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. 2021 Sep 27;7(3):00785-2020.
doi: 10.1183/23120541.00785-2020. eCollection 2021 Jul.

Xenon ventilation MRI in difficult asthma: initial experience in a clinical setting

Grace T Mussell  1 , Helen Marshall  1 , Laurie J Smith  1 , Alberto M Biancardi  1 , Paul J C Hughes  1 , David J Capener  1 , Jody Bray  1 , Andrew J Swift  1 , Smitha Rajaram  1 , Alison M Condliffe  2   3 , Guilhem J Collier  1 , Chris S Johns  1 , Nick D Weatherley  1   3 , Jim M Wild  1 , Ian Sabroe  3
Affiliations

Xenon ventilation MRI in difficult asthma: initial experience in a clinical setting

Grace T Mussell et al. ERJ Open Res. .

Abstract

Background: Hyperpolarised gas magnetic resonance imaging (MRI) can be used to assess ventilation patterns. Previous studies have shown the image-derived metric of ventilation defect per cent (VDP) to correlate with forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) and FEV1 in asthma.

Objectives: The aim of this study was to explore the utility of hyperpolarised xenon-129 (129Xe) ventilation MRI in clinical care and examine its relationship with spirometry and other clinical metrics in people seen in a severe asthma service.

Methods: 26 people referred from a severe asthma clinic for MRI scanning were assessed by contemporaneous 129Xe MRI and spirometry. A subgroup of 18 patients also underwent reversibility testing with spirometry and MRI. Quantitative MRI measures of ventilation were calculated, VDP and the ventilation heterogeneity index (VHI), and compared to spirometry, Asthma Control Questionnaire 7 (ACQ7) and blood eosinophil count. Images were reviewed by a multidisciplinary team.

Results: VDP and VHI correlated with FEV1, FEV1/FVC and forced expiratory flow between 25% and 75% of FVC but not with ACQ7 or blood eosinophil count. Discordance of MRI imaging and symptoms and/or pulmonary function tests also occurred, prompting diagnostic re-evaluation in some cases.

Conclusion: Hyperpolarised gas MRI provides a complementary method of assessment in people with difficult to manage asthma in a clinical setting. When used as a tool supporting clinical care in a severe asthma service, occurrences of discordance between symptoms, spirometry and MRI scanning indicate how MRI scanning may add to a management pathway.

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Conflict of interest statement

Conflict of interest: AstraZeneca awarded a research grant to I. Sabroe, J.M. Wild, H. Marshall and colleagues for the period 2020–2023 to study effects of therapies on airway imaging. In 2019, I. Sabroe participated in a scientific advisory board for AstraZeneca, generating a small consultancy income paid to the University of Sheffield to support research, and has attended an annual respiratory research meeting supported by Boehringer Ingelheim. J.M. Wild and H. Marshall attended and advised on an AstraZeneca global respiratory experts meeting, generating a small consultancy income paid to the University. All other authors declare no conflicts of interest related to this study.

Figures

FIGURE 1
FIGURE 1
Examples of the different visual patterns observed on ventilation magnetic resonance imaging from three patients. Ventilation is shown in greyscale; black regions within the lungs are ventilation defects. a) Subject was reported to have no defects; b) and c) subjects were noted as having substantial ventilation defects on the radiologists’ report. a) forced expiratory volume in 1 s (FEV1) −1.17, FEV1/forced vital capacity (FVC) 0.91, ventilation defect per cent (VDP) 0.40%, ventilation heterogeneity index (VHI) 0.10. b) FEV1 −3.27, FEV1/FVC −2.99, VDP 1.85%, VHI 0.13. c) FEV1 −2.3, FEV1/FVC −3.58, VDP 17.96%, VHI 0.14.
FIGURE 2
FIGURE 2
Correlations of ventilation defect per cent (VDP) and ventilation heterogeneity index (VHI) with forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC). Data show the correlations in VDP and FEV1, VHI and FEV1, VDP and FEV1/FVC, and VHI and FEV1/FVC. The lower limit of normal is indicated at −1.64 z-scores. Spearman correlations with VDP and Pearson correlations with VHI.
FIGURE 3
FIGURE 3
Images showing changes with bronchodilator in two different patients: a) subject 5 and b) subject 3. Arrows highlight areas where defects resolved or worsened. Images show increased ventilation in subject in a) after bronchodilator inhalation and decreased ventilation in subject in b). Table 3 shows details of each subject's metrics.
FIGURE 4
FIGURE 4
Contribution of magnetic resonance imaging to clinical assessment. a) Small to moderate sized ventilation defects in a symptomatic patient with consistently normal spirometry. b) Relatively homogeneous ventilation in a highly symptomatic patient.
See this image and copyright information in PMC

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