MRI扫描方法可以表征与这些情况相关的呼吸功能受损。我们还将在这些患者接受支气管扩张剂之前和之后进行MRI扫描，以测试我们是否可以检测到由于药物治疗而导致的通风特性的变化。这项研究是一种研究药物的临床试验，将在适当的监管批准和监督下进行。一旦我们进行了这些研究，我们将处于有利地位，进一步开发我们的MRI技术来评估肺通气性。我们打算在目前的项目之后进行更大规模的多地点研究，展示全氟丙烷核磁共振在呼吸道疾病患者管理中的效用，然后进一步开发这项技术，使其能够被NHS和其他医疗保健提供者采用。该项目将在纽卡斯尔和谢菲尔德两个地点进行，是纽卡斯尔大学、谢菲尔德大学、纽卡斯尔泰恩医院NHS基金会信托基金和谢菲尔德教学医院NHS基金会信托基金的合作项目。

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.