Wei Zha1, Stanley J Kruger1, Robert V Cadman1, David G Mummy2, Michael D Evans3, Scott K Nagle4, Loren C Denlinger5, Nizar N Jarjour6, Ronald L Sorkness7, Sean B Fain8. 1. Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705. 2. Department of Biomedical Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706. 3. Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin. 4. Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705; Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792; Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin. 5. Department of Medicine-Allergy, Pulmonary & Critical Care, University of Wisconsin-Madison, Madison, Wisconsin. 6. Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin; Department of Medicine-Allergy, Pulmonary & Critical Care, University of Wisconsin-Madison, Madison, Wisconsin. 7. Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin; Department of Medicine-Allergy, Pulmonary & Critical Care, University of Wisconsin-Madison, Madison, Wisconsin; School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin. 8. Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705; Department of Biomedical Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706; Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792. Electronic address: sfain@wisc.edu.
Abstract
RATIONALE AND OBJECTIVES: To determine lobar ventilation patterns in asthmatic lungs with hyperpolarized 3He magnetic resonance imaging (HP 3He MRI). MATERIALS AND METHODS: Eighty-two subjects (14 normal, 48 mild-to-moderate asthma, and 20 severe asthma) underwent HP 3He MRI, computed tomography (CT), and pulmonary function testing. After registering proton to 3He images, we segmented the lungs from proton MRI and further segmented the five lung lobes (right upper lobe [RUL], right middle lobe [RML], and right lower lobe [RLL]; left upper lobe and left lower lobe [LLL]) by referring to the lobar segmentation from CT. We classified the gas volume into four signal intensity levels as follows: ventilation defect percent (VDP), low ventilation percent, medium ventilation percent, and high ventilation percent. The local signal intensity variations in the ventilated volume were estimated using heterogeneity score (Hs). We compared each ventilation level and Hs measured in the whole lung and lobar regions across the three subject groups. RESULTS: In mild-to-moderate asthma, the RML and RUL showed significantly greater VDP than the two lower lobes (RLL and LLL) (P ≤ .047). In severe asthma, the pattern was more variable with the VDP in the RUL significantly greater than in the RLL (P = .026). In both asthma groups, the lower lobes (RLL and LLL) showed significantly higher high ventilation percent and Hs compared to the three upper lobes (all P ≤ .015). CONCLUSIONS: In asthma, the RML and RUL showed greater ventilation abnormalities, and the RLL and LLL were more highly ventilated with greater local heterogeneity. These findings may facilitate guided bronchoscopic sampling and localized airway treatment in future studies.
RATIONALE AND OBJECTIVES: To determine lobar ventilation patterns in asthmatic lungs with hyperpolarized 3He magnetic resonance imaging (HP 3He MRI). MATERIALS AND METHODS: Eighty-two subjects (14 normal, 48 mild-to-moderate asthma, and 20 severe asthma) underwent HP 3He MRI, computed tomography (CT), and pulmonary function testing. After registering proton to 3He images, we segmented the lungs from proton MRI and further segmented the five lung lobes (right upper lobe [RUL], right middle lobe [RML], and right lower lobe [RLL]; left upper lobe and left lower lobe [LLL]) by referring to the lobar segmentation from CT. We classified the gas volume into four signal intensity levels as follows: ventilation defect percent (VDP), low ventilation percent, medium ventilation percent, and high ventilation percent. The local signal intensity variations in the ventilated volume were estimated using heterogeneity score (Hs). We compared each ventilation level and Hs measured in the whole lung and lobar regions across the three subject groups. RESULTS: In mild-to-moderate asthma, the RML and RUL showed significantly greater VDP than the two lower lobes (RLL and LLL) (P ≤ .047). In severe asthma, the pattern was more variable with the VDP in the RUL significantly greater than in the RLL (P = .026). In both asthma groups, the lower lobes (RLL and LLL) showed significantly higher high ventilation percent and Hs compared to the three upper lobes (all P ≤ .015). CONCLUSIONS: In asthma, the RML and RUL showed greater ventilation abnormalities, and the RLL and LLL were more highly ventilated with greater local heterogeneity. These findings may facilitate guided bronchoscopic sampling and localized airway treatment in future studies.
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