Characteristics of Diaphragmatic and Chest Wall Motion in People with Normal Pulmonary Function: A Study with Free-Breathing Dynamic MRI

Yang, Xiufen; Sun, Haishuang; Deng, Mingke; Chen, Zhong; Li, Chen; Yu, Pengxin; Zhang, Rongguo; Liu, Min; Dai, Huaping; Wang, Chen

doi:10.3390/jcm11247276

Cited by 5 publications

(12 citation statements)

References 33 publications

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“…Our previous study on the effect of scoliotic spinal curves in TIS using dMRI showed a qualitative postoperative increase in the chest wall and diaphragmatic excursion. 4 Additionally, Yang X. et al 5 conducted a study on diaphragmatic motion in normal individuals using thoracic ratios and free-breathing dMRI. Their findings demonstrated a heightened prominence in the motions of the diaphragm apex and posterior diaphragm compared to the anterior diaphragm, supporting our observed trends.…”

Section: Discussionmentioning

confidence: 99%

“…4 The normal diaphragm does not move uniformly during active breathing, with the greatest movement typically occurring in the middle and posterior third regions. 5 There is significant natural asymmetry between the morphological features and dynamics of normal right and left ventilatory volume components. 6 The right hemi-diaphragm (RHD) dome is positioned higher than the left hemi-diaphragm (LHD) during spontaneous breathing due to different mechanical properties of the diaphragm, phrenic nerve innervation, and the effect of the surrounding anatomical structures.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of 3D hemi-diaphragmatic motion via free-breathing dynamic MRI in pediatric thoracic insufficiency syndrome

Hosseini,

Udupa,

Hao

et al. 2024

Preprint

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Purpose: Thoracic insufficiency syndrome (TIS) affects ventilatory function due to spinal and thoracic deformities limiting lung space and diaphragmatic motion. Corrective orthopedic surgery can be used to help normalize skeletal anatomy, restoring lung space and diaphragmatic motion. This study employs free-breathing dynamic MRI (dMRI) and quantifies the 3D motion of each hemi-diaphragm surface in normal and TIS patients, and evaluates effects of surgical intervention. Materials and Methods: In a retrospective study of 149 pediatric patients with TIS and 190 healthy children, we constructed 4D images from free-breathing dMRI and manually delineated the diaphragm at end-expiration (EE) and end-inspiration (EI) time points. We automatically selected 25 points uniformly on each hemi-diaphragm surface, calculated their relative velocities between EE and EI, and derived mean velocities in 13 homologous regions for each hemi-diaphragm to provide measures of regional 3D hemi-diaphragm motion. T-testing was used to compare velocity changes before and after surgery, and to velocities in healthy controls. Results: The posterior-central region of the right hemi-diaphragm exhibited the highest average velocity post-operatively. Posterior regions showed greater velocity changes after surgery in both right and left hemi-diaphragms. Surgical reduction of thoracic Cobb angle displayed a stronger correlation with changes in diaphragm velocity than reduction in lumbar Cobb angle. Following surgery, the anterior regions of the left hemi-diaphragm tended to approach a more normal state. Conclusion: Quantification of regional motion of the 3D diaphragm surface in normal subjects and TIS patients via free-breathing dMRI is feasible. Derived measurements can be assessed in comparison to normal subjects to study TIS and the effects of surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of 3D hemi-diaphragmatic motion via free-breathing dynamic MRI in pediatric thoracic insufficiency syndrome

Hosseini,

Udupa,

Hao

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…The height of the thorax was measured on the coronal cranial-caudal directions (CC) (Figure 3b and c) [11,18,19].…”

Section: Segmentation Of Mr Imagesmentioning

confidence: 99%

“…According to Yang et al [18], D-MRI was respectively obtained in one coronal, one right sagittal, and three transversal planes during free quiet-breathing and free deep-breathing with a breathing navigator to monitor the respiratory situation (Figure 2). The transversal images were respectively acquired at the level of the aortic arch, tracheal carina, and the right diaphragmatic dome which represent the upper, middle, and lower part of the chest wall (Supplement Figure 1).…”

Section: Mri Protocolmentioning

confidence: 99%

“…The motion of the chest wall during quiet breathing and deep breathing was respectively by right and left AP ratio, LR ratio, and thoracic area ratio at the end-inspiration and end-expiration on three transversal planes at the aortic arch, tracheal carina, and the right diaphragmatic dome levels [11,18,19]. The AP is defined as the longest distance between the anterior inner chest wall and the posterior inner chest wall and the LR is defined as the longest distance between the right inner chest wall and the left inner chest wall (Figure 3a).…”

Section: Evaluation Of the Motion Of The Chest Wallmentioning

confidence: 99%

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Evaluation of Respiratory Muscle Dysfunction in Patients with Idiopathic Pulmonary Fibrosis: A Prospective Observational Study with Magnetic Resonance Imaging

Yang,

Wang,

Liu

et al. 2024

Preprint

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Objective: Respiratory muscle dysfunction in patients with idiopathic pulmonary fibrosis (IPF) is a big challenge for treatment and rehabilitation nursing. To quantitatively assess diaphragm and chest wall dysfunction using dynamic Magnetic Resonance Imaging (D-MRI) in patients with IPF. Methods: Ninety-six patients with IPF and 50 gender- and age-matched controls were prospectively included and underwent D-MRI with a dynamic fast spoiled gradient-recalled echo sequence Respiratory Muscles function were assessed with thoracic anterior-posterior (AP), left-right (LR), cranial-caudal (CC), and lung area ratios, height (DH) and area (DA) of diaphragm curvature between end-inspiration and end-expiration during quiet and deep breathing. Results: During quiet breathing, the functional metrics of the diaphragm and chest wall were comparable between IPF patients and controls. However, during deep breathing, IPF patients exhibited significantly reduced ratios of AP, CC, and lung area compared to controls. Moreover, the median ratios of DH and DA were higher in IPF patients than in controls (DH: 0.96 vs 0.81, p<0.001; DA: 1.00 vs 0.90, p<0.001). Furthermore, the ratios of AP, CC, and lung area during deep breathing were found to correlate with pulmonary function, total lung volume, and 6-minute walk distance. Conclusion: D-MRI demonstrated dysfunction of the diaphragm and chest wall in IPF patients and respiratory muscle dysfunction correlates with the severity of IPF.

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Auto-segmentation of thoraco-abdominal organs in pediatric dynamic MRI

Akhtar,

Udupa,

Tong

et al. 2024

Preprint

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Purpose: Analysis of the abnormal motion of thoraco-abdominal organs in respiratory disorders such as the Thoracic Insufficiency Syndrome (TIS) and scoliosis such as adolescent idiopathic scoliosis (AIS) or early onset scoliosis (EOS) can lead to better surgical plans. We can use healthy subjects to find out the normal architecture and motion of a rib cage and associated organs and attempt to modify the patient's deformed anatomy to match to it. Dynamic magnetic resonance imaging (dMRI) is a practical and preferred imaging modality for capturing dynamic images of healthy pediatric subjects. In this paper, we propose an auto-segmentation set-up for the lungs, kidneys, liver, spleen, and thoraco-abdominal skin in these dMRI images which have their own challenges such as poor contrast, image non-standardness, and similarity in texture amongst gas, bone, and connective tissue at several inter-object interfaces. Methods: The segmentation set-up has been implemented in two steps: recognition and delineation using two deep neural network (DL) architectures (say DL-R and DL-D) for the recognition step and delineation step, respectively. The encoder-decoder framework in DL-D utilizes features at four different resolution levels to counter the challenges involved in the segmentation. We have evaluated on dMRI sagittal acquisitions of 189 (near-)normal subjects. The spatial resolution in all dMRI acquisitions is 1.46 mm in a sagittal slice and 6.00 mm between sagittal slices. We utilized images of 89 (10) subjects at end inspiration for training (validation). For testing we experimented with three scenarios: utilizing (1) the images of 90 (=189-89-10) different (remaining) subjects at end inspiration for testing, (2) the images of the aforementioned 90 subjects at end expiration for testing, and (3) the images of the aforesaid 99 (=89+10) subjects but at end expiration for testing. In some situations, we can take advantage of already available ground truth (GT) of a subject at a particular respiratory phase to automatically segment the object in the image of the same subject at a different respiratory phase and then refining the segmentation to create the final GT. We anticipate that this process of creating GT would require minimal post hoc correction. In this spirit, we conducted separate experiments where we assume to have the ground truth of the test subjects at end expiration for scenario (1), end inspiration for (2), and end inspiration for (3). Results: Amongst these three scenarios of testing, for the DL-R, we achieve a best average location error (LE) of about 1 voxel for the lungs, kidneys, and spleen and 1.5 voxels for the liver and the thoraco-abdominal skin. The standard deviation (SD) of LE is about 1 or 2 voxels. For the delineation approach, we achieve an average Dice coefficient (DC) of about 0.92 to 0.94 for the lungs, 0.82 for the kidneys, 0.90 for the liver, 0.81 for the spleen, and 0.93 for the thoraco-abdominal skin. The SD of DC is lower for the lungs, liver, and the thoraco-abdominal skin, and slightly higher for the spleen and kidneys. Conclusions: Motivated by applications in surgical planning for disorders such as TIS, AIS, and EOS, we have shown an auto-segmentation system for thoraco-abdominal organs in dMRI acquisitions. This proposed setup copes with the challenges posed by low resolution, motion blur, inadequate contrast, and image intensity non-standardness quite well. We are in the process of testing its effectiveness on TIS patient dMRI data.

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Characteristics of Diaphragmatic and Chest Wall Motion in People with Normal Pulmonary Function: A Study with Free-Breathing Dynamic MRI

Cited by 5 publications

References 33 publications

Assessment of 3D hemi-diaphragmatic motion via free-breathing dynamic MRI in pediatric thoracic insufficiency syndrome

Assessment of 3D hemi-diaphragmatic motion via free-breathing dynamic MRI in pediatric thoracic insufficiency syndrome

Evaluation of Respiratory Muscle Dysfunction in Patients with Idiopathic Pulmonary Fibrosis: A Prospective Observational Study with Magnetic Resonance Imaging

Auto-segmentation of thoraco-abdominal organs in pediatric dynamic MRI

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