W Gerald Teague1, Jaime Mata2, Kun Qing2, Nicholas J Tustison2, John P Mugler2,3, Craig H Meyer2,3, Eduard E de Lange2, Yun M Shim4, Kristin Wavell1, Talissa A Altes5. 1. Department of Pediatrics, Child Health Research Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA. 2. Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, Virginia, USA. 3. Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA. 4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Vorginia, USA. 5. Department of Radiology, University of Missouri School of Medicine, Columbia, Missouri, USA.
Abstract
BACKGROUND: Hyperpolarized gas with helium (HHe-3) MR (magnetic resonance) is a noninvasive imaging method which maps and quantifies regions of ventilation heterogeneity (VH) in the lung. VH is an important feature of asthma, but little is known as to how VH informs patient phenotypes. PURPOSE: To determine if VH indicators quantified by HHe-3 MR imaging (MRI) predict phenotypic characteristics and map to regions of inflammation in children with problematic wheeze or asthma. METHODS: Sixty children with poorly-controlled wheeze or asthma underwent HHe-3 MRI, including 22 with bronchoalveolar lavage (BAL). The HHe-3 signal intensity defined four ventilation compartments. The non-ventilated and hypoventilated compartments divided by the total lung volume defined a VH index (VHI %). RESULTS: Children with VHI % in the upper quartile had significantly greater airflow limitation, bronchodilator responsiveness, blood eosinophils, expired nitric oxide (FeNO), and BAL eosinophilic or neutrophilic granulocyte patterns compared to children with VHI % in the lower quartile. Lavage return from hypoventilated bronchial segments had greater eosinophil % than from ventilated segments. CONCLUSION: In children with asthma, greater VHI % as measured by HHe-3 MRI identifies a severe phenotype with higher type 2 inflammatory markers, and maps to regions of lung eosinophilia. Listed on ClinicalTrials. gov (NCT02577497).
BACKGROUND: Hyperpolarized gas with helium (HHe-3) MR (magnetic resonance) is a noninvasive imaging method which maps and quantifies regions of ventilation heterogeneity (VH) in the lung. VH is an important feature of asthma, but little is known as to how VH informs patient phenotypes. PURPOSE: To determine if VH indicators quantified by HHe-3 MR imaging (MRI) predict phenotypic characteristics and map to regions of inflammation in children with problematic wheeze or asthma. METHODS: Sixty children with poorly-controlled wheeze or asthma underwent HHe-3 MRI, including 22 with bronchoalveolar lavage (BAL). The HHe-3 signal intensity defined four ventilation compartments. The non-ventilated and hypoventilated compartments divided by the total lung volume defined a VH index (VHI %). RESULTS: Children with VHI % in the upper quartile had significantly greater airflow limitation, bronchodilator responsiveness, blood eosinophils, expired nitric oxide (FeNO), and BAL eosinophilic or neutrophilic granulocyte patterns compared to children with VHI % in the lower quartile. Lavage return from hypoventilated bronchial segments had greater eosinophil % than from ventilated segments. CONCLUSION: In children with asthma, greater VHI % as measured by HHe-3 MRI identifies a severe phenotype with higher type 2 inflammatory markers, and maps to regions of lung eosinophilia. Listed on ClinicalTrials. gov (NCT02577497).
Authors: J de Blic; F Midulla; A Barbato; A Clement; I Dab; E Eber; C Green; J Grigg; S Kotecha; G Kurland; P Pohunek; F Ratjen; G Rossi Journal: Eur Respir J Date: 2000-01 Impact factor: 16.671
Authors: Eleanor M Dunican; Brett M Elicker; David S Gierada; Scott K Nagle; Mark L Schiebler; John D Newell; Wilfred W Raymond; Marrah E Lachowicz-Scroggins; Selena Di Maio; Eric A Hoffman; Mario Castro; Sean B Fain; Nizar N Jarjour; Elliot Israel; Bruce D Levy; Serpil C Erzurum; Sally E Wenzel; Deborah A Meyers; Eugene R Bleecker; Brenda R Phillips; David T Mauger; Erin D Gordon; Prescott G Woodruff; Michael C Peters; John V Fahy Journal: J Clin Invest Date: 2018-02-05 Impact factor: 14.808
Authors: Nicholas J Tustison; Brian B Avants; Lucia Flors; Talissa A Altes; Eduard E de Lange; John P Mugler; James C Gee Journal: J Magn Reson Imaging Date: 2011-08-11 Impact factor: 4.813
Authors: Stephen Costella; Miranda Kirby; Geoffrey N Maksym; David G McCormack; Nigel A M Paterson; Grace Parraga Journal: Respirology Date: 2012-11 Impact factor: 6.424
Authors: Eduard E de Lange; Talissa A Altes; James T Patrie; John D Gaare; Jeffrey J Knake; John P Mugler; Thomas A Platts-Mills Journal: Chest Date: 2006-10 Impact factor: 9.410
Authors: Julia A Wisniewski; Lyndsey M Muehling; Jacob D Eccles; Brian J Capaldo; Rachana Agrawal; Debbie-Ann Shirley; James T Patrie; Lisa J Workman; Alexander J Schuyler; Monica G Lawrence; W Gerald Teague; Judith A Woodfolk Journal: J Allergy Clin Immunol Date: 2017-09-20 Impact factor: 10.793
Authors: Nadzeya V Marozkina; Xin-Qun Wang; Vitali Stsiapura; Anne Fitzpatrick; Silvia Carraro; Gregory A Hawkins; Eugene Bleecker; Deborah Meyers; Nizar Jarjour; Sean B Fain; Sally Wenzel; William Busse; Mario Castro; Reynold A Panettieri; Wendy Moore; Stephen J Lewis; Lisa A Palmer; Talissa Altes; Eduard E de Lange; Serpil Erzurum; W Gerald Teague; Benjamin Gaston Journal: Eur Respir J Date: 2014-10-30 Impact factor: 16.671
Authors: Sean B Fain; Guillermo Gonzalez-Fernandez; Eric T Peterson; Michael D Evans; Ronald L Sorkness; Nizar N Jarjour; William W Busse; Janet E Kuhlman Journal: Acad Radiol Date: 2008-06 Impact factor: 3.173
Authors: Kian Fan Chung; Sally E Wenzel; Jan L Brozek; Andrew Bush; Mario Castro; Peter J Sterk; Ian M Adcock; Eric D Bateman; Elisabeth H Bel; Eugene R Bleecker; Louis-Philippe Boulet; Christopher Brightling; Pascal Chanez; Sven-Erik Dahlen; Ratko Djukanovic; Urs Frey; Mina Gaga; Peter Gibson; Qutayba Hamid; Nizar N Jajour; Thais Mauad; Ronald L Sorkness; W Gerald Teague Journal: Eur Respir J Date: 2013-12-12 Impact factor: 16.671