Using hyperpolarized ³He MRI to evaluate treatment efficacy in cystic fibrosis patients

Abstract

Purpose: To use hyperpolarized (HP) 3 He MR imaging to assess functional lung ventilation in subjects with cystic fibrosis (CF) before and after treatment. Materials and Methods: We performed HP 3He static ventilation MRI scans on three subjects, using a Philips 3.0 Tesla (T) Achieva MRI scanner, before and after 11 days of in-patient treatment with combined intravenous and inhaled therapies for pulmonary exacerbations of CF. We also collected spirometry data. We quantified pulmonary ventilation volume measured with HP 3 He MRI using an advanced semi-automated analysis technique.Results: Following 11 days of treatment with intravenous antibiotics, hypertonic saline, and rhDNase, HP 3 He MR images in one subject displayed a 25% increase in total ventilation volume. Total ventilation volume in the other two subjects slightly decreased. All three subjects showed increases in FEV 1 and FVC following treatment. Conclusion:In all subjects, the HP 3 He MR images provided detailed information on precisely where in the lungs gas was reaching. These data provide additional support for the conclusion that HP noble gas MRI can be a powerful tool for evaluating lung ventilation in patients with cystic fibrosis, but also raise important questions about the correlation between spirometry and HP gas MRI measurements.

Evaluation of high resolution computed tomography findings of cystic fibrosis

“…Moreover, Forced Expired Volume in one second (FEV 1 ) values correlate better with HP 3 He MRI than with CXR measures [38]. The ventilation volume (VV) and ventilation volume percentage (VVP) as measured by HP 3 He MRI correlate positively while the ventilation defect volume (VDV) and the ventilation defect percentage (VDP) negatively correlate with equivalent spirometry and HRCT results in CF patients [38,39]. HP 3 He MRI is useful to assess different treatments and progression of CF disease by measuring ventilation volumes.…”

“…HP 3 He MRI is useful to assess different treatments and progression of CF disease by measuring ventilation volumes. The effectiveness of an eleven day intervention with intravenous tobramycin, beta-lactam antibiotic, inhalation of 2.5 mg of recombinant human DNase administrated daily, inhalation of 4 mL of 7% hypertonic saline and chest physiotherapy twice a day was monitored by HP 3 He MRI and showed a 25% increase in VV in treated patients [39]. Improvement in VV was observed despite no changes in FEV 1 [40,41] indicating that HP 3 He MRI may provide greater sensitivity in detecting changes.…”

“…Following this, hyperpolarized helium-3 MRI (HP 3 He MRI) has been examined in multiple settings and has shown high sensitivity for the detection of ventilation impairments [34][35][36][37][38][39][40][41][42][43][44]. This typically requires production of hyperpolarized gas on site which is then mixed with nitrogen and administered to patients with a one litre Tedlar Bag.…”

Semiautomated Ventilation Defect Quantification in Exercise-induced Bronchoconstriction Using Hyperpolarized Helium-3 Magnetic Resonance Imaging

“…O ver the past decade, hyperpolarized helium-3 magnetic resonance imaging (HP 3 He MRI) has been used extensively in research for evaluating ventilation and defect in asthma (1)(2)(3)(4), cystic fibrosis (CF) (5)(6)(7), and chronic obstructive pulmonary disease (COPD) (8)(9)(10). Quantitative assessment of ventilation and its regional distribution is critical to the application and advance of HP gas MRI in clinical research.…”

Assessment of Repeatability of Hyperpolarized Gas MR Ventilation Functional Imaging in Cystic Fibrosis

“…Therefore, HP gas MRI offers promise as an outcome measure in clinical trials for CF and other chronic pulmonary diseases. HP gas MRI has been successfully used to measure lung ventilation function in individuals with CF in a number of studies (9)(10)(11)(12)(13) and has also successfully been applied to other chronic lung diseases (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”